Treatments and thier impact

Mood swings

Going through the stresses of cancer treatment is enough to make anyone sad, irritable, and frustrated. At times, you may notice that you don’t have control of your emotions, and you may cry about minor things. At the other extreme, you may find your mood is a little high and you feel euphoric, without any apparent reason. It is important to know that the cause may be the medications you’re taking. For example, both prednisone, which is often used to control extreme discomfort from nausea, may affect mood, causing unexplained highs that can be followed by intense lows. This emotional seesaw will pass, and you will return to feeling normal. If the mood swings are severe, ask for help in coping with them; you may even need to take medication to counter them. A persistent low mood could turn into a depression, with the symptoms of sadness, “bad” mood (feeling negative or hopeless), taking no pleasure in things you usually enjoy, and having trouble eating and sleeping. These are signs that you should seek counseling and perhaps receive medication to control these symptoms.
It’s important to recognize that these moods are signs of the brain’s biochemical reactions to drugs. They do not reflect failure on your part to cope with cancer, nor are they a sign of mental illness. You are fine-it’s what the medicines are doing to you.

Irritability

Are you more easily frustrated and annoyed than usual? Is it harder to tolerate frustrations that you usually manage easily? This irritability may be part of your response to the physical and emotional stresses you are experiencing, but it also may be caused by the drugs you are taking. Often the simplest things can help you calm down and feel better, such as soothing music, physical exercise, a warm bath, or relaxation or meditation exercises.

Difficulty concentrating

While going through chemotherapy, some people complain of having trouble remembering things, reading books and newspapers, and concentrating on their usual work. Sandra was frightened that she simply could not do her work at her law firm. She blamed herself for not coping better. She became disconsolate and depressed and considered taking a leave of absence from her highly responsible job. She was taking a high dose of interferon as part of the treatment for melanoma. Most of the symptoms were controlled with an antidepressant medication. When the interferon dose was lowered, her previous level of concentration was restored, and her mood returned to normal.
We know that some chemotherapy agents, especially in high doses, may temporarily affect a patient’s to think clearly, causing memory and concentration problems. Keep in mind that these symptoms usually get better, and you should be back to normal by the time the treatment is over. However, sometimes these difficulties may persist beyond the completion of the treatment; we don’t know for how long. Some studies are that finding cognitive changes last as long as two years.
If you find it hard to concentrate during the treatment, try to postpone serious work that requires your full attention for a while. If this side effect persists after the treatment is finished, tell your doctor. Most important, do not blame yourself. In general, problems with concentration are subtle and don’t interfere with your normal activities. If you’re feeling very distracted or disoriented, check with your doctor about potentially dangerous activities, such as driving. Impaired concentration is usually one of those troublesome side effects that you have to put up with temporarily in exchange for the positive effect of the drug on your tumor.

Poor sleep

Although the stress of illness and treatment alone can be sufficient to throw off your sleep-wake cycle, drugs like prednisone also contribute to sleep problems, so trouble sleeping may be a complication of treatment. Try your usual “tricks” to get to sleep, but if you are arising tired and unfit to start your day, ask your doctor for some sleep medication to reset your cycle back to normal.

Fatigue

While fatigue is a physical symptom, it feels as though it controls your psychological state as well. During chemotherapy, it can come from low red blood cell counts, causing anemia, or it may be an effect of the treatment on your physical state. Fatigue makes it difficult to get motivated, rouse positive emotions, or undertake physical activities. Some of the high-dose chemotherapy regimens produce profound fatigue, so that for a time, all you can do is simply sit or lie in bed. It may be time to “go with the flow” and get as much rest as you need. Try to remember that the fatigue is a side effect and will go away when the treatment is over. However, it can persist for weeks to months.

Psychological side effects of radiation

Radiation has been used as a treatment for cancer since the early 1900s, soon after its discovery. However, for many years the dose was difficult to control. Only much later on did it become possible to carefully control the dose, so that we could obtain its curative power without intolerable, damaging side effects. For example, cancer of the cervix, larynx, and several other sites can now sometimes be cured by radiation alone. However, most older people remember that when radiation was recommended in earlier days, it meant that the cancer was not curable and it was palliative treatment (meaning its aim was to delay the growth of the tumor rather than destroy it completely). Almost everybody knows about the radiation damage to people at Hiroshima and Chernobyl, so that the destructive side of radiation is fresh in our memories. Being told that you need radiation treatment for your cancer may arouse these fears: that your cancer cannot be cured or that you might be left with very bad radiation sickness. These are fears based on myths that simply don’t apply today; your doctor can explain reality to you.

