Cancer

Cancer

How You Can Help Yourself

When a woman is told she has cancer, a lot of questions zip through her mind: "Am I going to die?" "Will surgery disfigure me?" "Will my husband think I'm less of a woman?" "What am I going to tell my friends and family?" "How are we going to pay the bills?" "Does this mean I won't be able to have more children?"

Cancer is a particularly powerful ager. It's a heartless disease that can cause debilitating pain and suck youth and vigor out of any one of us.

The disease can actually accelerate the aging process by causing chemical changes in the body that lead to painful joints, dulled appetite, weight loss, weakness, fatigue and loss of stamina, says Ernest Rosenbaum, M.D., an oncologist at the University of California, San Francisco/Mount Zion.

"Cancer drains you. If you have cancer, you can feel aged and older very quickly," says Charles B. Simone, M.D., an oncologist in Princeton, New Jersey, and author of Cancer and Nutrition.

The Truth about Cancer

Cancer is life-threatening because its abnormal cells grow uncontrollably, can spread throughout the body and can damage surrounding normal cells, says John Laszlo, M.D., national vice president for research at the American Cancer Society. It is actually not one disease but an array of more than 100 kinds of malignancy that attack different organs of the body in a variety of ways. So lung cancer, for example, may spread to other tissues in a slightly different way than breast cancer.

"There's this perception that cancer is a single entity and that we're going to find some magic pill that will totally prevent the disease or will be the ultimate cure for all forms of cancer. Unfortunately, cancer is more complicated than that," says Ronald Ross, M.D., director of cancer cause and prevention research at the University of Southern California Kenneth Norris, Jr., Comprehensive Cancer Center in Los Angeles.

Researchers suspect that 5 to 10 percent of cancers may be inherited, meaning that the disease is passed on from one generation to another through an abnormal gene. But in the vast majority of cases, cancer develops through a complex series of steps that often includes prolonged exposure to carcinogens, which are cancer-causing substances such as tobacco and asbestos, Dr. Laszlo says. These carcinogens usually affect cells in specific organs. Asbestos, for example, increases a person's risk of lung cancer, while excessive sun exposure is linked to increased risk of skin cancer.

Some researchers believe that carcinogens cause the formation of free radicals, unstable oxygen molecules that can damage the string of DNA molecules that tell cells how to reproduce. Once the DNA is damaged in critical places, a cancer cell may form.

"The free radicals that cause aging are the same things that cause cancer," Dr. Simone explains. "How do we prevent that? We need to decrease our exposure to the things that cause free radicals, including fatty foods, tobacco and alcohol."

Each year, about 576,000 new cases of cancer are diagnosed among American women, according to the American Cancer Society. The most common types of cancer in females are found in the breast, colon and rectum, lungs, uterus, lymph tissue and ovaries. In women who are under age 35, cancers of the breast and skin and lymphomas such as Hodgkin's disease are the three most prevalent.

Cancer kills about 255,000 women annually and is the second leading cause of death for Americans of all ages. By the year 2000, cancer is expected to affect two in every five Americans and will surpass heart disease as the nation's leading killer, Dr. Simone says.

But having cancer isn't an automatic death sentence. In fact, more than half of all Americans diagnosed with cancer survive it, according to the American Cancer Society. If detected early, some types of cancer, such as those of the skin and breast, have five-year survival rates topping 90 percent. If a patient appears free of cancer symptoms for five years, doctors may consider her "cured," although some cancers may relapse after ten or more years.

"We've made slow, steady progress against cancer in the past 50 years. Step by step, we're winning this war," says Harmon Eyre, M.D., the American Cancer Society's deputy executive vice president for research and medical affairs.

Most cancers occur in women older than age 50, and 66 percent of cancer deaths occur after 65. In fact, of the 182,000 cases of breast cancer--the most common cancer among women--diagnosed annually, less than 11,000 are among women under 40.

"For the most part, the young don't have to fear cancer. It's something that lurks in the distant future, sometimes up to 30 or 40 years away," says Carl Mansfield, M.D., professor and chairman of the Department of Radiation Oncology and Nuclear Medicine at Thomas Jefferson University Hospital in Philadelphia.

What You Can Do

Some cancers, however, can take more than 30 years to develop. So what you do now can have a tremendous impact on your ability to have a long, healthy and cancer-free life, Dr. Lazlo says. In fact, oncologists estimate that perhaps 50 percent of cancers could be prevented if women made just a few simple adjustments in their lifestyles. Here's where to start.

