Introduction

I’ve been thinking about George today. He would’ve been 76. That’s not too bad: 76. He lived his life hard but honest (well, mostly!) and enjoyed it. George always treated me like his own son. I couldn’t have asked for a better father-in-law. He died six years ago from prostate cancer that had spread throughout his blood and his bones. George was one of those guys who never went to the doctor. He started to have a difficult time urinating, so much so that he almost couldn’t pee at all. He made a quick trip to the emergency room. The prostate specific antigen (PSA) level in his blood was 250. Normal PSA level for most men is less than 4. Two years later, he was gone.

Wish I could say that was our only loss. George’s ex, Sandy, my mother-in-law, was a classy lady. I sometimes kidded with my wife that if her mom was our age, I would’ve married her instead. She was attractive, street smart, charming, and always looked sharp. Sandy lived for her grandchildren! After we moved from Philly to Carolina, she’d visit frequently and stay with the kids so Jill and I could get out together for a nice dinner or a couple of cocktails. She’d made this most recent trip down to help with our daughter’s “Welcome to Preschool” party. Sandy had been telling Jill about this nagging pain in her back. It’d been going on for a couple of months, but clearly was getting worse. I walked in our front door with the newspaper that Sunday morning and saw her sitting on the couch in the living room. She was sobbing, and this was not a woman who cried easily. Her pain had gotten unbearable. We were off to the hospital. A few hours later, the radiologist was showing me the MRI images of her spine. “This can’t be anything but cancer,” he said. She was dead in six weeks!

Well, at least we still had my parents! They were both retired, my dad from a commercial HVAC company, where he was the purchasing agent, and my mom from the railroad, where she was an administrative assistant. Although they were enjoying their leisurely years, both were plenty tired of shoveling snow and scraping ice every winter in Bucks County, Pennsylvania. They had no problems when I suggested that they move south, especially since they’d been aching to be closer to their grandkids anyway. All was good for awhile, until my dad started to get extremely tired…all
the time. Dave could spin a yarn a mile long about distant relatives, sports stars from the 1950s, bad movies that nobody had ever seen but him, even a classic 20-minute impromptu speech during an Eagles game one year about how to make a good Philly hoagie. My college buddies still laugh about that one! When he got too tired to tell his tales, I knew something wasn’t right. He failed to mention the couple of episodes of dark bowel movements that he’d been having. It didn’t take his doctors long to find the source of his problems, a large stomach ulcer. He needed an operation, and he got it quickly from a very skilled surgeon. What we weren’t expecting was the cancer in the ulcer.

Barb was the one I expected to leave us first. My mom had smoked two to three packs a day from birth. At least it seemed that way to me. I almost couldn’t picture her without a smoke and a romance novel in her hands. Much as I loved her, I found it tough to fathom how she could put a cigarette between her teeth even before she brushed them in the morning. But then, that’s addiction, I guess?!

One morning before work, I stopped at my parents’ house so that I could drive my dad to his doctor’s appointment. It’d been a couple of months since his surgery. His doctors needed to run a light down into his stomach to make sure that the cancer hadn’t returned. He greeted me at the door with a confused look. Since he’d lost so much blood from the ulcer, then took another hit from the surgery to remove it, his mind hadn’t quite recovered. It was like he was in a constant fog. The upbeat, talkative guy that I knew all of my life was gone, and this new guy had taken his place, still very sweet, but much too quiet. That particular morning, however, something else was wrong. As soon as I walked in the front door, I heard the alarm buzzer from my parents’ bedroom. My dad said “Mom won’t open the door, Pat.” I checked myself. The door was actually unlocked, which I hadn’t expected. There she was, lying on her side, hands under her head, peaceful, almost like she was still sleeping…but clearly not. It was the week before Christmas, 2006. When I called my aunts and uncles (and there are many in our large Irish family on both sides), they were anticipating bad news about my dad. That sad day was
to come just three months later.

Thinking about it all again today keeps it as raw as I can stand. I know cancer. I’ve dealt with plenty of it in my first 42 years, thank you very little. Now I’d like to be done with it. Only one problem: I’m an oncologist.

Why Did I Write?

Cancer isn’t a topic that most folks look forward to reading about. Unfortunately, it’s one that many people find themselves needing to read about. Cancer kills nearly 600,000 people per year in the United States, similar to heart disease. Virtually everyone knows someone, a relative, a friend, a co-worker, who’s been diagnosed with cancer. Breast, colorectal, lung, and prostate cancer, “the big four,” together are diagnosed in about 750,000 people per year in the United States alone. Fortunately, our society has come a long way from the days when “She’s got the cancer” was whispered quietly at dinner parties and family gatherings. However, a shocking number of myths and misconceptions still thrive.

As a doctor who sees and treats dozens of patients with cancer every day, I’ve been asked countless questions about it. Some of these questions are specific to the treatments that are being recommended, side effects, and chances for cure. Other inquisitive patients and family members ask, “What is cancer? What could I have done to prevent it? How could I have found this earlier?” These are all excellent questions that prompted my writing.

You’d think, with nearly limitless information at most people’s fingertips, that there’s not much need for a book to cover these topics. At least, that’s what I assumed initially. However, I’ve found as both a provider and a consumer of cancer care services for my family, that’s just not the case. Unfortunately, there are countless Web sites and books in print about cancer treatment or prevention that are so misleading as to be potentially harmful.
There are a few excellent resources that aim to guide patients through treatments for specific cancers. Dr. Susan Love’s book about breast cancer and Dr. Patrick Walsh’s book about prostate cancer are fine examples. There are multiple textbooks to guide oncologists (cancer specialists) and other medical professionals in their care of patients. Personally, I’ve also been inspired reading several patients’ stories of their own journeys. There aren’t, however, many good books to educate people about cancer in language that’s easily understood. My intent with writing this book was to fill that niche by creating a commonsense guide to common cancers.

