Cancer is a term used to describe more than 100 different diseases that can affect almost any part of the body. In healthy people, cells replicate and create exact copies of themselves to replace dead or damaged cells. Cancer occurs when the deoxyribonucleic acid (DNA) makes an error when copying itself, resulting in a cell that cannot perform its proper function. This bad cell replicates quickly and can form a tumor or can be found in the bloodstream (e.g., leukemia). Thus, cancer develops from our own bodies, but represents a mistake in a normal body process.
Each type of cancer presents with a distinct set of symptoms, although in many instances the symptoms do not appear until the cancer is advanced. These symptoms tend to be specific to the location of the cancer. However, there are some general symptoms that occur in many forms of cancer. For example, unexplained weight loss, fever, fatigue, pain, and skin changes (e.g., pigmentation) are often associated with cancer. Other common symptoms include changes in bowel or bladder functioning, unusual bleeding or discharge, a lump in the breast or other part of the body, chronic indigestion, or a persistent cough or hoarseness. Since early detection is important for successful treatment, it is essential to consult with a physician if you are experiencing any number of these symptoms.
According to 2003 statistics, cancer causes 23% of deaths among adults, second only to heart disease. In deaths resulting from illness, it is the leading cause of death among children. More than 1.3 million people are expected to be diagnosed with cancer in the year 2004. Far more adults than children experience cancer, as nearly one half of men and one third of women will be diagnosed with cancer sometime in their lives. The most common forms of cancer in adults occur in the prostate, breast, lung, and colon/rectum. Cancer is still rare among children, occurring in about 1.5 of every 10,000 children. Leukemia accounts for approximately 30% of childhood cancer cases.
To obtain higher rates of recovery, aggressive treatment including a combination of surgery, chemotherapy, and radiation therapy is frequently needed. Depending on the type of cancer and degree to which the cancer has spread, different treatments are used.
If the cancer is detected early, surgery can be used to remove the cancerous cells and may be the only treatment necessary. Surgery is also used to diagnose cancer by removing a small portion of the tumor (a biopsy) to determine whether the tumor is cancerous. A tumor that is cancerous is termed “malignant,” while a noncancerous tumor is designated as “benign.” Surgery can also provide information to determine how far the cancer has spread, through a process called staging. Almost all cancer patients undergo surgery at some time during their cancer treatment. Although complications can occur during and after surgery, the advantages of removing the cancerous cells usually far outweigh the side effects. Some patients may experience excessive bleeding during the procedure, damage to surrounding organs, or reactions to anesthesia during surgery. Following surgery, most people experience varying degrees of pain. Other side effects can include infections, bleeding, pneumonia, and blood clots. In cases of brain tumors, cognitive or behavioral changes may occur as a result of the cancer or of the surgery.
High doses of radiation can kill cancer cells or keep them from multiplying. Radiation therapy is a component in the treatment of approximately half of cancer patients. There are two different types of radiation therapy: external radiation (most common) and internal radiation (also called brachytherapy). The side effects differ by type of treatment, site of the radiation, and a number of patient variables. However, the most common acute side effects include fatigue and skin irritation or changes at the radiation site. Very young children who receive cranial irradiation therapy for leukemia or brain tumors may be at greater risk for cognitive or behavioral changes.
For patients with leukemia and those with cancer that has affected multiple parts of the body, chemotherapy may be necessary. Chemotherapy medications are designed to kill rapidly reproducing cells, such as cancer cells. Multiple chemotherapy medications are given together to create the best treatment for the cancer. Chemotherapy is administered in cycles, rotating between therapy and recovery periods. The length of treatment and number of chemotherapy cycles depends on the type, severity, and location of the cancer. The average length of treatment is 6 months. Side effects result primarily from the fact that the chemotherapy medications kill rapidly reproducing healthy cells such as those in the bone marrow, digestive tract, reproductive system, and hair follicles as well. The damage to the reproducing cells in these areas can result in low white blood cell counts (increased risk for infection), low red blood cell counts (anemia), low platelet counts (difficulty with blood clotting correctly), appetite loss, taste changes, nausea, vomiting, constipation, diarrhea, fatigue, hair loss, and pain. Most side effects start to decrease after chemotherapy has ended and the cells that were damaged have been replaced.
In some cases, when more aggressive treatments have proven to be ineffective in curing cancer, patients can choose to have only those procedures that will reduce pain and make them more comfortable (called supportive or palliative care). In instances where the cancer has spread to many parts of the body and has not responded to treatment or when it continues to recur, death may be imminent. Palliative care and hospice teams can provide support for the patient and families during the end of life.