Become an ex-smoker. Lung cancer was a rare disease before cigarette smoking became popular. Now it kills about 59,000 women annually and has surpassed breast cancer as the number-one cause of cancer-related deaths in women, says Dennis Ahnen, M.D., associate director for cancer prevention and control at the University of Colorado Cancer Center in Denver. (Breast cancer, however, is still the most common type of cancer women get.) Smokers are ten times more likely to develop lung cancer, and up to 30 percent of all cancer deaths are caused by smoking, says Dr. Rosenbaum, author of You Can Prevent Cancer. Studies also suggest that women who smoke are twice as likely to get cervical cancer. So if you don't smoke, don't start, and if you smoke, quit.

Watch out for passive smoke. Up to 8,000 lung cancer deaths a year among nonsmokers can be attributed to secondhand smoke, Dr. Simone says. Researchers at the University of California, Berkeley/University of California, San Francisco Preventive Medicine Residency Program found that restaurant workers are exposed to twice as much passive smoke as people who live in households where at least one person smokes. Bartenders are exposed to 4½ times as much passive smoke. Compared with the general population, these food service workers were found to be 50 percent more likely to develop lung cancer, a difference attributable, at least in part, to passive smoking in the workplace. Avoid smoky bars and always ask to be seated in nonsmoking sections of restaurants, Dr. Simone suggests. If people in your household smoke, ask them to quit or establish an area where they can smoke without endangering you.

Go light on the booze. Heavy alcohol consumption increases your risk for cancers of the liver, mouth, esophagus and larynx. Studies attempting to link alcohol to breast cancer have had contradictory results, but it's best to be cautious, says Louise Brinton, Ph.D., chief of the Environmental Studies Section at the National Cancer Institute in Rockville, Maryland. Dr. Rosenbaum recommends that you limit yourself daily to no more than one 12-ounce beer, one 4-ounce glass of wine or 1 ounce of liquor in a cocktail or shot.

Fill up on fiber. Women who eat lots of fibrous fruits, vegetables and whole grains, such as broccoli, brussels sprouts, cabbage, apples, bananas, mangoes and whole-wheat cereals and breads, may have fewer breast, colon and rectal cancers than those who don't eat these foods, Dr. Simone says. Fiber reduces the amount of estrogen in the blood. Estrogen possibly alters cell structure and promotes breast cancer, Dr. Mansfield says. In addition, fiber helps speed stool through your body and reduce exposure of your digestive tract to carcinogens.

Fiber may also help prevent other cancers. In a study of 399 women with endometrial cancer and 296 disease-free women, Dr. Brinton found that women who ate more than two servings of high-fiber breads and cereals a day had 40 percent less risk of developing endometrial cancer.

The National Cancer Institute recommends that women eat at least 20 to 30 grams of fiber a day. If you start your day with a cereal that has at least 7 grams of fiber per serving, add another 3 grams of fiber by topping your cereal with one medium sliced banana and two tablespoons of raisins. Then you're halfway to the minimum daily recommendation of 20 grams, says Gladys Block, Ph.D., professor of public health nutrition at the University of California, Berkeley. Then all you need to do is make sure you get three more servings of fruits, vegetables and/or grains through the rest of the day. Beans, for example, are particularly high in fiber.

Go for vegetables. Eat at least five servings of fruits and vegetables a day, Dr. Rosenbaum says. These foods contain antioxidant vitamins and minerals such as beta-carotene, selenium and vitamins A and E that combat the formation of free radicals.

Take a supplement. Supplements containing vitamins C and E and other antioxidant vitamins and minerals can help neutralize certain carcinogens such as the nitrites found in bacon, sausage, hot dogs and cured meats, according to Kedar N. Prasad, Ph.D., director of the Center for Vitamins and Cancer Research at the University of Colorado Health Sciences Center in Denver and author of Vitamins in Cancer Prevention and Treatment. Supplements can also strengthen your body's immune system so that it can destroy newly formed cancer cells before they multiply, Dr. Prasad says. He suggests taking 15 milligrams of beta-carotene once a day, 2,500 IU of vitamin A twice a day, 500 milligrams of vitamin C twice a day, 200 milligrams (or 134 IU) of vitamin E twice a day and 50 micrograms of selenium twice a day.

Trim the fat. A high-fat diet, like many American women eat, is believed to trigger cancer. Researchers at the University of Hawaii at Manoa compared the fat consumption of 272 postmenopausal women who had breast cancer with that of 296 women who were cancer-free. The researchers found a significant association between breast cancer and eating sausage, processed cold cuts, beef and lamb. Doctors aren't certain why fat promotes tumors, but several factors could play a role, Dr. Mansfield says. Some suspect that fatty foods spark the production of bile acids that interact with bacteria in the colon to form carcinogens. It could also be that fat cells are more susceptible to carcinogens than other cells. Whatever the cause, many experts suggest slashing your dietary fat consumption to no more than 25 percent of calories. To do that, eat more fruits, vegetables and whole-grain foods, trim all visible fat from meats and eat no more than one three-ounce serving of red meat, fish or poultry a day.

