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Treatment
What are the 7 steps to be taken when diagnosed of cancer?
Step 1: Step one is to overcome the long-term inner fear.
  • In cancer, it is the fear that kills a person partly.
  • The problem is not from immediate fear, which is intense and acute, but from the persistent gnawing type that comes after the acute fear passes off.
  • To overcome the fear important thing is being comfortable with this disease (as if it is diabetes or hypertension), in order to maintain body immunity and to maintain the homeostasis. This will improve the chances of cure.
  • (Note: It is like a situation where dog will attack the person if it “smells” fear in the victim, else it will threateningly bark from a distance.)
Step 2: Second step is to replace the acute fear with “action”.
  • Action does not mean hurry.
  • To come to the stage of diagnosis, cancer would have taken 10 to 15 years to grow.
  • It won’t matter waiting for a couple weeks for proper diagnosis and staging before starting the treatment.
Trials have shown that “certain necessary delay” has not shown any difference in the outcome.
Step 3: First “action” step is confirming the disease and building the profile of cancer.
  • One can seek opinion from more than one lab and doctor (even if appears contradictory – not to worry- consensus can always be reached). The findings can make lot of difference in treatment.
  • Important not to be disappointed if the tests are not favorable – what is unfavorable today may be favorable tomorrow.
  • To attack something first we should know how it is; how it looks like and how it behaves (sometimes people are reluctant in spending for tests but not on treatment). Lab technology is growing phenomenally by the day and there are now tests to study cancer surface “receptors”. Receptors are like innumerable “mouths” (which are not in the normal cells) through which specific medicines can be sent inside the cancer cell to kill or disarm.
  • Recent trends in treatment cancer are in the direction of “personalized medicine” where the strategy is to build the profile of cancer and tailor make the treatment to the individual person.
  • Many of these tests can be done later on the stored material and some at a future date as and when the tests are introduced. Often newer drugs use depends on certain receptor status. If the drug is for prevention of recurrence, then the availability previous material becomes critical to study the usefulness of drug. For this, always keep a set of slides and blocks of the biopsy safely.
Step 4: Simultaneously, studies have to be done to know the extent of disease.
  • Emphasis is on not to worry about outcome of these tests.
  • Although, in earlier stage chances of cure are better, even the advanced stage one can get cured and in early stage disease can come back.
  • One does not truly know what the situation is, in the “natures dice”. The important thing, therefore, is the right attitude (not the negative nor the positive, but the practical attitude).
  • Usual tests are
  • PET-CT (Positron Emission Tomography-Computerized Tomography) scan is the one where whole body is evaluated at one go, along with detailed analysis of part where the disease is present.
  • MRI is the other test that may be required.
  • General tests to know the status of other organs in the body e.g. cardiac, liver and renal functions, which has to withstand the rigors of cancer treatment.
  • Possibly immunological and body inflammation response tests.
  • Different images/tests give different kinds of information, all of which when put together forms the basis of strategy of treatment.
Step 5: Decision about the (combinations of) treatment.
  • Cancer treatment is not one.
  • Most of the time it is combinations of surgery, radiation therapy and chemotherapy.
  • One has to get ready mentally at this stage to deal with multiple doctors (with the ensuing problems of communication) and sometimes-long duration of treatment.
  • It would be good if one can feel strong enough to shuttle from the treatment couch to the work & office.
  • Cancers are basically of three groups.
    • Cancers arising from
      • organs,
      • lymph nodes
      • or blood tissue.
    • Last two are usually or expected to be all over the body and requires chemotherapy and/or targeted therapy as the first choice (many times only choice) of treatment.
  • In the cancers arising from the organs e.g. lung, liver, brain etc. treatment strategy involves surgery and/or radiation therapy and/or chemotherapy, because each type of treatment attacks different parts of cancer Part of cancer Treatment combinations
