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Common Questions About Cancer

A cancer diagnosis can generate many questions. Some questions patients ask, such as "how did I get it?" or "why me?" can be difficult or impossible to answer. But it’s more important to talk about where to go from here, whether “here” is a recent diagnosis, during treatment, or post treatment. To help clear up any ambiguities about cancer, share facts and advice, and guide patients toward good health, Dr. Colleen Yavarow, Board Certified Medical Oncologist at Sturdy Memorial, addresses some common, cancer-related questions:

• What does metastatic cancer mean?
• What happens if treatment is no longer working?
• I want the best care possible for my cancer. Should I go to Boston?
• Can a person ever be sure cancer will never come back?
• If I am a cancer survivor, are my children more likely to get it, too?
• How can cancer survivors improve overall health?
• What is a port, and why/when is it used? How do you care for it?
• Is “chemo brain” real, and what can patients do about it?
• What is complementary and alternative medicine? Is it for me?

What does metastatic cancer mean?
Metastatic cancer is cancer that has grown and spread beyond its original, primary site to distant organs or locations. This usually happens when cancer cells from a tumor travel through the bloodstream and/or lymphatic system. Oftentimes, cancer that becomes metastatic is no longer curable; however, it can usually be managed with treatment such as chemotherapy. Screening for some cancers is advised to catch cancers early, when cancer is most likely to be cured.

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What happens if cancer treatment is no longer working?
Sometimes, despite our best efforts in providing treatment, cancer grows and spreads. It can be devastating for patients and their families. If patients are well enough, other forms of treatment can be offered. Clinical trials can be pursued, which can offer the newest, most innovative treatments available. We have many more chemotherapy agents available today, even compared to five years ago. Patients who reach a point where they choose to no longer have aggressive medical treatments, can opt to focus on their comfort and quality of life. This can be achieved with palliative care, which provides chronic or terminally ill patients relief from the pain and other symptoms of their disease.

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I want the best possible care for my cancer. Should I go to Boston?
It’s a common misconception that top-quality cancer care is only available in large, academic or tertiary hospitals, like those in Boston. This isn’t true. Sturdy provides the full spectrum of cancer care including diagnostic services; comprehensive therapeutic services including surgical oncology, chemotherapy, and radiation therapy; clinical trials; and access to palliative care, right here in the community. We can handle essentially all cancers, and any cases we feel would be better suited for a larger facility, we would refer appropriately. For a cancer patient, going back and forth to appointments, consultations, testing, treatment, support groups, and other programs can be stressful and tiring. But there’s no reason to travel for advanced, personalized, and comprehensive cancer services; conveniently, they’re all available close to home.

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Can a person ever be sure cancer will never come back?
It is our hope that with today’s advanced treatments, the possibility of cancer recurrence will be low. But unfortunately, cancer is unpredictable and different types of cancer have varying recurrence rates. Even after treatment, there is always a chance that some cancer cells remain in the body, undetectable by tests used today. These cells can start growing and can eventually cause recurrent cancer. Patients are sent for routine scans and lab work to watch for any clues that suggest recurrence.

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If I am a cancer survivor, are my children more likely to get it, too?
According to the American Cancer Society (ACS), the estimated number of cancer survivors (people with cancer from the time of diagnosis on) in the United States is about 13.7 million. Cancer is very common, so it’s not uncommon for multiple people within a family to get cancer. Most often, cancers are caused by multiple factors. These include modifiable risk factors such as smoking and obesity as well as certain gene defects passed through generations that can potentially lead to cancer.

Certain factors such as having several relatives with a particular cancer, which may suggest a family predisposition to cancer, signal oncologists to offer screening tests to patients. Cancer survivors are encouraged to ask their oncologists specifically if their children or relatives are more at risk of certain cancers. Sometimes, the starting points and frequency of screening tests need to be modified. For example, for a patient who develops colon cancer at the age of 50, it would be recommended that his or her children and first-degree relatives start colon cancer screening at the age of 40. Other syndromes shared among family members would call for patients to start colon cancer screening even earlier than that.

