Читать книгу Cancer is a Word, Not a Sentence - Miriam Stoppard - Страница 11

Although there are literally hundreds of symptoms and tests that may eventually lead to a diagnosis of a cancer, for practical purposes we can divide the situations into three broad categories. This way of thinking about the process of diagnosis may actually make it easier for you to keep track of where you are at the moment, and what your future options are, as you move along what may feel like a very convoluted and slippery path.

In broad terms, then, the main routes to a diagnosis of a cancer are: First, diagnosis from a test investigating a symptom or problem [or several symptoms or problems] that you have been experiencing. A symptom is something you notice yourself, such as a lump in your breast, or chest pain, or blood in your sputum or on your stool. You go to your doctor, who orders a test, or several tests.

If, in your case, a test has led to a biopsy—taking a piece or specimen of tissue—then you’ll probably want to go straight to page 24, which explains what a biopsy tells us.

If you’ve had a test or tests, but haven’t yet had a biopsy, then you may want to go to page 27, which will discuss the different degrees of certainty and suspicion that nearly all tests will yield.

Second, diagnosis via a screening test that yields an abnormal result. Screening tests are, by definition, tests done on people who do not have any symptoms or problems related to the disease for which they’re being tested. Tests that are used in this way—for screening of people without symptoms—include mammograms, smear tests, colonoscopies and prostrate-specific-anitgen [PSA] blood tests. The whole idea of a screening test is to detect the condition—and some cancers are good examples of this—at an early stage when treatment may have a better effect than if it is given later when symptoms have developed.

For example, all women who have ever been sexually active should have a regular smear test, everybody over the age of sixty should have a rectal examination and if necessary a colonoscopy, and women should have annual mammograms starting at age fifty. These tests, which have been studied and researched, increase the chance of a cancer being detected at an early stage before it causes symptoms. In these particular cancers, and in some others, the studies show that by detecting the cancers at earlier stages, treatment results are improved and some lives are saved.

That is the idea, and it works extremely well in many medical conditions, including quite a few cancers. But there are some problems with every screening test, and it is worth going over them here because you might, at this moment, be hovering near the phone, worrying about the results of a screening test. Or you might have been told that a screening test result is abnormal or uncertain, and you might wonder why screening tests are ever done in the first place if the results don’t tell you whether you’ve got a cancer or not.

Most of the time screening tests give clear and dependable results. But sometimes the results may be unclear or worrying. So let’s go back and explain why.

Here’s the bottom line: all screening tests sometimes yield unclear results (the correct term is equivocal) because there are virtually no tests that have an infallible 100 per cent success and reliability record. All biological populations vary. There is a range of every aspect of human life—a range of heights, of intelligence, of athletic prowess and so on. This goes for most diseases too: there are very many situations in which one cannot be certain whether a particular result is normal or abnormal.

As well as test results sometimes being equivocal, they can also sometimes be wrong—telling you that there is a disease when there isn’t, or telling you that there isn’t a disease when there is. This means that with every screening test, some people may be very disappointed that there is not a clear result, some may be unduly alarmed, and a few may be falsely reassured. Unpleasant, but inevitable. At present, we don’t have the technology to eradicate those uncertain and unsettling results even though there are very few of them.

Third, diagnosis as an incidental finding during a procedure for something else. It sometimes happens, and it is not all that rare, that a procedure is carried out for a purpose not related to a cancer (or even the suspicion of a cancer) but during the procedure a cancer is found. You may be having a hysterectomy for fibroids, for example, when evidence of a cancer is found.

If this happened to you—an unexpected incidental finding during a procedure for something else—then psychologically it is very tough indeed (as you may be feeling right now).

But take heart. It is usually a good thing if a cancer is discovered as an incidental finding. Generally speaking, cancers that do not cause you any problems or symptoms usually have a somewhat better prognosis than those that call attention to themselves by producing symptoms or problems.

However, the lack of symptoms often makes the intellectual shock worse. Almost every patient to whom this happens says, ‘But I was feeling so well’. And they mean it. If you are feeling unwell, you may be prepared psychologically for a diagnosis of something potentially serious. But if you have no problems, much less a suspicion of a cancer, the shock is often much greater.

The secret to coping with that shock—in line with the central message of this book—is to get informed. It’s worth spending a little time trying to get an overview of your cancer. As I pointed out earlier, a few cancers pose an immediate (and sometimes serious) threat to you, but most cancers do not. So it’s really important that you try to get a handle on what has been discovered in your case. That information will greatly help you in marshalling your own coping strategies. So, even though a diagnosis out of the blue may well knock you sharply off balance, you can help yourself steadily to regain that balance by finding out what kind of a problem you are now dealing with.