Saturday, October 22, 2011

The biggest fear

I saw my oncologist the other day for my quarterly checkup. All is well, except that my liver enzymes are elevated. That freaked me out a bit because I damaged my liver 15 years ago by taking too much ibuprofen (unfortunately more isn't always better). But elevated liver enzymes refers to any one of a number of conditions, and does not necessarily indicate any specific disease. It can be caused by any number of things, such as: too much alcohol consumption, diabetes, cancer drugs, high cholesterol and cholesterol medication and overuse of pain relievers (aspirin, Tylenol, Advil, Aleve, etc.) I felt like I was being lectured to about my recent alcohol over-consumption, although Dr. Chaudhry couldn't possibly know about that, could he? Me thinks I am potentially screwed here. But that wasn't so bad in the scheme of things. You see, my mother just found out she has pre-cancerous cells on her face. Like many cancers, skin cancers start as pre-cancerous lesions. These pre-cancerous lesions are changes in skin that are not cancer but could become cancer over time. They discovered it in plenty of time so it can be removed pretty easily. But that news just feeds my biggest fear - being diagnosed with another type of cancer!

I heard so much of that during chemo from my "Chemo Compadres". Beating one form of cancer only to then be diagnosed with another type. That fear is #1 on my list. For patients who thought they had successfully conquered cancer, a second diagnosis of the disease is just as devastating, if not more so, as the first, experts say. It is re-traumatizing. The trauma goes back to the shock and fear of being diagnosed again with a potentially life-threatening illness. When you've gone through a first diagnosis and treatment, time has passed and you gain greater confidence in your health. So when there is a re-experience of that diagnosis, all the same feelings of fear and uncertainty race to the surface even more quickly than before. It's like you thought you had left that in your past and all of a sudden it's part of your future again. There's definitely feelings of anger, which really represents frustration over a sense of losing control in your life, again.

One diagnosis of cancer can be overwhelming, but the effects are compounded psychologically with a second one. One of the common things upon diagnosis with cancer is that you go through a phase of insecurity, instability, not having faith in your body, feeling every little twinge and ache as a possible manifestation of a recurrence. So you're regaining your confidence and you get another diagnosis. Psychologically it's hard, you start to wonder if you're prone to cancer and/or if you'll die of cancer. I have learned that when someone has treatment for a primary tumour, on average there is a 30 to 50 per cent chance of recurrence, across all organs and all tumors. Recurrence is the term doctors use to describe when the primary tumour type has returned in the same or another site. The likelihood that an individual develops multiple tumour types in their lifetime is about 10 per cent. So the chance of that is not high, it's low, but not insignificantly low. But since we are now detecting tumors earlier, it opens the door to more people showing up with another primary tumor elsewhere. It's usually the prevalent cancers: lung, breast, colorectal or prostate.

Now, supposedly, the two diagnoses don’t compound your likelihood of death. They’re independent odds. So it’s a totally new fight starting all over again. The only way they would be related is if the treatment of one tumor limits how much treatment you can do for the second one, but biologically, the odds should be independent of each other. There is not yet a lot of specific information about how likely it is that survivors of specific cancer types will have second cancers. Current research shows that cancer survivors in general have an increased chance of developing cancer compared to people of the same age and gender who have not had cancer. This means that it is even more important for cancer survivors to be aware of the risk factors for second cancers and maintain good follow-up health care. A second cancer can appear at any time during survivorship. Some studies show that a common time for cancers to develop is from five to nine years after completion of treatment. However, because the exact causes of second cancers are not yet known, it is difficult to predict when they might appear. Lifetime monitoring by health care providers who are knowledgeable about survivorship care is recommended--even years after completing treatment for the original cancer.

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