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How can cancer survivors improve overall health?
Health usually equates to feeling well, in terms of the mind, body, and spirit. To help improve overall health, it’s important to maintain a balanced lifestyle by eating healthy, staying active, and managing stress. Physical health can be maximized by adhering to a well-balanced, low-fat diet of lean proteins, complex carbohydrates, and vegetables, and by avoiding processed foods. It’s also recommended to quit smoking. Exercise promotes a healthy weight, is good for the cardiovascular system, can contribute to reducing rates of certain cancers, and can help boost mental, emotional, and spiritual well-being. Engage in activities and hobbies you like; this will keep you motivated to keep exercising. Stress management can also be achieved with exercise as well as with relaxation techniques, meditation, counseling or talk therapy, support groups, and medications for depression or anxiety.

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What is a port, and why/when is it used? How do you care for it?
Delivery of cancer medications such as chemotherapy and blood transfusions can require frequent access to the veins through intravenous (IV) catheters, which can damage tissue and make administering medications difficult and uncomfortable. Implantable devices like ports (a.k.a. portacaths or chemoports) can improve quality of life. A port is a small, thin, plastic or metal disk surgically inserted under the skin of the chest or upper arm, with a catheter also implanted under the skin that connects the disk to a blood vessel. A port acts as the IV line used to administer injections. Before each injection, the skin over the port is numbed with a cream, and a special needle is inserted into the port to administer medication.

Ports, which can remain in place for several weeks or several years, reduce the number of needle sticks in the vein and enable longer and more frequent IV treatments and blood testing. Caring for a port calls for flushing a small amount of fluid into the catheter so it doesn’t become blocked, after each treatment or every four weeks if it isn’t used regularly. Clinicians can teach patients (or a family member or friend) to do this.

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Is “chemo brain” real, and what can patients do about it?
“Chemo brain” is a term widely used by cancer survivors to describe concentration and memory problems that can occur after cancer treatment. The term, also referred to as chemo fog or chemotherapy-related cognitive impairment, is somewhat misleading; chemotherapy likely isn’t the sole cause of cognitive issues and fatigue. Other treatments such as radiation therapy and hormone therapy, complications of cancer treatment such as nutritional deficiencies and insomnia, and emotional reactions to cancer diagnosis and treatment such as anxiety and depression, can all contribute to chemo brain.

Ways of coping with chemo brain, according to the ACS, include: using a detailed daily planner; exercising your brain by taking a class or learning a new language; getting enough sleep; engaging in physical activity; eating more vegetables; establishing and following routines; focusing on one thing at a time; tracking memory problems in a diary; and telling family, friends, and your health care team about what you’re going through. If symptoms make it difficult to work, tell your doctor; you may be referred to an occupational therapist for help adjusting with symptoms.

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What is complementary and alternative medicine? Is it right for me?
Nonmainstream or holistic health approaches such as acupuncture, meditation, massage therapy, and natural products such as herbs and vitamins, are widely used for specific conditions or for overall well-being. “Complementary” refers to using nonmainstream approaches together with conventional or standard medicine; “alternative” refers to using these approaches in place of conventional medicine. For cancer survivors, using nonmainstream approaches may help alleviate the side effects of cancer or of cancer treatment. However, they should not replace standard treatment, as scientific studies have not determined these approaches to be effective on their own. To determine whether nonmainstream health approaches are right for you, talk to your doctor about options, benefits, and possible medication interactions and side effects.

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Additional questions about cancer?
Click here to email your cancer-related questions. Appropriate questions will answered in a timely fashion and may be posted to this webpage.

Cancer Care at Sturdy
Sturdy’s Cancer Care Program involves the close collaboration of the Hospital, Sturdy Hematology & Oncology Associates, Shields Radiation Oncology Center Mansfield, as well as our surgeons, surgical oncologists, pulmonary medicine specialists, urologists, gynecologists, oncology nurses, and others, so that we can deliver sophisticated, personalized care to our patients. To see a list of our cancer specialists, click here.

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