QUESTIONS ON CANCER

Alison Boyd, the Macmillan Cancer Information Nurse Specialist at the London Clinic Cancer Centre, who provides information and support to patients diagnosed with cancer and their families, answers some commonly, asked questions.

How many different types of cancer are there?

About 200, but some are rarer than others.

Does cancer hurt?

This depends on where you have it. With the majority of cancers, people do not experience pain as a first symptom. The cancer cells themselves are not painful, but when they make a tumour that presses somewhere, for example on the spine, or blocks an airway or passage, this can be painful. If the disease is advanced and has spread to the bones, then pain may be a symptom.

How does it kill you?

Cancer at an early stage does not kill you: it is only when advanced that it can become fatal. Not all cancers kill and some have survival rates of more than 90 per cent. The way cancer causes death varies according to what type it is. Some cancers kill you by interfering with your body’s vital functions. Cancer can take over an organ, such as the lung, causing it to collapse and preventing you from breathing properly. Or it may cause a blockage in the digestive system that stops your body from absorbing vital nutrients. If it reaches the liver or bones, it upsets the body’s delicate chemical balance, leading to unconsciousness and eventually death. Cancer may also make you immobile. This causes you to develop infections such as pneumonia, which the body is too weak to fight. However, the pain-control options available mean that those with cancer should not die in pain.

How many stages of cancer are there?

Most types have four stages. Generally speaking your prognosis is better the earlier the cancer is diagnosed.

· Stage One – localised cancer, it is contained where it started. .

· Stage Two – usually means that the tumour is larger than in Stage One, but can also mean that there is evidence of cancer in nearby lymph nodes. This would indicate that cancer cells have spread and therefore already entered the bloodstream, increasing the risk of cancer developing elsewhere in the body. .

· Stage Three – the cancer is larger than in Stages One or Two. There are cancer cells in the lymph nodes in the surrounding area. It may have started to invade surrounding tissues or organs. .

· Stage Four – also called secondary or metastatic cancer. It has spread and there is evidence of it in other organs in the body. You can live with Stage Four cancer but it is often a case of managing rather than curing the disease.

Is it possible to tell how long someone has had cancer?

Patients often want to know the answer to this. With skin cancer, once the lesion has been removed you can measure its depth to get an idea how long it has been growing.

With other cancers it can be hard to tell. Cancer takes many years to develop before symptoms appear.

If I have had one cancer, am I at greater risk of getting another type?

Your risk increases slightly, because of the treatment for the initial cancer. If you have received radiotherapy, especially for breast, testicular and skin cancer, it damages the healthy cells as well as killing the cancer cells, and these damaged cells may then mutate to become cancerous. But this is only a slight risk.

Do age and fitness affect your chances of surviving?

It is generally seen as positive to be young and fit as you will probably have a better immune system and be strong enough to withstand the treatment.

The fitter you are, the better equipped you will be to cope. Cancer is not more aggressive in young people and there is no pattern for who gets which grade and at what age.

Do race and skin colour have any effect on your risk?

Generally not, though some cancers are more common in people of colour. For example, prostate cancer-has a higher incidence in Afro-Caribbean men (it is not known why) and myeloma (blood cancer) is more common in the black population.

Which cancers are hereditary?

Ovarian, bowel, breast and uterine cancer have identified susceptibility genes: scientists have discovered the gene responsible for each of those cancers. It does not mean you are going to get that cancer if you have the gene, but it does put you at an increased risk. You can, if you choose, be tested to see if the gene has been passed on. Testicular, pancreatic and prostate may also run in families but have no identified gene, so cannot be tested for.

What is the difference between primary and secondary cancer?

Primary cancer is where the cancer started to grow. Secondary cancer is when some cancer cells have broken away from the primary tumour, travelled in the bloodstream (or lymph system) to another site in the body and started to grow. Secondary cancer is considered to be advanced disease and becomes more difficult to treat. You cannot usually eradicate the disease once it is in the bloodstream because it will just grow somewhere else. But doctors can manage the disease with treatment that may slow its growth or alleviate its symptoms.

Why can’t cancer be cured by organ transplants?

Transplanted organs are not used to treat cancer in organs because if the cells have already traveled to other parts of body, even if you remove the organ with the primary cancer, the cancer cells will continue to grow on the new organ, or somewhere else.

Also, you would need anti-rejection medication for the transplant to work. This would dampen the immune system that may be fighting the cancer naturally.

Can you catch cancer from someone else?

No. Cancer is caused by cell changes in a person’s body – it is an internal process; you cannot catch cells so you cannot catch cancer.

What happens if a GP suspects you have cancer?

They will refer you to a specialist for further tests according to National Institute for Health and Clinical Excellence guidelines. Most cancers are treated by surgery first, so you would initially see a surgeon, then a medical oncologist to decide if further follow-up therapy is required after surgery, such as chemotherapy, hormone therapy and biological therapy. If necessary, you may also be referred to a clinical oncologist for radiotherapy.

Can diet and exercise help beat cancer?

A good, balanced diet means that you will be healthier before you start cancer treatment. Your immune system will be in better shape to fight infection and you may heal faster. Exercise helps you feel better, gives you energy and also boosts morale. But patients should not push themselves. Keep doing what is normal for you, within the limits advised by your doctor.

I have been diagnosed with cancer. How do I tell my children?

There is no right or wrong way. Generally, the best policy is to be honest, but not harsh. It is OK to say: ‘We don’t know what’s going to happen.’ For younger children who do not understand what cancer is, we tend to talk in terms of bad cells and good cells.

Can I get a second opinion?

Yes and most specialists are happy to do a second referral. Speak to your current specialist or GP and ask for a referral to another specialist. If they are not happy, you can see someone privately or speak to a clinical nurse specialist or local cancer information support centre, such as a Macmillan Centre.

Will cancer affect my chances of conceiving?

It depends on what type of treatment is required. Some types of chemotherapy and radiotherapy can affect fertility. It is easy for men to bank sperm, but a much more complicated and longer process for women to freeze eggs or ovarian tissue. Discuss it with your specialist.

Why are some cancers inoperable?

If tumours are in an awkward position, too close to major blood vessels or organs, or if they are growing round the spine it can be too difficult to operate, or it might not be appropriate if the cancer is at an advanced stage, when the primary site is elsewhere. Blood cancers or bone marrow cancers cannot be operated on. But other treatments such as chemotherapy, radiotherapy, hormone or biological therapies may be used.

Which types have the best survival rate?

Testicular and prostate in men and breast and uterine in women, because they can be removed early.