Throw the deep fryer away. Frying simply adds more fat to food, and fat promotes cancer. Broil, steam, bake or boil your food instead, Dr. Mansfield says. Brown or sauté in nonstick pans, or use vegetable spray or chicken broth.

Go easy on the barbecue. The smoke and heat of charbroiling creates several cancer-causing substances, including nitrosamine, one of the most potent carcinogens known, Dr. Mansfield says. If you like to barbecue, do it carefully and sparingly, Dr. Prasad suggests. Place the grill as far above the coals as possible, and wrap aluminum foil around the grill to prevent fat from dripping onto the flame and causing excessive smoke and charring.

Lose weight. If you're overweight, you could be producing more estrogen than you need. Excessive amounts of estrogen, a reproductive hormone, are believed to alter cell structure and have been linked to increased risk of breast cancer, Dr. Mansfield says. Keep your weight within the range suggested by your gynecologist or family physician.

In one study, researchers at the Harvard School of Public Health concluded that women who remain physically active throughout their lives are 2½ times less susceptible to cervical and other cancers of the reproductive system. Try doing regular aerobic exercise such as swimming, walking or running for 20 minutes a day, at least three times a week, Dr. Simone says.

Stay in the shadows. Skin cancer, one of the most common cancers (it affects more than 700,000 Americans), is caused primarily by sunburn. To prevent skin cancer, avoid prolonged sun exposure, wear hats and long-sleeved blouses, and don't go bare-legged without using a sunblock that has a sun protection factor (SPF) of at least 15. You should apply sunblock to exposed skin when you're outdoors, says Dr. Rosenbaum.

Don't douche too often. Researchers at the Uniformed Services University of the Health Sciences in Bethesda, Maryland, found that the cervical cancer risk was four to five times higher in women who douched more than four times a month. Women who douched less had no increased risk. The type of douching liquid made little difference in risk. The researchers speculate that too-frequent cleansing may upset the normal chemical balance, diluting secretions or destroying friendly bacteria that may protect against viral invaders.

Practice safe sex. Human papillomavirus (HPV), a sexually transmitted disease, has been linked to precancerous changes in the cervix called dysplasia. Multiple sex partners and unprotected sex are the two major risk factors for HPV. Use condoms and maintain a mutually monogamous relationship, Dr. Rosenbaum suggests.

Check out your family tree. Although less than 10 percent of cancers have genetic roots, finding out if cancer runs in your family can help your doctor evaluate your risk and recommend ways to prevent the disease or detect it early, Dr. Rosenbaum says. Include as many relatives on both sides of your family as you can. If someone had cancer, jot down the age at which they were diagnosed and the organ in which it originated.

Screening Safeguards Your Health

Even if you eat right, don't smoke and don't have a family history of cancer, you can still get the disease. In fact, 75 percent of women who develop breast cancer have no known risk factors, says Charles Taylor, M.D., director of medical oncology in the Breast Cancer Program at the Arizona Cancer Center in Tucson. But the earlier cancer is detected, the more likely you can be cured.

That's why it's important for women to do monthly breast self-exams, to get their first mammograms between the ages of 35 and 40 and to have Pap smears at least every other year.

Here's the lowdown on the mammogram and Pap smear. (For more on the breast self-exam, see Breast Care, chapter 76.)

Mammograms: Catching Trouble Early On

A mammogram, an x-ray of the breast, detects lumps that can't be felt by either the patient or the physician, Dr. Taylor says. Here are a couple of tips that can make your mammogram more pleasant.

Be a pal. Arrange with a friend to remind each other to schedule and keep your mammogram appointments. Or better yet, go together, suggests Phyllis Kornguth, M.D., Ph.D., chief of breast imaging at Duke University Medical Center in Durham, North Carolina. Afterward, do lunch or go shopping--make it a special time to enjoy each other's company.

Take charge. Mammograms can be uncomfortable because in order to find small cancers, the breast must be compressed. But if you have control over the amount of pressure applied, you may find it more comfortable, Dr. Kornguth says. "In fact, studies show that women who compress their own breasts get just as good images with less pain," she adds. At your mammogram, ask "Would you mind if I operated the compression device?" You could also arrange for a verbal signal. Tell the technician "I'll say 'That's enough' when I want you to ease up on the pressure." Most technicians are willing to accommodate you.