    1. Growth visible in the imaging Surgery/ Radiation therapy/Both if surgery not possible or refused then radiosurgery/radiation therapy/both (Sometimes chemotherapy is given first to reduce the size of growth before surgery/radiation therapy)
    2. High risk area with invisible disease, around the visible disease and in the lymph nodes adjacent to the growth. This area has dense number of invisible cancer cells Surgery/Radiation therapy/Both (Many times, to save the organ, only visible disease with minimal normal tissue around the cancer is removed by surgery and remaining cells are eliminated by radiation therapy)
    3. Lesser risk area away from the immediate vicinity of visible cancer mass including the lymph glands located further away having occasional number of cancer cells Radiation therapy (Chemotherapy given along with radiation in a lesser dose improves the effect of radiation)
    4. Distant parts of the body. Even though test do not show growth elsewhere in the body, over last 100 years compiled data allows a fair prediction of probability of incidence of invisible cancer cells in the other parts of the body. This could be high, medium low or very low probability, Chemotherapy when probability invisible disease in the other parts of body is high to low. Very low probability may not require chemotherapy. High probability may require relatively aggressive chemotherapy. (surgery/Radiation therapy or radiosurgery to selected sites in various organs)
Step 6: Treatment process
  • Will be over immediately if the treatment is only surgery.
  • Radiation with or with concurrent chemotherapy (4 to 6 doses) can take as much as 5 to 8 weeks.
  • Radiosurgery, when recommended, is usually in 3 to 5 sittings and may take 1 to 2 weeks
  • Chemotherapy of 4 to 6 cycles can take 3 to 5 months.
  • It could be 6 months of total treatment
  • It is important to follow all the care to be taken to lessen & prevent the side effects of treatment and improve the chances of cure.
  • One should have balanced view towards side effects. If one wants safer treatment, the control of cancer may not be up to the desired level.
Step 7: Follow-up.
  • One should understand that even if the disease has disappeared, once the diagnosis of cancer is made, always there could be a threat to life.
  • Therefore, once the treatment is over focus should be on prevention of side effects and reducing the chances of side effects.
  • Visiting the oncologist at regular interval after completion of the treatment is follow-up.
  • It is also important for the early detection of side effects of treatment and prevent the long term effects.
  • Usually the first visit is at 1 ½ months
  • After the completion of treatment the interval is
    • Every 3 months (1 ½ months form the first visit) first year, every 6 months 2- 3 year and every year afterwords.
  • Three months after the treatment is complete, when results come back free of cancer (without disease anywhere), many patients break down for the first time. For the first time apprehension creeps in; immediate relief outside and persistent fear inside - is it still there in the body? Actually getting rid of the known disease is only part of action. It is better to presume that threat persists despite the positive results of the tests (this will keep the inner fear outside). Also, this is the right time to improve the body immunity by incorporating drastic changes the life style, which might have provoked cancer. (See section on prevention of recurrence)

Steps Towards Cure – “Mind versus Cancer” Game

It is not just the proper treatment that helps in cure. There are several aspects listed below which are out of reach of doctors and with in the reach of patients that helps in increasing the chances of cure.

  • First and foremost is to overcome fear. (“Due care for treatment and give a damn for illness?”)
  • Total treatment time could take 6 months. Mentally preparing for this long course of events and being relaxed about it helps in a step towards cure.
  • It would be good if one can feel strong enough to shuttle from the treatment couch to work & office.
  • Changing the weak portions of life style will help in the prevention of recurrence. This aspect could be critical and rarely patients and relatives give importance to this.
  • After the 3rd month of follow-up tests, even when the results show no disease, it is better to presume that threat of cancer recurrence persists. This might help in preventing the apprehension (of whether the cancer will come back) creeping in. This apprehension may reduce body immunity and precipitate recurrence. Also, this is the right time to improve the body immunity by changing the life style, which might have provoked cancer. It is the right time and could be the last chance to toughen up the body.
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