Cancer: a handbook

In The Sunday Telegraph Rosie Squires revealed that statistics from the NSW government agency tasked with improving outcomes in cancer diagnosis, treatment, care and survival, the Cancer Institute of NSW, indicated that the war on cancer is being won. Amen to that.

Ms Squires reported that five-year survival rates are soaring to record levels."The odds of beating the dreaded disease have risen to 64 per cent compared with49 per cent in 1982". And "mortality rates from breast, prostate and thyroid cancer have plunged in the past three decades following ground-breaking advancements in screening and treatment of all forms of the disease".

For those diagnosed with cancer this is terrific news. In fact, so good that leading oncologists predict that if Australian research continues at this rate, within two decades some of the most feared cancers will have been cured and turned into chronic diseases. After all, diagnostic tools have, in the last five years greatly improved clinicians 'understanding of tumours and specialists now know which cancers best respond to chemotherapy and which need a different treatment.

Another bit of good news included the story of Ms Kylie Darmanin from far western Sydney who was diagnosed two years ago with Stage 3 Melanoma who found support in Mr Jay Allen, who had prevailed over the same disease two years earlier.

Mr Allen's reaction to his diagnosis was emblematic of most sufferers: "I was 32, it was a total shock. I felt alone and very frightened. I thought I was going to die for eight months after diagnosis."

What was clear from Rosie Squires' three-part report is what was not mentioned. And what was not mentioned is a reality for many Australian patients awaiting confirmation of the news that they may or may not have the dreaded disease. That is, that there is an absence of a much-needed guidebook to cancer. A book that addresses the concerns of patients and their families. A book that comforts, informs and helps traverse the pathways to understanding what is cancer, why some people develop it and how it can be treated.

An easy to read, easy to find, popular, well informed handbook for patients explaining the whole shebang from diagnosis to acceptance to options to managing cancer seems invisible in the Australian market.

Out of luck at local bookstores, I was one such patient.

But fortunately for me, in the weeks after I was told my (hand) tumour looked "suspicious" I happened to be in a bookshop in Anchorage when I discovered Dr Mathew D. Galsky. Or more correctly, a book penned by the former oncologist with the Genitourinary unit at Memorial Sloan Kettering Medical Center, arguably the world's leading centre for cancer treatment. He is now with the Comprehensive Cancer Center in Las Vegas, Nevada.

In Everything You Need to Know about Cancer he presents a guide to the disease that is neither encyclopaedic nor folksy in style. He doesn't offer a menu as to what to eat and what pills to pop to help you steer the disease. His contribution is 130 odd pages of step-by-step explanations from the moment of diagnosis. Topics covered include:

· What is cancer? Here he describes benign tumours, malignancy, carcinomas, leukaemia, lymphoma, mass, metastasize and sarcomas.

· What is the bone marrow and why is it important in cancer? Bone marrow Galsky explains is a factory, which produces three major types of cells: white, red and platelets. White blood cells are infection-fighting cells. When they are reduced in numbers or functioning abnormally, one is at risk of developing infections. Red blood cells carry oxygen from the lungs to other parts of the body. When they are decreased in number, the condition is referred to as anaemia. Platelets are the cells that keep us from bleeding. When the number of platelets is short, one is more susceptible to bleeding. The chapter explains that while cells are constantly produced by the bone marrow, problems develop if a cancer arises in the bone marrow (called "liquid" tumours as opposed to cancers that start in solid organs like the colon, called "solid" tumours) or if the side effects of chemotherapy suppress the body's bone marrow's ability to manufacture cells.

• How is cancer diagnosed? Cancer presents in many ways. The symptoms that lead to the detection of cancer depend on the type of cancer, the site of origin and whether it has spread (or 'metastasised'). Often cancer is an accumulation of out of control growing cells or other abnormalities, which can be seen on an imaging test (such as CT scans or x-ray). Even with imaging and blood work, cancer is often confirmed with a biopsy, which is the removal of a sample of the tissue for examination.
• What is a pathology report? This document contains key information about the cancer, including indicators of prognosis and a list of what treatments may be beneficial. It is imperative to know just how to read the report. This relates to histology (a description of what the cells look like); the grade of the cancer (how aggressive it is on a scale of 1 to 4). Another way of stating its aggressiveness is by studying if the cells are differentiated. Are they well differentiated, moderately differentiated or poorly differentiated. Well-differentiated cancers are low grade and look more like normal cells. They grow slowly and behave less aggressively. Poorly differentiated (or high grade) cancers grow faster and are generally more aggressive.
• What is cancer "staging"? How is cancer treated? The different forms of staging (both localised and cancers that have spread from their origin) are explained as well as what treatments are usually prescribed (be it surgery, chemotherapy or radiation therapy).
• What is chemotherapy and what is targeted therapy? This refers to pharmaceuticals whose task is to kill cancer cells. Both cytotoxic chemotherapy (traditional approach) and targeted chemotherapy (designed with less side effects in mind than cytotoxic chemotherapy) are explained.
• What is radiation therapy? As described in an earlier chapter, chemotherapy is a systemic treatment where drugs travel in the bloodstream to different parts of the body. That way, chemotherapy can attack cancer cells wherever they lurk in the body. Radiation therapy however is localised. Like shining a torch on the sole of your foot, radiation therapy in that case will be limited to that part of your anatomy. A machine called a linear accelerator administers radiation and specifically, only the tissue in the path of the torch's beam (on the sole of the foot) will be destroyed. The other major 'localised' treatment for cancer which is discussed is surgery.

Other topics covered by Glasky include:

• why do I have blood drawn at every appointment;
• what do I need different scans?
• what questions should I ask my doctor and
• what side effects are possible (from the cancer or the treatment).

The book is written for a broad audience: those newly diagnosed with cancer (or fearful of such a diagnosis); their families; as well as those already living with cancer.

If you or someone you care for has been diagnosed with cancer, you can do a lot worse than buy them than this book. As expected with books written for foreign markets, there are both pluses and minuses with Galsky's book. On the plus side is a long list of groups from which patients can source information. Fortunately they are listed by cancer type:

• General
• Bladder
• Brain
• Breast
• Childhood
• Colon
• Head & Neck
• Kidney
• Leukaemia & lymphoma
• Lung
• Melanoma
• Multiple Myeloma
• Ovarian
• Pancreatic
• Prostate
• Thyroid

On the minus side, the organisations are U.S. based and some elements of their offering may not be applicable to Australian patients.

But that is small beer compared to the knowledge and comfort patients and their families can take away from these sites.

Both the book and the web sites listed helped prepare me for possible bad news. In my case I was lucky. Very lucky. The tumour was not cancer.

When facing cancer, key questions patients need to ask of their physicians are the same three fundamental points drummed into most oncologists' training, which they routinely bear in mind when considering prescribing the most optimal treatments possible for their patients:

• Is it cancer?
• Is the cancer curable?
• If the cancer is not curable, is it treatable?

Good physicians remember that even when all hope seems lost and the cancer is no longer treatable, the patient is always treatable. Always.