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What is cancer?
The body is made up of many types of cells. Normally, cells grow, divide and then die. Sometimes, cells mutate (change) and begin to grow and divide more quickly than normal cells. Rather than dying, these abnormal cells clump together to form tumors. If these tumors are cancerous (also called malignant tumors), they can invade and kill your body’s healthy tissues. From these tumors, cancer cells can metastasize (spread) and form new tumors in other parts of the body. By contrast, noncancerous tumors (also called benign tumors) do not spread to other parts of the body.
There are many different types of cancer, but all cancers begin with abnormal cells growing out of control. The type of cancer is determined by what type of cells begin to grow abnormally and where in the body the abnormal growth occurs. The most common cancers in adults are skin cancer, lung cancer, colon cancer, rectal cancer, breast cancer, endometrial cancer, ovarian cancer and prostate cancer.
CAUSES & RISK FACTORS
Who is at risk for cancer?
Everyone has some risk for cancer. According to the Canadian Cancer Society, 1 in 2 Canadians (49% of men and 45% of women) is expected to develop cancer during their lifetime. The amount of risk you have depends on a number of factors. These factors include tobacco use, lifestyle choices (such as diet and exercise), family history and factors in your workplace and environment.
How do I know if I am at risk for cancer?
Contact your health care provider. Your health care provider can help you understand your risk for cancer, especially if other members of your family have a history of cancer. Your health care provider can also help you understand how your risk for cancer is affected by the following:
- Using or having used tobacco products, such as cigarettes or chewing tobacco
- Drinking alcohol
- Having eaten a diet high in fat for much of your life
- Being exposed to chemicals that can cause cancer
- Being at risk for skin cancer
Depending on your age and your risk factors, your health care provider may begin screening you for certain types of cancer. Screening means looking for certain cancers before they cause any symptoms. Some health care providers recommend that people who are at high risk or have a family history of cancer be screened more often, or at a younger age, than people who have average cancer risks. The recommendations for screening vary for different cancers.
How does smoking and other tobacco use affect my risk for cancer?
If you smoke, quitting smoking is the single most important thing you can do for your health. Cigarette smoking is a major cause of cancers of the lung, larynx (voice box), mouth and esophagus, and it can also contribute to cancers in other parts of the body.
The single most important thing you can do to reduce your risk of cancer is to live smoke-free. The longer a person smokes and the more cigarettes smoked each day, the more the risk increases.
Other forms of tobacco can also cause cancer, such as cigars, chewing tobacco and snuff. If you use tobacco products and want to stop, contact your health care provider. They can help you make a plan to quit.
How does my family history affect my risk for cancer?
Unfortunately, some types of cancer seem to run in families. People of a certain race or ethnic group may also have a higher risk of some kinds of cancer.
Your health care provider will ask you whether other people in your family have had cancer. If someone in your immediate family (a parent, brother, sister or child) has had cancer, you probably are at higher risk for cancer, also.
You can’t change your family history, but it helps to be aware of it. If you and your health care provider know that cancer tends to run in your family, you can watch more closely for the early signs of the disease. For example, if you are a woman and have a family history of breast cancer, your health care provider may want you to start having mammograms more often or at a younger age.
What about factors in my workplace or environment?
There may be substances in your surroundings that can cause cancer or put you at a higher risk of developing cancer. These can include dust and vapors in the air you breathe and chemicals that touch your skin. Exposure to the sun without protection can cause skin cancer and breathing tobacco smoke (by smoking yourself or by breathing second-hand smoke) puts you at risk of lung cancer and other types of cancers.
Ask your employer if there are any materials in your workplace that can cause cancer. These may include asbestos, solvents and chemicals used for manufacturing or cleaning, smoke or fumes from burning materials and many others. Your employer should have a material safety data sheet (MSDS) for each substance that could potentially damage your health. All employers are required by law to complete these forms and you have a right to see them. Your employer should also provide safety equipment, such as a mask and protective clothing, to help decrease your exposure to any harmful materials.