Phobias and enclosed spaces

Deborah, a forty-year-old broker who had cancer of the tongue, had a fear of being in enclosed spaces. This was a long-existing phobia that didn’t usually bother her because she avoided situations that provoked the fear. The radiation treatment required that she be fitted into a mold that was made for her head and shoulders to ensure that she was positioned exactly the same during each treatment. The beam came from a large source lowered from above her. Each time, she required an anti-anxiety drug before the treatment to control her terror of the machine and the restriction on her motion. A series of frightening thoughts would go through her mind each time she was in the room: The machine might fall on her; the dose might be too high; she might move and the treatment will go to the wrong part of her body. Reassurance, medication, and counseling all helped her to control an old phobia that had caused her little trouble until this new situation required her to face it.

Becoming fatigued

A prominent, almost universal symptom caused by radiation therapy is fatigue, similar to that caused by chemotherapy, although the exact cause of radiation fatigue is not known. The feeling is of lack of energy, inability to carry out your usual tasks, having less interest in your usual activities including sex, and not feeling rested or able to “shake it.” Although these symptoms are physical and may come from the radiation, they can also be symptoms of depression, to which you are vulnerable during radiation therapy. Tell your doctor your fatigue is severe and that the cause of it should be sorted out.
The fatigue can linger for weeks or months after the radiation is completed, so don’t be surprised if your energy doesn’t rebound quickly at the end of the treatments. High expectations of an immediate return of energy will only make the period more difficult.

Becoming depressed

Coming after the crises of diagnosis and possibly surgery, the daily routine of going for radiation treatment and seeing others who are ill makes you feel the reality more keenly. Don’t be surprised if you begin to feel sad as you respond to all that has happened to you. Do ask for help if you need it.

Effects of radiation to specific sites

Radiation over the mouth, neck, or chest is apt to affect your swallowing and eating. Loss of appetite and nausea are common, as is a change in the taste of foods, especially if the radiation is over the mouth or throat. Radiation to the chest can affect the esophagus, with discomfort and pain on eating.
Radiation to the brain causes hair loss, which is often permanent. It may be necessary to get a wig (which is better purchased before the hair loss occurs). You may have a period of poorer concentration while you are receiving radiation to the brain, but your concentration will improve after the treatment ends. In some cases, mild memory problems may persist, such as trouble remembering names. Should this occur, find out if your local hospital or cancer center has a memory-retraining program, which can help you compensate for and cope with this problem. Radiation appears to have remarkably little impact on mood and emotions. However, the steroid drug dexamethasone (Decadron) is often given at the same time, and it can cause mood changes and irritability.