Pap Smears: Checking Your Cells' Health

A Pap smear is a test to detect abnormal cells in and around the cervix, the narrow, doughnut-shaped opening to the uterus. Your doctor collects a sample of cells from the cervix and upper vagina with a wooden scraper, cotton swab or cervical brush and places the sample on a glass slide. The slide is sent to a medical laboratory for evaluation.

About 15 to 40 percent of Pap smears are reported normal when, in fact, cell abnormalities are present. Here are a few ways to improve the accuracy of your results.

Avoid sex. Abstain from sexual intercourse for at least 12 hours before a test because semen can interfere with test results.

Shoot for the midpoint. Schedule your Pap smear in the middle of your menstrual cycle. The exact timing isn't critical, but you should avoid the days of your menstrual period, since blood can obscure cells on the slide.

Don't test if you have yeast. Postpone your Pap smear if you have an active yeast infection. Inflammation from the infection can mask abnormal cells on your cervix.

Keep them alive. Don't douche or wear a tampon for at least 72 hours before the test. If you do, you may reduce the number of cells available for examination.

You Have It--Now What?

Nobody wants to hear her doctor tell her that she has cancer, but if you are diagnosed with it, don't panic, oncologists say.

"For many cancers, cure is clearly possible," says Dr. Eyre. "The majority of individuals in this country who have cancer can expect to live normal life spans."

Treatments include surgery, radiation, chemotherapy and immunotherapy, which consists of injections of proteins and antibodies that assist or stimulate the immune system to fight the cancer. New combinations of treatments are also promising. In many cases, lumpectomy, in which a small part of the breast is removed, combined with radiation is proving to be just as effective a treatment for breast cancer as mastectomy, the removal of the breast, Dr. Taylor says. It's also possible to have a mastectomy and reconstructive surgery of the breast during the same operation.

Which treatments are right for you will depend on the type of cancer, its size, how fast it is growing and if it has spread beyond the original site.

But whatever type of cancer you have, the psychological strain can be enormous.

"It feels unfair," says Karen Syrjala, Ph.D., a psychologist at the Fred Hutchinson Research Cancer Center in Seattle. "They think 'At 30 or 40, how can this be happening to me?' It's not really what you planned to be doing with your life at that point, so it feels like an intrusion. It feels wrong. The whole family can feel that way."

Even the closest of friends and family may start distancing themselves from a woman who has cancer because of their own dread of cancer or fears that she will die, Dr. Mansfield says. As a result, the woman with cancer often ends up socially isolated.

Here are some strategies for coping with cancer.

Become a know-it-all. Find out everything you can about your cancer and treatment. Ask your doctors and nurses question after question. "The first thing to do is gather information, so you understand what is happening to you and what your options are," Dr. Syrjala says. "Any time you know that you have options, you're going to feel more in control of the situation."

Don't blame yourself. "That's something that women sometimes do," Dr. Syrjala says. "You didn't cause your cancer. Yes, there are things you can do to reduce your chances of getting cancer, but nothing will absolutely prevent it."

Have a daily laugh. A sense of humor is extremely important because it can help you cope with the worst aspects of cancer and its treatment, Dr. Syrjala says. Make time to watch funny movies or have a good laugh with a friend.

Don't be a passive patient. Treatment shouldn't be something that your doctor does to you; it should be something in which you have an active role. Think about what you can do for yourself that might help you recover, says Dr. Syrjala, and discuss it with your doctor.

Be honest with your doctor. Your oncologist won't know if a treatment is bothering you unless you speak up. If you don't have a good relationship with your physician, consider seeing someone else, Dr. Syrjala says.

Talk about it. "It's helpful to talk about your fears and sadness, because if you talk about them, you might find out there's something you can do about them," Dr. Syrjala says. "If you don't talk about your fears, you tend to not do anything about them. Sometimes talking takes away the power of your fears." Counseling may help.

Know you're not alone. Find a support group for people with your type of cancer. "People in support groups live longer," Dr. Syrjala says. "We don't know why, but clearly, there is something about sharing your experiences with people who are in similar circumstances that can help you live a longer, more fulfilling life." Your doctor or local affiliate of the American Cancer Society should be able to help you find such a group.

Keep eating. Up to 40 percent of women who have cancer actually die of malnutrition, Dr. Simone says. That's because cancer cells release a hormone called cachectin that suppresses the appetite. That loss of appetite is compounded by some types of cancer treatment that can cause nausea and vomiting, such as chemotherapy. "The foundation of healing is good nutrition. I tell my patients that even if a meal seems unappetizing, try to eat some of it. Just chew and swallow, because you need that food," Dr. Mansfield says. He suggests eating small meals such as half a sandwich and a glass of orange juice several times a day and nibbling on healthy snacks such as carrots, apples and other fruits and vegetables.