Take a look at the environments you spend time in outside your workplace, as well. Too much exposure to the sun can cause skin cancer, the most common form of cancer. Try to stay out of the sun as much as you can. If you must spend time in the sun, wear protective clothing and sunscreen with an SPF (sun protection factor) of at least 30.
Breathing in smoke from a cigarette, cigar or pipe (even if you’re not the person who’s smoking) causes damage to your body that can lead to cancer. If you smoke, you need to quit. If someone in your family smokes, offer to help them quit, or ask them to not smoke when you are around. Cigarette smoke that clings to surfaces like carpet or clothing can also pose a risk, especially for infants and toddlers.
DIAGNOSIS & TESTS
What screening tests should women have?
Increasing age is the most important risk factor for breast cancer for most women. To help find breast cancer early, your health care provider may perform a clinical breast exam (where he or she checks your breasts for lumps). Discuss the benefits and harms of a clinical breast exam with your health care provider.
A mammogram is a special type of low-radiation X-ray of the breast. In Nova Scotia, women between age 40-49 are recommended to have annual screening mammography. Women in Nova Scotia, aged 50-69, are recommended to have screening mammography at two year intervals. Women 50-69 can also be recommended to return on an annual basis if they:
- have a strong family history of breast cancer (mother, sister, daughter, father, brother, son),
- are currently on HRT or
- the radiologist has recommended returning sooner.
Women over the age of 70 are recommended to continue to have screening mammography if they are in good health.
In Prince Edward Island, women between ages 40-49 are recommended to have annual screening mammography. Women in PEI aged 50-75, are recommended to have screening mammography at two year intervals
In Prince Edward Island, a screening mammogram is recommended for women aged 40-75 who:
- have never had breast cancer;
- do not have symptoms such as a breast lump, puckered skin, rash or nipple discharge;
- have not had a mammogram in the last 12 months;
- do not have breast implants; or
- have a parent or sibling with breast cancer.
- Your health care provider may request a diagnostic mammogram if you find a change in your breast such as a lump or nipple discharge. In this case, the mammography department will contact you to schedule an appointment.
If you have risk factors for breast cancer, such as a family history of breast cancer, your healthcare provider may want you to have mammograms more often or start having them sooner.
During a Pap smear, your health care provider takes a sample of cells from your cervix to be tested for cervical cancer. Unless your health care provider suggests that you need one more often, you should have a Pap smear:
- Every 1-3 years beginning at 21 years of age and continuing until 65-69 years of age (recommendations may vary depending on province, discuss your situation with your health care provider)
- All women who have been sexually active should have regular pap smears by the time they are 21 years of age, or within 3 years of becoming sexually active
Certain things put you at higher or lower risk for cervical cancer. Your health care provider will consider these when recommending how often you should have a Pap smear.
If you’re older than 69 years of age, talk with your health care provider about how often you need a Pap smear. If you’ve been having Pap smears regularly and they’ve been normal, you may not need to keep having them.
If you’ve had a hysterectomy with removal of your cervix, talk with your health care provider about how often you need a Pap smear.
If you’ve never had a high-grade precancerous lesion or cervical cancer, ask your health care provider how often you need a Pap smear.
What screening tests should men have?
To make a decision about screening for prostate cancer, first talk to your health care provider about the pros and cons of screening. Factors such as family history, age and race play a part in the risk of prostate cancer.
The Canadian Cancer Society recommends that men talk to their health care providers about screening and make a decision based on what is right for them.
If you decide to have screening, your health care provider will order a blood test called the PSA test. PSA is short for prostate-specific antigen. Men who have prostate cancer may have a higher level of PSA in their blood. However, the PSA level can also be high because of less serious causes, such as infection.
Why is it important to find cancer early?
Some common cancers are easier to treat and cure if they are found early. If the tumor is found when it is still small and has not yet spread, curing the cancer can be easy. However, the longer the tumor goes unnoticed, the greater the chance that the cancer has spread. This usually makes treatment more difficult.
What are the different kinds of cancer treatment?