Clinical trials

The best way to prove that a new cancer treatment works and is superior to others is by studying it in clinical trials. Trials are carried out by developing a research protocol in which the therapy is given at a specific dose on a defined schedule to people who have the same stage and type of cancer. Repeated observations are required and specified. The effects on tumor growth can then be determined. It is important that you know something about the why, what, and how of clinical trials, since there are many misunderstandings about them.
First, all clinical trials are under federal regulation, which mandates who is qualified to conduct the studies and requires that each hospital have its own institutional review board (IRB), responsible to the federal oversight agency, to review and monitor every research study being conducted by its staff. The IRB examines the expected benefits of each trial and evaluates the evidence that potential benefits outweigh the risks to the patients. Patients who agree to participate in clinical trials must be informed about all of the risks and benefits, be told about other treatment options available to them, and be told that their care will not be jeopardized if they choose not to participate in the trial.
The federal guidelines for conduct of research on human subjects are derived from the post-World War II Nuremberg trials, which revealed evidence of terrible abuse of people who were made the subjects of unethical experiments by Nazi physicians. The resulting outcry after the trials led to the extensive rules we have today to protect any person who is treated in a clinical trial.
Clinical trials are divided into Phases I, II, and III, each with a different goal. These phases guide how a new drug or method of treatment is identified, tested, and finally approved for general use.
Phase I trials are designed to test a new drug or combination of drugs in humans for the first time and to determine a tolerable dose of the drug for patients in terms of toxicity. Phase I is the most experimental phase, and these trials are open only to patients whose tumors have not responded to standards treatments available. The number of patients studied in a Phase I trial is relatively small, rarely more than twenty. Patients in Phase I trials understand that the drug has been tried only animals and that a standard dose has not been established in humans. Indeed, their informed consent document states this fact and also that the purpose of the clinical trial is to determine such a dose. Both patient and doctor hope the drug will be active, however, and that the patient will be in the first group to benefit.
Phase II trials constitute the second level of testing of a new drug or combination of drugs that have undergone testing in a Phase I trial, during which the safe dose was determined. Phase II trials are also small, usually composed of about fifteen to forty-five patients. These patients are studied carefully to determine whether a particular tumor type responds to the drug at the dose and schedule established in the Phase I study. Patients are studied before and after receiving the treatment to assess the size of the tumor and clinical benefit. A complete response (CR) means all signs of the tumor have disappeared, and a partial response (PR) means that the sum of all the diameters of all the tumors has decreased by half. Phase II trials often test a new drug or combination of drugs in several different types of tumors. For example, gemcitabine (Gemzar) was first shown to be effective in pancreatic cancer. It was tested in other Phase II trials and found valuable in the treatment of other tumors as well.
Patients who choose to participate in Phase II trials understand that standard, available treatments may not be effective against their tumors and that, while there is no assurance of benefit as a result of the new treatment, there is hope that the drug will be effective for them.
Phase III trials study drugs that have proved to be effective treatments in Phase II trials and that appear to be as good as or better than standard treatments for a particular tumor. A Phase III trial is termed a randomized controlled trial. Patients are assigned to either the standard treatment or the new one by a chance mechanism, hence the term randomized.
Patients participate knowing that they will receive either the best standard treatment or the experimental one, which may be better. They cannot choose, however. No placebo or sugar pill treatments are used; the best standard treatment is compared with the new one. Several hundred patients are recruited for Phase III studies, which are often conducted by large cooperative clinical trials groups directed by the National Cancer Institute. Patients are matched as nearly as possible for any other factor that might affect response or survival, like level of physical performance, age, menopausal status, or prior treatment. The size of the study groups for Treatment A and Treatment B is determined by statisticians on the basis of the size of any expected difference. If the investigators think a new treatment would be of interest only if it could double the response rate, or double the survival rate, they will take fewer patients than if they are willing to settle for a treatment that will improve these parameters by only 25 percent. The outcome of this large study is then presented to the Food and Drug Administration. If the new treatment turns out to be more effective than the standard one, the results are announced to doctors, who then can use it as first-line therapy.
To be sure that the two groups are nearly identical and that there is no bias in choosing which patients go into either group, participants must agree to be assigned randomly to receive either the experimental treatment or the standard treatment. Which group you go into is determined by a centralized computer that your doctor doesn’t control. The reason for this randomization is the notion that doctors or patients might be biased if they were allowed to select the treatment the patient will get. It is critical that the determination of groups be unbiased. This is sometimes a sticking point for patients, and may be for doctors, but is the only way to determine when a new treatment is truly better. It is crucial to remember that you will receive either the current best treatment for a tumor or one that may be even better. No investigator plans to study a treatment regimen that he or she thinks is less effective than the standard.
As difficult as these trials seem, they are essential for improving the treatment of cancer, which still falls far short of where everyone wants it to be. When you take part in a clinical trial, you are carefully monitored, your treatment options are fully explained, you get either the best treatment known or possibly a better one, and you contribute to improving treatment of future cancer patients.
Some people are afraid of clinical trials because they think they will be treated less well: “I’ll just be a guinea pig.” This is far from true since much preparation and review goes into the protocol plan, watching for side effects, and observing tumor response. In a study of children treated in clinical trials compared with those who were not, survival was better among the children treated in trials.
In many trials today, investigators also monitor the functioning of patients in the different areas of their lives, that is, the physical, psychological, social, work, and sexual domains. These data constitute what is called “health-related quality of life”, which yields scores that are then used to measure not only length of survival, but also the quality of that survival.
Others who are ill become upset when a particular clinical trial isn’t available to them because their medical status doesn’t exactly fit the criteria set out in the protocol. Some people are bitterly disappointed at not being able to take a new experimental treatment, especially people for whom standard treatment has failed and who are seeking treatment on Phase I and II protocols. It is hard to balance the demands of doing good science that gives solid answers versus the human needs of people who are seriously ill. At times, in exceptional situations, an IRB will give permission for a “compassionate exception,” so that a doctor can treat someone who does not meet the criteria for participation in the trial.
There are added psychological strains on both the physician who is at the same time a clinical investigator and a personal physician, and the patients, who are very aware of how much is riding on the outcome of the experimental treatment for themselves and others. The doctor and patient become partners not only in treatment, but in research. It is amazing the altruism of the many people who say, “Maybe it won’t help me, but I’m glad to be helping to find a better treatment for patients with cancer who will come after me.”
Without clinical trials, better treatments for cancer cannot be found. The human side of clinical research is as important as the human side of clinical care. Clinical trials require a high level of trust between the doctor and the patient and knowledge that improvement is possible, providing the basis for hope.
In summary, the main treatments for cancer-surgery, radiation, chemotherapy, and immunotherapy-have some common physical side effects and some common psychological side effects. Anxiety or depressed feelings sometimes arise from dealing with illness, but also arise from the treatments themselves. Thanks to psychological support through family, friends, clergy, and group and individual therapy, there are ways to help you tolerate the treatments. Medications to control sleeplessness, anxiety, mood swings, and poor concentration are available. Such drugs are not addictive when taken under supervision and can bring great relief from troublesome symptoms. Self-managed methods of relaxation and meditation are also effective. Use what suits you and your personality best. The important thing is: Don’t suffer in silence. There is help available if you ask for it. If participation in a clinical trial is offered to you as a possible treatment option, be sure to obtain full information by reading the materials given to you and talking with the physician. Becoming a partner in a clinical investigation is a helpful way of coping for many people.

