Herbal Health

Surgery is a good way of tackling a few particular types of pain due to cancer. For example, pain due to a blockage of the bowel or kidney can sometimes be relieved by removing the responsible growth or bypassing the blockage. Pain due to a fracture through cancer in a bone, can often be most quickly relieved by putting a metal pin or plate in the bone. The bone is most likely to remain pain free if this surgery is followed up by radiation treatment.

Even chemotherapy is sometimes recommended for people who have painful cancer growths. The pain will be relieved only if the growth is shrunk, so consider this method of pain relief only if you have a type of cancer which is very likely to be sensitive to the chemotherapy.

If you do decide to seek pain relief by tackling the responsible cancer itself, you will still need painkillers in the meantime. The fact that your pain may be relieved by radiotherapy or surgery later doesn’t mean that you shouldn’t be getting relief with painkillers right now. The following section is important for all of you with cancer pain — those who are having anti-cancer treatment as well as those who are not.

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Of course, not all doctors and ofher practitioners who treat cancer are as black as I have painted. I hope that your practitioners combine the best of modern scientific medicine with the art of healing. I hope they take as much care in finding out how you are feeling and what life is like for you as they do in arranging and assessing tests. I hope your practitioners place as much, or more, importance on the quality of your life as they do on its length. I hope they treat you as a whole person who happens to have cancer and not just as a cancer with a body wrapped around it!

If you don’t have this kind of practitioner, life is going to be difficult for you. Those practitioners who are least likely to make the best decisions for you are also the most difficult to get enough information from to make your own decisions. Switch to another practitioner, if possible. If not, you may have to seek information from other sources such as other practitioners, nurses, other hospital staff, books, other patients, and friends. If you make a decision that does not follow such a practitioner’s recommendation, be prepared to be told by them that you are foolish, ignorant and incapable of properly assessing the situation. Trust your own judgement and commonsense. Don’t be intimidated or cajoled into giving away control of what happens to your own body. Remember, you are the world’s greatest expert on yourself. Nobody else knows how you feel inside and what is important for you. This personal knowledge is of vital importance when it comes to deciding on treatment that could totally alter your life.

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Dr. Thomas Glynn of the American Cancer Society has a lot to say about lung cancer, and it doesn’t take long for him to say it. Here’s a transcript of a lecture he sometimes gives: “This is going to be easy. Don’t smoke. Thank you for listening.”

Smokers sometimes give themselves little talks, too: statements meant to make them and their loved ones think that they’ll somehow be able to smoke and not hurt themselves. Here are some of the most common – and error-ridden.

“I’ll stop when I’m older.” True, quitting smoking reduces your risk whenever you do it, but sooner is much better than later. In the words of the American Lung Association, “The more you smoke and the longer you smoke, the greater your risk of lung cancer.”

“I’ll get lots of antioxidants.” It was once thought that antioxidants like beta-carotene reduced lung cancer risk. But it’s a false friend, as several studies have shown. “Beta-carotene was actually found to be a culprit in the progression of lung cancer,” says Dr. Warren Heston of the Memorial Sloan-Kettering Cancer Center. And, he adds, so may single supplements, such as lycopene. So much for that one.

“I’ll mat lots of vegetables.” They help, but there’s no salad bar big enough to offset the smoking risk. As a team of Harvard-affiliated researchers put it in a 1996 report on cancer prevention, “A smoker consuming the largest tolerable amounts of vegetables is still at much higher risk of lung cancer than a nonsmoker.”

“The smog is going to got me anyway.” Says who? “It’s really difficult to pin lung cancer on air pollution,” says Bill McDonnell, M.D., Ph.D., a medical officer for the U.S. Environmental Protection Agency (EPA) in Chapel Hill, North Carolina. “There’s just not very strong evidence for that.” And even if there were, Dr. McDonnell points out, “cigarette smoking is in a class by itself, both in regard to the variety and amount of inhaled substances and with regard to its ability to cause cancer.”

“I’ll avoid other carcinogens” Indeed, there are some to avoid, most notably radon, which the EPA estimates is found at higher-than-acceptable levels in 1 out of 15 homes in the United States. On-the-job exposure to things such as asbestos, uranium, arsenic, and certain petroleum products is also something to look out for. But all of them are more dangerous when combined with smoking. And remember, another environmental hazard that causes the death of some 3,000 nonsmokers a year from lung cancer, according to the EPA, is none other than tobacco smoke-from other people’s cigarettes.