The three most common types of cancer treatment are surgery, radiotherapy and chemotherapy. Treatment is aimed at removing the cancer cells or destroying them with medicines or by other means.
Surgery is a way to physically remove the cancer. Surgery can be very successful in treating some kinds of cancer, but it isn’t an option in all cases. If the cancer is in the form of a malignant tumor (a tumor that spreads) but the tumor is still in one place (localized), it may be possible to safely remove the tumor and any surrounding affected tissue. Surgery may not be possible if the cancer has spread to other areas of the body or if the tumor cannot be removed without damaging vital organs, such as the liver or brain.
Different types of surgery are used to remove cancer. Some of these include:
- Laser surgery. Beams of light and sometimes heat from a laser are used to target and destroy cancer cells.
- Laparoscopic surgery. Very small incisions are made in the body, and the health care provider uses a tiny camera to see inside your body. The camera sends signals to a video screen so that your health care provider can see the tumor and your organs. The health care provider uses a surgical tool to remove the tumor.
- Mohs’ surgery. Layers of cancer cells are removed one at a time. Each layer is examined before the health care provider removes the next layer. In this way, only the diseased layers are removed and healthy tissue remains intact.
- Cancer cells are frozen and destroyed using a very cold material, such as liquid nitrogen.
Radiotherapy uses radiation—in the form of a special kind of X-ray, gamma rays or electrons—to damage cancer cells so that they can’t multiply. There is usually no pain during this kind of therapy. Depending on the area that is treated, side effects from radiation damage to normal tissues may occur. Your health care provider can tell you what to expect. Radiotherapy is sometimes the only treatment needed, or it may be used with other therapies. A combination of surgery and radiotherapy may be used for tumors that grow in one place.
Chemotherapy uses medicines to attack the cancer cells. The word “chemotherapy” sometimes causes a lot of fear because the side effects can be severe. However, not all people experience severe side effects. The side effects of chemotherapy can often be treated with other medicines.
Chemotherapy is usually used when the cancer has spread to other areas in the body. Chemotherapy can also be used in combination with surgery and radiation. Sometimes the tumor is surgically removed and then chemotherapy is used to make sure any remaining cancer cells are killed.
Another kind of treatment is biological therapy (also called immunotherapy). This treatment is used to trigger the body’s immune system to produce more white blood cells, called lymphocytes (say: limf-o-sites). Two kinds of lymphocytes can attack and kill cancer cells: T-cells and B-cells. Immunotherapy aims to boost the ability of the T-cell and B-cell lymphocytes to kill cancer. This kind of therapy can also be used in combination with surgery, radiation therapy or chemotherapy.
Hormone therapy is sometimes used to treat breast or prostate cancer, often in addition to chemotherapy or radiotherapy. Hormone therapy involves taking drugs that contain other hormones to block the effects of estrogen and testosterone, also hormones. These drugs are necessary because the hormone estrogen can make breast cancer tumors grow faster. Similarly, the hormone testosterone can make cancerous tumors in the prostate grow faster. In other cases, surgery to remove the ovaries or the testicles may be used. Removing these organs reduces the amount of estrogen or testosterone in the body.
Other specialized treatments may be available. Your health care provider may talk to you about these treatments if they are an option for you.
How do I decide what treatment option to use?
Your health care provider, or a team of health care providers, will help you understand your options and will recommend options for treatment. You may not have a choice in the treatment. Many factors are involved, including the stage that your cancer is in, what organs are affected, and the type of cancer that you have. Some cancers, such skin cancer, are easier to treat than others. Your age and health, as well as the potential side effects of treatment, may also be factors in how much control you have over your treatment plan.
You and your health care provider will want to consider both the advantages and disadvantages of each therapy. In addition, you and your health care provider will want to discuss alternative therapies in case your cancer doesn’t respond to treatment.
What are clinical trials?
Clinical trials are used to research new ways of treating people who have cancer. After a new medicine goes through many tests in the lab and on animals, it is tested on people who have cancer and volunteer to take part in a clinical trial. The trial helps health care providers decide whether a medicine is safe and effective. It also helps determine the correct dosages that patients should receive.