http://oralcancerfoundation.org/emotional/treatments.htm

Diagnosis and uncertainty

Many peoples first experience with cancer begins quite simply with the discovery of a symptom or sign known to be a possible cancer indicator. A lump, a sore that has changed in appearance or hasn't healed properly, any persistent severe pain, the presence of unexplained blood, a sore throat or cough that persists -these are several of the most common signs. From this moment, the uncertainty of cancer begins. Could this symptom mean cancer, or can I assume it's nothing?
This moment, before the doctor has even been called or a single test has been done, often transforms a person's life from one of general well being and confidence, to one of enormous anxiety and uncertainty about the future. This pervasive sense of uncertainty probably characterizes the journey with cancer more than anything else. It often lessens when things are going well, but it is a feeling that never completely goes away. This seems to be what people mean when they say, "The diagnosis completely changed my life." That wonderful sense of certainty and expectation of continued life and health, a kind of denial that the bubble can ever burst, which we all start out with, is destroyed forever. Learning to live with uncertainty becomes the bottom line in dealing with cancer.
Many people who notice a "suspicious" symptom have encountered cancer before through the illness of a loved one, such as a parent or grandparent. If a symptom suggests that you might have the same type of cancer as your loved one had, you may become terrified. Fear that you might go through the same vividly recalled cancer experience as someone close to you did, can be overwhelming. In such cases, a person may be too frightened to go to a doctor. A sense of hopelessness (if it's cancer, nothing can be done) or a feeling of panic can paralyze your ability to act. This can be the case for some who have seen family or friends with cancer. They can fear it so much, that they delay being treated, sometimes for something that isn't even cancer.
Others have not had such personal experiences, but have seen cancer statistics in the media and are extremely afraid of "learning the worst." They delay going to the doctor, even though most warning signs turn out to not be cancer. These feelings of fear, leading to the ostrich syndrome, wanting to put your head in the sand and thinking that the problem will just go away, can be both dangerous and foolhardy if the problem turns out to be cancer. As most people now know, a cancer diagnosed in the early stages is usually curable. So it is far better to overcome the fear or denial and see a doctor. The relief that follows finding out that it was nothing important allows life to get back to normal, and the fears can be laid to rest. If the problem does turn out to be cancer, you will get a head start on the treatment and improve your chances of cure.
If you are putting off checking out a suspicious symptom because of anxiety, it best to call your physician rather than letting your anxious feelings keep you from going through appropriate tests. Also, let your doctor know that you're having a lot of anxiety about what is happening, and that you may need help to control the fears, especially if difficult tests like scans or sonograms, are ordered. If you have been troubled with anxiety in the past, or if you have feared cancer, it may be wise to ask your doctor for a referral to a mental health professional to help you get through the tests and procedures. The same advice holds for friends or loved ones who have these problems; you can play a pivotal role in ensuring they get help.
Before you go to the doctor, you may wish to make some notes to take with you so that you can give an accurate account of your symptom. You may also wish to have a family member or close friend accompany you, since it is sometimes hard to remember things when you feel nervous. Also, it is important to have family involved in the decision making process, and this way they will have all the information to do so.
Once you have seen the doctor and had an examination, and the tests have been ordered such as biopsy or scans, your thoughts may alternate between "It's probably nothing" and "I know it's the worst." Feelings of optimism and despair change from hour to hour. This is part of the response to the possibility of hearing bad news: anticipating what you may feel should it be cancer. For most people this is one of the most difficult times for them-waiting to hear the news.