“I’ll catch it early.” That’s a good strategy for most cancers but usually hopeless for lung cancer. “By the time it’s detectable, it’s generally too late to do anything,” Dr. Glynn says. “If you go in for a chest x-ray and they find a tumor, the outlook’s not good.”

“Lots of people beat it” But most don’t. Lung cancer’s five-year survival rate is 13 percent, one of the lowest of all cancers. “It’s a virtually certain killer,” Dr. Glynn says. “You’re looking at a one in eight chance that you’re going to be alive in five years. And most people from the time of diagnosis are dead in two years.”

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Women visiting their GPs complaining of pain in the breast or having detected a breast lump may be referred to a specialist for further investigations, although some women, particularly young ones, may need to push their GPs for a referral. Sometimes, specialists have a particular interest in and experience of breast diseases, but often referral will be to a general surgeon at a hospital. A specialist in breast cancer will be more experienced in treating women with this disease than will a surgeon who also deals with a variety of other conditions, and it is wise for all women to ask to see such a specialist.

If, having seen a consultant, you would like a second opinion, or feel you would prefer to be treated by a surgeon who specializes in breast diseases rather than by a general surgeon, do discuss this with your GP, the practice nurse, or the breast care nurse if your hospital has one. They will be able to find out which hospitals have designated breast surgeons. You should be able to choose to be treated elsewhere if you have any concerns about the treatment you are being offered, but in practice you may have to be prepared to push hard to get what you want.

Your GP will have written a referral letter to a specialist asking for an appointment to be made for you. If what is said in this letter leads the specialist to suspect you have cancer of the breast, you may be seen within a few days. If cancer is diagnosed, or suspected, the course of events will vary depending on the normal procedure at a particular hospital.

Clinic visits

Any necessary investigations may be carried out at your first clinic visit, and you may be asked to return to discuss the results within a week. At some clinics, all investigations ñàë be done and their results received during the first visit. If treatment is necessary, it may begin within a few days. However, at some hospitals, women have to wait 6 to 8 weeks after a diagnosis is made before their treatment can start. Although this delay is not likely to have any harmful effect on the outcome of treatment for most cancers, it can mean a very difficult and anxious few weeks for the women concerned and their families.

About 90 per cent of cancers are obvious to the specialist on clinical examination. If cancer is suspected, any of the investigations explained above can be carried out to confirm or refute the diagnosis. Some hospital specialists, having received a referral letter from a GP, will arrange for a mammogram to be done before the woman attends her first clinic so that the X-ray results are available when she sees the specialist for the first time. Diagnosis is often made following a clinical examination, mammography and cytology, i.e. a fine needle aspiration biopsy.

Some specialists prefer to discuss at the first clinic visit the possible courses of action should their suspicion of cancer be confirmed. They feel that this allows the woman time to consider her options and to talk things over with her family, and they find that many women return for their investigation results with a firm resolve to fight the disease. Many other specialists prefer to leave any detailed discussions until a second clinic visit when the results of the tests are known. You may wish to consider for yourself which you would prefer, and be ready to ask the specialist to discuss things with you at the outset if you feel this would be helpful. Always remember, you are free to do nothing: having no treatment is an option open to you if you choose it.

For the majority of women, the clinical examination will indicate a benign condition such as a non-malignant tumour, a cyst, or a normal change in the breast. Further investigations may be required, and arrangements will be made for these to be carried out if necessary.

It is a good idea to take someone with you when you go for your clinic visits – perhaps your husband, partner or a friend. People often find it difficult to absorb what they are told when they are anxious – particularly if the news is not good. It may also be helpful to have made notes of any questions you wish to ask the specialist or breast care nurse.

The breast care nurse

Once you have discussed the diagnosis and possible treatment with the surgeon, you may be able to talk to a breast care nurse, perhaps to clarify any points you have not understood. At some hospitals a breast care nurse always attends the clinics; at others you may be given a card with her name and a contact number. You and your relatives may find it easier to discuss things with a specialist nurse, and she will probably be very aware of the worries you are likely to have. If your hospital does not have a breast care nurse, there may be someone else you can talk to if you would like to do so.

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