Cancer trials are run differently than some other clinical trials. In other types of trials, patients taking new medicines are compared to patients who receive no medicine at all (called a placebo or “sugar pill”). It would not be ethical for health care providers to give people who have cancer a sugar pill containing no medicine. So, cancer trials compare patients receiving a current medicine to patients receiving the new medicine. Health care providers hope that the trial will reveal that the new medicine works better than the current one.
There are some advantages to taking part in a clinical trial. Patients who do participate may receive the newest and best medicines available. Also, patients are monitored very closely throughout the trial, so their overall health often benefits. In addition, patients who take part in a clinical trial may not have to pay for the medicine they receive. The company or organization that sponsors the trial will usually provide the medicine at no charge, and will pay for extra testing and health care provider visits.
Clinical trials also come with some risks. The medicines you may receive in a clinical trial may have unwanted side effects, or it may not work as well as health care providers hope it will. You may have to commit more time to your treatment if you take part in a clinical trial, and you may have to have more frequent tests.
If you think you might want to take part in a clinical trial, talk to your health care provider. He or she can tell you about the possible benefits and risks and can help you look for a trial. You may also want to check the Canadian Cancer Society’s website for more information.
I sometimes don’t understand what my health care provider is saying. What do I do?
Tell your health care provider that you don’t understand. You need to be aware of what’s going on at each stage of your treatment, including all the options ahead of you. Bring a close friend or relative to your appointments to act as a second set of ears and eyes on your behalf. Your companion can help advocate for you.
It may help to take notes during your appointments. Write down any questions that you want your health care provider to answer. You can also record all of your conversations, and then make notes from the recording. It’s important that you understand what your health care provider tells you, and that your health care provider is aware when you don’t understand. Be honest with your health care provider. Don’t hold back any information, even when answering questions about how you feel, physically or emotionally, or how well you understand what the health care provider is saying.
Who does what in my treatment program?
Cancer treatment can be very complex. The kind of cancer you have, the stage that it’s in, and the treatment program you go through affects the kinds of health care professionals you’ll see. Your primary health care provider may oversee your treatment and rehabilitation programs, and can help answer questions you have. Sometimes an oncologist may manage your treatment program, but your primary health care provider may take over once therapy is completed. An oncologist is a health care provider who specializes in treating people with cancer.
A surgeon may do the operation to remove as much cancerous tissue as possible. A pathologist will examine the tissue that is removed during a biopsy or surgery to check for signs of cancer. Radiation oncologists administer radiation treatment. The radiation oncologist is often helped by diagnostic radiologists, radiotherapy technologists and radiation physicists, who plan treatment and check the radiation dosages to ensure that treatment is as safe as possible.
Oncologists, primary health care providers, and internists often prescribe chemotherapy medicines, hormones and other drugs. Laboratory technicians or nurses may draw your blood for tests.
Nutritionists evaluate your diet and help you plan your meals during and after treatment. Physical therapists can help you keep your muscle tone and restore your ability to move around if there are any changes to your body from treatment. Psychologists, psychotherapists and other counselors, such as clergy or social workers, can help you talk through your feelings and manage the emotional reactions to your cancer and cancer treatment. Pharmacists mix the complicated medications and check that you are getting the correct dosages.
Don’t hesitate to contact your health care provider about any questions and concerns you have about your treatment. If something is on your mind, ask about it. By getting answers to your questions, you can become a more active participant in your care.
What can I do about side effects?
Cancer treatment affects every person differently. Some people have few side effects or even none at all. However, the side effects of cancer treatment make many people feel very sick. Your health care provider will tell you what kinds of side effects you might expect with your cancer treatment. They will also tell you which side effects are unusual and when you need to call the health care provider’s office.
Don’t downplay your side effects. It’s important to tell your health care provider, members of your care team and the people around you how you are feeling. If you feel very sick, very tired or are in a lot of pain, your health care provider may be able adjust your treatment or give you other medicine to help you feel better.