Most tests today, including bone scans and sonograms, are generally performed on an outpatient basis rather than in the hospital, so it is good to take someone along to help you get home. You may not feel up to par if you're drowsy from medication that was given with the procedure.
The diagnostic tests themselves may be difficult to tolerate if you have phobias-intense and overwhelming fears-of doctors, hospitals, needles, seeing blood, or claustrophobia during an MRI.




If you have high anxiety or strong fears about any of the diagnostic procedures, your doctor may prescribe an anti-anxiety drug to help you through the process. It is important that you discuss your emotional state with him as well as your physical situation.
If you have had fears of being confined in a small space (claustrophobia), you may find magnetic resonance imaging (MRI) to be frightening. This scan requires being placed in a small cylinder surrounded by a large, noisy machine. About 20 percent of people find it hard to tolerate, and about 5 percent are unable to go through with it. There are ways to make it easier today, such as listening to music or relaxation tapes or taking a medication to reduce your anxiety during the procedure. Tapes with instructions for relaxation, guided imagery, and medication can be listened to ahead of time to help you become calmer. When you have an intense fear or phobia, it may seem so overwhelming that you cannot imagine overcoming it. But your doctor or a mental health professional can help you to relieve the fear to the point that you can get the medical tests you need.
The workup is important to determine the medical situation and to help you decide on a treatment course; therefore, any fears or phobias standing in the way must be looked into. Let your doctor know that you're frightened, that this fear has troubled you in the past; you can receive mediation to be less anxious. Later, ask for a referral to a mental health professional to treat the phobia, so that you can get through future tests more easily.