While I consider myself a good doctor, I’m neither the smartest nor the most well-known oncologist in America. My promise to myself and to my patients is that I continually strive to improve. It’s a work in constant progress. However, if I do have a gift in my relationship with patients and their families, it’s the ability to describe the complex and often scary process of cancer diagnosis and treatment in plain terms that are clear and easy to understand. Fear of the unknown weighs heavy. If I’m able to lessen that fear with this book for even a few people, then I’ll have achieved my goal.

Who Should Read This?

The short answer to that question is anyone who wants or needs to learn more about cancer in plain, commonsense language. Specifically, you may benefit from reading this book if you:

• want to reduce your risk of being diagnosed with cancer;
• want to learn more about how cancers can be diagnosed at the earliest stages and, therefore, provide the best chance for cure;
• have been recently diagnosed with cancer yourself, or someone else close to you has been diagnosed and you need to know about cancer treatment options, risks, and benefits.

As opposed to many other books or Web sites that contain information for the public about cancer treatment or prevention, this guide is based on scientific evidence, described in simple terms. Whether it’s risk reduction, early diagnosis, or treatment of individual cancer types, each chapter includes most of the major medical studies that cancer specialists and other doctors use to support their decisions in helping patients. In fact, general medical professionals (primary care physicians, nurses, medical students, and residents) may find the guide to be of assistance in their care of patients who wish to reduce their risk of cancer or are struggling with understanding the process of diagnosis, the stages of cancer, and treatment options.

Format and Recommendations

Part I, “Reduce Your Risk of Cancer,” is written for anyone who wants to minimize his or her chances of a cancer diagnosis. The main sections of Part I discuss recommendations for the most prevalent cancer-causing agents to avoid, active choices about nutrition and lifestyle changes to consider, as well as specific cancer screening tests to undergo in order to maximize the chance for early diagnosis. These sections could be read individually or all at once, the latter likely in a day or two at most. Whether or not you know someone with cancer, there are major potential health benefits to be gained by learning the concepts and guidelines in Part I.

Part II , “Cancer Treatment Options for the 20 Most Common Types,” is written specifically for patients with cancer and those who care for them, both physically and emotionally. Medical jargon is minimal throughout the book to ensure ease of understanding. However, the most important cancer related terminology is defined for further reference in “Essentials of Cancer Diagnosis, Staging, and Treatment,” the first chapter in Part II. Each subsequent chapter is devoted to a specific common cancer site or type, with personalized patient stories at the beginning and end. These stories are based on a compilation of the thousands of real patients that I’ve met and/or treated over the past 14 years as a cancer specialist. Their purpose is to highlight key concepts about each cancer type. After the beginning of the patient story through diagnosis, each chapter proceeds with a general overview of that particular type of cancer. Included are warning signs and symptoms of cancer, red flags that may signal its presence. A summary of the diagnosis and cancer staging process follows. Current cancer treatment options (as of this writing in 2010) are then discussed in detail. Each chapter concludes with the treatment and outcome for the fictional patient in the story. Not all of the stories have happy endings, unfortunately, just like in real life.

The chapters are listed alphabetically by disease site for convenient reference. Readers will likely want to first delve deeply into those chapters that are most acutely pertinent to their lives. Other chapters can be read later, to improve general knowledge about cancer diagnosis and treatment. Since many types of cancer are very common, unfortunately most people will have more than one type affect their family and friends during their lifetime.

That said, there will undoubtedly be people who read this guide and become acutely concerned that they or someone close to them has cancer. Whether it’s a nagging symptom or a new lump, questions and anxiety may arise. There is no substitute for a thorough discussion and physical examination with your primary doctor. Absolutely nothing within this book should take the place of that important relationship.

What is Cancer?

Most people have no reason to think about cancer unless/until they’re directly affected by it. Unfortunately, since it’s an exceedingly common disease, that time comes for almost every family in the United States. At that point, many people will ask the basic question, “What is cancer anyway?” There are entire textbooks dedicated to the underlying mechanisms of cancer development and progression. However, the best definitions are often the simplest. In order to understand cancer, one needs to understand the cancer cell. The key characteristics of a cancer cell that make it different from most normal cells in the body are its abilities to grow unregulated by the body’s defense, the immune system, and usually (though not always) to metastasize or spread to distant sites in the body through lymphatic channels and blood vessels. Cancer cells arise generally from damaged DNA , the building material that makes cells. Some people are born with this damaged DNA , thanks to their parents. Inherited cancers constitute about 10% of all cases in the United States. For most other patients who develop cancer, however, most of the damage occurs as a result of exposures or events that occur after they’re born.

In an ideal world, cancer wouldn’t exist. Although that’s not yet the case in the real world in 2010, we’re fortunate to have thousands of brilliant scientific minds working toward the goal of eliminating cancer. Until we achieve that ultimate goal, our short-term goals need to be focused on reducing the numbers of patients who are diagnosed with cancer and, for those who have a cancer diagnosis, to increase their chances for cure. Part I of this guide is largely dedicated to the former goal, while Part II is aimed at the latter.