Will I lose my hair?
Radiotherapy to the head and some types of chemotherapy can cause people to lose their hair. Other types of treatment do not cause this side effect. If you’re having chemotherapy, ask your health care provider whether the drugs you’re taking can cause hair loss. Losing your hair can be a difficult experience. If your health care provider tells you this might happen, try to prepare yourself.
Decide what you want to do if you start to lose your hair.
Some people who lose their hair during cancer treatment wear a wig or hairpiece. Others cover their heads with hats, scarves or turbans. Still others leave their heads uncovered. Do what feels right for you. Many people switch back and forth, depending on where they are, who they’re with and what they’re doing.
If you decide that you want to wear a wig or hairpiece, it’s a good idea to pick one out before you start losing your hair. That way, you can match it to your natural hair color and texture. Some shops specialize in wigs and hairpieces for people who have cancer. You may also be able to order your wig or hairpiece over the Internet.
If you decide to shave your head or leave it uncovered, you will need to protect your skin with sunscreen, a hat or a scarf when you’re outside.
If you do lose your hair during radiotherapy or chemotherapy, it will almost always grow back after you finish your treatment. However, it might be a different color or texture when it grows back.
What if I don’t feel like eating?
You may not feel well enough to eat while you’re getting cancer treatment. But it’s important to eat as much as you feel you can. Food helps your body build new, healthy cells and also helps boost your energy level.
It may help to eat several small meals a day instead of 3 large ones. Try eating bland foods like saltine crackers, plain toast and broth. Sip water, juices and soda. Ask your health care provider about whether you should take a nutritional supplement, such as Ensure. Avoid spicy foods or foods with strong odors if they make you feel nauseous. You may also find that it’s easier to eat and drink lukewarm food and beverages.
Some people who have cancer (especially people who are being treated with chemotherapy) have problems with mouth soreness or sensitivity. This may make it even more difficult to eat. Try eating soft, bland food or cooked food that has been pureed in a blender. If sores develop in your mouth, contact your health care provider. These sores can become infected and cause serious problems. You may want to drink through a straw to bypass mouth sores. Also, try rinsing your mouth with 5 ml/cc (1 teaspoon) of baking soda dissolved in 240 ml (8 ounces) of water. This can help prevent mouth infections and help your mouth heal faster.
When you do feel like eating, try to get as much protein and as many calories as possible. Ask your health care provider whether you need to add certain nutrients or types of food to your diet. Your health care provider may want you to visit a nutritional counselor, who can help you figure out ways to get the right amount of protein, nutrients and calories. If you find you can’t eat at all for more than 24 hours, contact your health care provider. They need to know that you’re not getting the nutrition you need.
Will I be able to work?
You may not know the answer to this question until after you’ve started your treatment. Some people find that the effects of cancer and its treatment make them feel so sick that they’re not able to work at all. Others are able to maintain their normal schedule or adjust it to work around their treatment.
Working during treatment can help keep your mind on things other than your cancer. You may also feel better knowing that you’re continuing your “normal” routine. Many people who decide to work during treatment also find that they receive a great deal of support from their employers and coworkers.
If you want to continue working during cancer treatment, explore ways to make the most of your time. Try scheduling treatments for the end of the week, so that you’ll have the weekend to recover. Ask your employer about working part-time or working from home. If necessary, ask coworkers to assist you with some of your tasks or duties. They will probably be eager to help.
How will I feel emotionally during treatment?
It’s normal to feel helpless, angry, scared and depressed during cancer treatment. You will probably feel all of these emotions and more while you’re going through treatment. On some days, you may feel like the treatment is not worth it.
Try to find a support system that you can rely on during these times. Many people count on family members and friends for support. Other people prefer to talk to people who are also going through cancer treatment. Cancer support groups can help people who have cancer and their family members cope with the disease and its treatment. Your health care provider can suggest ways to find a support group, or you may contact a local hospital or the local chapter of the Canadian Cancer Society.