The diagnosis

Many people describe the period of waiting between hearing the diagnosis-the dreaded words "You have cancer"-and the start of their treatment as the worst time in their illness. The anxiety begins to peak when the bad news is given, but there isn't as yet any plan in place to move ahead and fight it. It is difficult to tolerate the feeling that there are cancer cells in your body and nothing is being done to destroy them. The unspoken fear that "I might die" may seem more overwhelming when you are not yet receiving treatment.
This generalized anxiety can be compounded by worries about particular treatments. People worry about chemotherapy, for example, because they carry visions of chemotherapy as it was given twenty years ago, before drugs were available to control nausea and vomiting and other troublesome side effects.
Cornelius Ryan, famed reporter of the American forces' invasion of Europe in World War II, kept a diary of the time surrounding his diagnosis of prostate cancer in 1970. Ryan who wrote the best-seller The Longest Day, dictated tapes that were his secret way of coping with the shock and the meaning of the diagnosis. He described in a masterly manner some of the emotions so many people feel.
The diagnosis changes everything . . . Now cancer will be my closest possession, going with me from the office to house to conferences and dinner parties, as I go myself. I have got to get used to having it always here. I have got to think of what influence it may assume in time, not only over me, but on my family, friends and work . . . What comes to mind immediately is how fast cancer alienates one from the usual routines and behavior . . . It is odd that apart from a slight aching of the prostate . . . there is no pain, no dramatic change caused by this malignancy except in my mind. Does this cancer really exist? Did some harassed technician mix my slides with those of some other poor bastard? I am grasping at straws. I suspect it is not uncommon in the first few hours. There is simply no way to maintain a precise progression of thoughts and actions after such an emotional shock. My mind swings from disbelief to fatalism. I am vacillating between a surging belief that all will be well and a maudlin conviction that nothing will ever be right again . . .
Just now I thought of something that is probably the closest comparison to my present predicament I have ever experienced. During World War II, I found myself caught up in a patrol in a minefield. My reaction, and I remember it so well, had two distinct plateaus: how did I get myself into this situation? And, now, let's get out of it. Curiously, back then, I cannot remember experiencing fear. Neither do I recall any great surge of courage. I think my reaction was mechanical. There was no point in dwelling on the fact that we were in a minefield. The sole objective was to get through it safely-and somehow we did . . . Now, as in those wartime days, I don't know what steps will bring me through this grave ordeal, but I can't stay rooted to one spot forever . . . Without scientific knowledge to back me up, I would guess that the worst time emotionally is in the first few hours after you get the bad news.
Ryan says it all, in terms of those early responses to hearing the diagnosis. In other excerpts, he tells of his anger: "Why my body? Why now when I have so much to write?" Then he berates himself for his self-pity but retains his humor as a way of expressing the anger: "There's a mosquito in here buzzing around the desk. If it stings me, I hope the damn thing gets cancer."
Early in the work on this topic at Memorial Hospital, Dr. Massie and Dr. Holland tried to understand these first responses to a cancer diagnosis. People were responding in the same way that people do when faced with other kinds of catastrophic news, the death of someone close, a natural disaster such as an earthquake, or a personal catastrophic like the loss of a limb-that profoundly affect life and the future. They began to see a general pattern to hearing the bad news. There is an initial response of denial and disbelief. "This can't be true! It's a mistake. I'm sure the slides sent to pathology were mixed up or the doctor confused my tests with somebody else's. It simply can't be happening to me." Ryan said it by suggesting that a harassed technician reversed the slides. This couldn't be happening to me" - All this is probably the psyche's protective device to provide a little time and space to let the information "sink in", so that the person does not feel instantly overwhelmed.
The second stage is called the turmoil phase. The truth can't be denied; it is cancer. You begin to confront the reality more directly. This often creates a period of restlessness; fearfulness which is hard to control; and preoccupation with the diagnosis and its implications. There is a sense of helplessness (What can I do?) and hopelessness (I can't find a way out), alternating with a sense of vague calm (Everything will be okay). Sleep and eating may become erratic, and concentration on work routine activities becomes impossible. You may repetitively go over all the fears that the word cancer conjures up: possible death with much pain, becoming disabled, perhaps needing surgery that will drastically change your body function or appearance, becoming dependent on others, losing the sense of acceptance from your family and friends, and then the terror of final abandonment. We know that these fears are exaggerated far beyond the actual likelihood of their happening. Still, they are powerful, as described so well by Ryan in his tapes. This stage often lasts a week or two, usually ending when you begin treatment and regain a sense of hope.It is important to realize that this turmoil is a common, normal response to the threat to your life. You are not "going crazy." It is unfortunate that important decisions about treatment must be made during this time of high distress when thinking clearly is apt to be most difficult.

