Читать книгу The Cancer Directory - Dr. Daniel Rosy - Страница 68

To get the information you want, you need to ask the right questions. Knowing what these questions are is difficult unless you have a basic understanding of cancer as a disease. A full explanation of cancer and its treatment is given in Chapter 4 for those who desire the full details. In essence, the information you need in order to ask the right questions is as follows:

• There are as many different types of cancer as there are types of cells in the body. Cancer arises from a single cell in which genetic material has been damaged. The damage allows the cell to replicate and spread out of control. As these ‘wild’ cells continue to grow, a lump or tumour is formed – this is known as a primary cancer. If the cell that started to grow out of control originated from breast tissue, this will be a breast cancer; if it was a bone cell, it will be a bone cancer, and so on.

• As the tumour grows, it may begin to invade the local blood and lymphatic vessels. At this point, cells may break off from the main tumour and travel to nearby lymph nodes, which may also become swollen because of the cancerous tissue that starts to grow in them. From there, the cancer may travel even further afield through the bloodstream or lymphatic vessels to distant sites in the body. There are certain preferred sites where these cells will become lodged, leading to a possible secondary cancer, or metastases, to start growing – for example, breast cancer secondaries can show up in the bones, lungs, liver or brain.

When a doctor is initially assessing the cancer, he will try to establish:

• the histology or type of the tumour – the cell type of origin of the cancer

• the grade or degree of aggressiveness of the tumour

• the stage of the disease – whether the tumour is still at its primary site or whether it has spread locally from the tissue of origin to nearby lymph nodes or even further afield to form secondaries or metastases

• whether there are any special markers (such as blood tests) by which its progress can be measured, or unique characteristics, such as being hormone-positive.

For most tumours, stage one means there is a primary only; stage two means the primary has begun to invade the blood vessels locally; stage three means that the tumour has spread to nearby lymph nodes; and stage four means that it has metastasized throughout the body. These stagings will differ somewhat from one type of cancer to another.

To diagnose and grade the tumour, the specialist will take a sample of the tumour tissue, usually by taking a biopsy. The tissue sample is then studied under the microscope to determine just how aggressive the cells are, and the results will appear on a histology, pathology or histopathology report. Cancer cells are described as well differentiated if they still closely resemble the cell of origin – in other words, a well-differentiated cancer of the breast will contain cells easily recognized as having originally arisen from breast tissue. Because the cells are also still similar in nature to normal breast tissue cells, the tumour would also be described as slow-growing and low-grade.

At the other extreme, the tumour cells may be barely recognizable as breast tissue cells because they had become ‘wild’. Such cells would then be described as poorly differentiated, and the tumour as fast-growing or aggressive and high-grade. Again, the grading system varies with different types of cancer, but most tumours will be graded on a scale of one to four.

Staging the tumour means having further screening tests done after a positive biopsy. These may be blood tests, X-rays and/or ultrasound, CT (computed tomography) or MRI (magnetic resonance imaging) scans of the parts of the body to which the cancer may have spread. How much you wish to know will also affect how much screening you allow your doctors to do. Some consultants, on discovering a primary tumour, will leave no stone unturned in looking for possible secondaries. Other consultants take a much more passive view, waiting until there are symptoms before looking for the presence of metastases.

Generally speaking, there is not much point in undergoing extensive screening unless it will potentially change the treatment being offered. For example, if the chemotherapy for a primary cancer is the same as for a similar cancer that has already spread, your consultant may not think it necessary to carry out widescale screening. But you may wish to know if there are secondaries, as this may significantly change your approach to the cancer and your life choices. So, you will need to be clear with your doctor as to just how far you want him to go with this process and how much information you wish to be given.

To get a clear picture of what you are dealing with, you need to find out:

• the type of cancer you have or its histology

• the stage of the cancer or how far it has spread

• the grade of the tumour or how aggressive it is

• the markers of your tumour by which the effectiveness of treatment or progress of the disease can be measured

• if the tumour is hormone-positive.

Once you have this information, you will then be armed, if you so choose, to go away and read about the cancer you have and discover the possible treatment options for your cancer type, stage and grade.

The exception is in the case of tumours of the blood cells. These are the leukaemias, in which there is no solid tumour because the cell that has grown out of control is one of the various types of white blood cells. The way this sort of tumour is diagnosed is by performing blood counts or looking at bone marrow. These tests might reveal that one cell type is growing very fast at the expense of other blood cells, the levels of which may be lower than normal. With leukaemias, classification is in terms of whether the illness is chronic (slow-growing) or acute (fast-growing).

Depending on how much information you wish to be given, you might ask your doctor for answers to some or all of the following questions:

IF YOU DO NOT WANT TO KNOW THE ANSWERS TO THESE QUESTIONS, TELL THE CONSULTANT AND GP WHAT YOU DO and DO NOT WANT TO KNOW.

• What type of primary cancer do I have (or what is the histology of the tumour)?

• How large is the primary site?

• Has it spread to the lymph nodes draining the site from which it has arisen?

• Has it spread elsewhere in the body, and what is its stage (1, 2, 3 or 4) (or how far has the tumour spread)?

• What is the ‘grade’ or degree of aggressiveness of the tumour?

• Are there other prognostic indications from the pathologist?

• Is the cancer hormone-receptor-positive? If so, to what hormones is the tumour sensitive?

• Are there any blood markers by which the growth or shrinkage of the tumour can be measured?

• To which parts of my body might this type of tumour spread?

• Would it be advisable for me to be screened thoroughly for secondary cancer?

• If secondary cancers were found on screening, how would this affect the choice of treatment I am being offered?

• In the case of leukaemia, is it acute or chronic?

• Left untreated, what is the usual course of events with this type of cancer?

• What is the prognosis (or average survival time) with this cancer if medically treated?