Recent advances in the treatment of cancer have resulted in increased survival rates, especially among children. The current 5-year survival rate for pediatric cancer is 78%, ranging from 45% for acute myeloid leukemia to 94% among Hodgkin’s lymphoma patients. Among adults, the average 5-year survival rate is 62%, with rates ranging from 15% for lung cancer to 97% for prostate cancer. The current 5-year survival rate for women with breast cancer is 87%. These rates are average survival rates and do not take into account age, physical health, or degree of cancer spread. Younger, healthy adults whose cancer is detected early on have the higher rates of survival.
Although it is unlikely that most forms of childhood cancer can be prevented, experts estimate that 50% to 75% of adult cancer cases result from unhealthy behaviors. For example, 30% of cancer cases have been linked to tobacco use. The American Cancer Society recommends eating five fruits and vegetables daily, remaining at a healthy weight, exercising, and avoiding tobacco and heavy alcohol consumption in an effort to prevent some forms of cancer. Decreased exposure to environmental toxins is recommended for both children and adults.
There are a number of screening methods available to allow early detection or prevention of certain types of cancers. These screening procedures include mammograms, clinical breast examinations, Papanicolaou (Pap) tests for cervical cancer, prostate examinations, and fecal occult blood tests (to screen for colorectal cancer). The guidelines regarding the timing and frequency of these screening procedures can be found on the American Cancer Society’s Web page or by consulting with a physician.
Coping With Cancer
The entire family is affected when a member is diagnosed with cancer. Common reactions to a cancer diagnosis can include shock, denial, anger, anxiety or fear, guilt, and sadness. Patients and family members, including children, frequently experience some or all of these symptoms. It is also common for children’s behavior to regress (start acting younger than their age). Children and adults may feel overwhelmed by the stress of the cancer diagnosis and uncertainty over the future, or worry over upcoming treatment.
Many people cope with the uncertainty of cancer by learning as much as possible about the disease. This information can help in making treatment decisions and with relieving fears. Although parents naturally want to shield children from bad news, it is important to provide children with age-appropriate information about cancer. Research has shown that it is not helpful to try to hide cancer diagnoses from children because they can usually sense that something is wrong regardless of how careful adults are to keep information away from them. Furthermore, the attempted secrecy may produce more of an emotional burden by sending a message that the children cannot talk with their families about the illness.
During cancer treatment, social support is essential. Extended family members, religious organizations, and community agencies can provide resources to minimize the overwhelming strain on the family. Multidisciplinary teams to treat cancer also include personnel who can assist with the stress and emotions associated with a cancer diagnosis. A social worker, child life specialist, or psychologist can work with the patient and family to teach healthy coping strategies. It is essential that the patient, as well as the caregiver, take care of both physical and emotional needs during cancer treatment and recovery.
Completing the stressful process of cancer treatment successfully is a huge accomplishment. However, adjusting to life after cancer can be stressful as well. Overall, cancer survivors are not different from healthy individuals in terms of psychological adjustment, but they have undergone a life-changing experience that may have impacted them for life. This impact can be positive, as in the case of many breast cancer survivors who reported that their relationships with other people improved following successful cancer treatment. For other people, the cancer experience has left them with physical or mental changes that may negatively impact their life. For example, some people have to adjust to life without a limb that was lost to amputation. Others, such as children who received high doses of radiation therapy at early ages, may face lifelong cognitive difficulties with sustaining attention, learning, and memory.
There is always some uncertainty about cancer recurring. Among children, secondary malignancies can result from the treatment of the first cancer. Each checkup and anniversary can be cause for great anxiety and subsequent celebration if the person remains cancer free. Cancer recurrences tend to elicit strong feelings of sadness, anger, and despair as families face repeating the entire treatment process again.
- American Cancer Society, http://www.cancer.org
- Bearison D. J., & Mulhern, R. K. (1994). Pediatric psychooncology: Psychological perspectives on children with cancer. Oxford, UK: Oxford University
- Candlelighters Childhood Cancer Foundation, http://www.candlelighters.org
- Laughlin, H. (2002). Coming to terms with cancer: A glossary of cancer-related terms. Atlanta, GA: American Cancer Society.
- National Cancer Institute, http://www.cancer.gov
- Powers, W., Vannatta, K., Noll, R. B., Cool, V. A., & Stehbens, J. A. (1995). Leukemia and other childhood cancers. In M. C. Roberts (Ed.), Handbook of pediatric psychology (2nd ed., pp. 310–326). New York: Guilford.
- Vannatta, K., & Gerhardt, C. (2003). Pediatric oncology: Psychosocial outcomes for children and f In M. C. Roberts (Ed.), Handbook of pediatric psychology (3rd ed., pp. 342–357). New York: Guilford.
- Woznick, L. , & Goodheart, C. D. (2002). Living with childhood cancer: A practical guide to help families cope. Washington, DC: American Psychological Association.