Today, many people seek several opinions about what the best treatment might be, and the opinions are often different.   Jack Price felt about his melanoma treatment that "surgeons are selling surgery; radiotherapists are selling radiation treatment . . . You know, it seems like the old saying that when you have a hammer in your hand, everything you see is a nail!"
Deciding whom to trust and with whom to cast your lot depends first on the treatment making sense to you, but also on finding a doctor you feel you can trust and who seems to have your best interests at heart. Ideally, your doctor should work in a multidisciplinary hospital that has the necessary equipment and highly qualified staff to provide expert care perhaps involving several different treatment types, such as surgery and radiation. They should be capable of handling whatever complications may arise, as occasionally they do. It's good during this tough, stressful period to take on day at a time, make one decision at a time, and keep a clear head and calm mind. Because of the difficulty in processing information when highly stressed, you may wish to have a relative or close friend help you gather information, meet your doctor, and help you weigh your options. But remember that the final decision-making is yours, it is your life and well being that is at stake.
A decision also has to be made quickly regarding whom you wish to tell about your diagnosis, both in the family and outside. For some people, maintaining the aura of health is important for the financial or psychological well being of others. They may find it difficult to make their illness public. Some of us recall the watershed events that led to drastic changes in social attitudes about cancer in the United States when Betty Ford, then the First Lady, made public her breast cancer and its treatment. Happy Rockefeller, Nelson Rockefeller's wife, did the same. It was suddenly okay to say you have cancer and to reveal the extent of it. They both announced that they had positive nodes under the arm and would receive chemotherapy. A great deal of stigma surrounding cancer, specifically breast cancer, was lifted. Today, an honest and open approach that reveals the diagnosis leads to the best opportunity for receiving the helpful support of others, although this attitude may be modified by personal style or circumstances.
The third stage of adjustment to the diagnosis usually comes when treatment begins, with the relief that comes from doing something about it. People usually feel reassured and become more optimistic as the treatment starts and they begin to work actively to combat the cancer and to return to their normal life. This is when we see the emergence of the many different ways people handle life's adversities. We enter into the realm of coping with disease and the broad range of coping styles developed by people on their own, honed by years of their own life experiences.
Most studies, when you sum them up, suggest that what works best is dealing head-on with the issues of illness and treatment, seeing them as problems to be solved. This mind-set encompasses people who want to do extensive research to find the right doctor and treatment, as well as those who are content to move forward without getting more opinions, wishing to get on with the treatment as soon as possible. What we know doesn't work well, as mentioned earlier, is the ostrich syndrome: passively refusing to deal with the diagnosis realistically.
Surely, there are as many ways of coping as there are people, but the key is to be certain that the diagnosis doesn't paralyze you into inaction and the inability to seek treatment. Finding a doctor with whom you can talk comfortably and honestly and work with as a partner, is a key to success. When you connect with such a doctor, the two of you become a team; coping becomes easier because you have someone who will face the fears with you.

http://oralcancerfoundation.org/emotional/diagnosis.htm

Pancreatic carcinoma

Pancreatic carcinoma is cancer of the pancreas.

Causes

The pancreas is a large organ located behind the stomach. It makes and releases enzymes into the intestines that help the body absorb foods, especially fats.

Hormones called insulin and glucagon, which help your body control blood sugar levels, are made in special cells in the pancreas called islet cells. Tumors can also occur in these cells, but they are called islet cell tumors.

The exact cause of pancreatic cancer is unknown. It is more common in:

    - People with diabetes
    - People with long-term inflammation of the pancreas (chronic pancreatitis)
    - Smokers

Pancreatic cancer is slightly more common in women than in men. The risk increases with age.

A small number of cases are related to genetic syndromes that are passed down through families.

Symptoms 

A tumor or cancer in the pancreas may grow without any symptoms at first. This means pancreatic cancer is often advanced when it is first found.

Early symptoms of pancreatic cancer include:

    - Dark urine and clay-colored stools
    - Fatigue and weakness
    - Jaundice (a yellow color in the skin, mucus membranes, or eyes)
    - Loss of appetite and weight loss
    - Nausea and vomiting
    - Pain or discomfort in the upper part of the belly or abdomen


Other possible symptoms are:

    - Back pain
    - Blood clots
    - Diarrhea
    - Indigestion

Exams and Tests

    - CT scan of the abdomen
    - Endoscopic retrograde cholangiopancreatography (ERCP)
    - Endoscopic ultrasound
    - MRI of the abdomen
    - Pancreatic biopsy

This disease may also affect the results of the following tests:

    - Complete blood count (CBC)
    - Liver function tests
    - Serum bilirubin

 Treatment

Because pancreatic cancer is often advanced when it is first found, very few pancreatic tumors can be removed by surgery. The standard surgical procedure is called a pancreaticoduodenectomy (Whipple procedure).

This surgery should be done at centers that perform the procedure often. Some studies suggest that surgery is best performed at hospitals that do more than five of these surgeries per year.

When the tumor has not spread out of the pancreas but cannot be removed, radiation therapy and chemotherapy together may be recommended.

When the tumor has spread (metastasized) to other organs such as the liver, chemotherapy alone is usually used. The standard chemotherapy drug is gemcitabine, but other drugs may be used. Gemcitabine can help about 25% of patients.

Patients whose tumor cannot be totally removed, but who have a blockage of the tubes that transport bile (biliary obstruction) must have that blockage relieved. There are two approaches:

    - Surgery
    - Placement of a tiny metal tube (biliary stent) during ERCP

Managing pain and other symptoms is an important part of treating advanced pancreatic cancer. Palliative care tams and hospice can help with pain and symptom management, and provide psychological support for patients and their families during the illness.