Keeping your mind active can also help. Try to stay busy by doing jigsaw or crossword puzzles, knitting, watching movies or playing games with friends and family. Exercise can help too, but only if you’re feeling strong enough. Talk to your health care provider about what physical activity is best for you.
Some research, as well as the experience of many people who have cancer and their health care providers, shows that a positive outlook may improve the health of people who go through cancer treatment. This positive-thinking approach can include forming a mental picture of how well your treatment and your body’s immune system are fighting the cancer (also called visualizing).
It’s also important to talk to your health care provider about your emotions. Depression is common during cancer treatment. If it is a problem for you, your health care provider may be able to prescribe medicine to help you feel better.
Should I tell my health care provider that I was treated for cancer as a child?
Yes, this information is important. Your health care provider will want to know about any childhood cancer and treatment. The treatments for a childhood cancer can lead to problems later in life. These problems include obesity, brittle bones, depression, heart trouble, women’s reproductive issues and a higher risk of other cancers. Up to 60% of childhood cancer survivors who are now adults have at least one ongoing or late-arising health problem.
You can work out a plan for follow-up with your family health care provider. You may have to talk to your parents or your childhood health care providers to get the best plan for your health care now.
What can I do to lower my risk of cancer?
Unfortunately, some risk factors for cancer (such as family history) are out of your control. But there are things you can do each day to improve your health and lower your risk of cancer. The best ways to lower your cancer risk are to stop smoking and to maintain a healthy weight, be active and eat a healthy diet. Limiting how much alcohol you drink is also important, as is limiting your exposure to sunlight or tanning beds. If you are a cancer survivor, these same lifestyle habits can help you stay healthy.
Seeing your health care provider regularly can also help. Depending on your age and medical history, your health care provider will probably run tests (called screenings) to try to detect the early signs of certain cancers. For most types of cancer, the sooner the cancer is found and treatment begins, the better your chances of recovering.
Why is my weight important?
Reaching and staying at a healthy weight lowers your risk of many different cancers. Maintaining a healthy weight will also help lower your risk of other conditions, such as heart disease and diabetes. Ask your health care provider what a healthy weight would be for you. If you are above a healthy weight, even losing just 5 percent to 10 percent of your current weight can help your health.
Why is being active important?
Being active on a regular basis can lower your risk of several types of cancer, including colorectal cancer and breast cancer. Exercise helps strengthen bones, build muscle and reduce body fat. It can also help improve self-esteem, and increase heart and muscle strength. Regular physical activity is also important for cancer survivors because it can help reduce tiredness and stress.
Most adults can do moderate activity without checking with their health care provider first. However, if you are a man older than 40 years of age or a woman older than 50 years of age, or if you are a cancer survivor, talk to your health care provider before starting an exercise program.
Try to get at least 150 minutes of physical activity per week, in bouts of 10 minutes or more. Try to keep a medium- to high-intensity level of activity. You can become more active by adding even a small amount of activity into your daily routine. For example, try taking the stairs rather than the elevator. Go for a walk during a coffee break or during lunch.
QUESTIONS TO ASK YOUR HEALTH CARE PROVIDER
- What is the best thing I can do to prevent cancer?
- Am I more likely to get certain types of cancer?
- How long after I’m diagnosed with cancer will treatment begin?
- How will I decide what treatment is best for me?
- Will I be able to work while I’m undergoing treatment for cancer?
- Can I still hold my children/grandchildren while I’m having chemotherapy or radiation therapy?
- Is there a special diet I should eat while I’m being treated for cancer?
- Now that I’m done with my cancer treatment, how often will I have to be tested to see whether my cancer has come back?
- Is it likely that my cancer will come back?
- How can I help my family to accept that I have cancer?
FOR MORE INFORMATION
Canadian Cancer Society
Toll Free 1-888-939-3333
Cancer Care Nova Scotia
Toll free: 1-866-599-2267
Health PEI – Cancer Support and Information https://www.princeedwardisland.ca/en/information/health-pei/cancer-support-and-information-patients-and-families