In the case of the painkillers on the list other than aspirin and paracetamol, if you take the same one regularly for some weeks, you are likely to find it is not working as well, or for as long. This is normal and expected. It does not mean that you are getting addicted to your painkiller. What happens is that your body develops ways of getting rid of the drug more quickly. It now takes more of the painkiller to achieve the same amount in your blood. Therefore, when you find that the dose which used to control your pain no longer does so, it is quite safe, and indeed necessary, to increase your dose. The higher dose is no more dangerous and will cause no more side effects for you than the usual starting dose would for someone who had not been taking painkillers.

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In the early 1960s, a group of doctors from the United States reported using a revolutionary new technique. They combined high doses of four different chemotherapy drugs (mustine, vincristine, procarbazine and prednisone) to produce a treatment that produced remissions in the majority of patients with Hodgkin’s disease. Prior to this, extensive Hodgkin’s disease was fatal within a few months. Now patients were living for years and, in fact, many of them later proved to be completely cured. The improvement in results was so great and significant that no special research techniques were needed to prove it.

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Only some cancers run in families. Many cancers do not occur with increased frequency in relatives of people with that type of cancer. Ask your doctor whether your relatives are at any increased risk for certain cancers because of your history of cancer.

Should My Family Members Tell Their Doctors about My Cancer?

It is a good idea for your relatives to notify their doctors of your history, because

•as medical knowledge about family risk changes, your relatives’ doctors will already be aware of your history

•your relatives’ doctors will be more sensitive to your relatives’ concerns about symptoms or tests

•your relatives’ doctors can encourage them to follow the cancer prevention recommendations

•your relatives’ doctors can modify the recommendations regarding prevention and screening where indicated

If My Cancer Tends to Run in Families, Is There Some Way to Prevent My Relatives from Feeling like Sitting Ducks?

Yes. Although their risk may be increased, even significantly, there is much they can do

•to prevent certain types of cancer •to detect cancer early

•to have hope in the availability of safe and effective treatment, if they need it

•to live with the uncertainty

Cervical and colon cancer are examples of cancers that are preventable if people at risk have routine screening. Breast cancer, colon cancer, and melanoma are examples of cancers that are very curable if detected and treated early.

Knowledge of family risk can ruin one’s quality of life if it causes a sense of hopelessness; knowledge of family risk empowers if it is used to maximize prevention and early detection.

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Antioxidants are micronutrients (substances found in tiny amounts) that serve as the body’s primary defense against free radicals and reactive oxygen molecules (two by-products of normal metabolism that are thought to cause damage to normal cells, possibly predisposing the damaged cells to become cancerous). If free radicals trigger the early changes of cancer, then antioxidants would protect patients by mopping up these free radicals. Antioxidants include

• carotenoids

• beta-carotenes

• vitamin С

• vitamin E

Selenium is an essential component of antioxidant enzymes.

What Are the Facts regarding Antioxidants as Protection against Cancer?

Animal studies suggest a protective role for antioxidants in the fight against various types of cancer, particularly lung and epithelial cancers. We cannot draw conclusions about humans on the basis of animal studies. The results from animal studies help us proceed to human studies in a safe and expeditious manner. Human studies have shown an association between

•a diet low in carotenoids and an increased risk of lung cancer

•a diet low in vitamin С and an increased risk of oral, esophageal, and stomach cancer

•a diet high in vitamin С and beta-carotene and a decreased risk of cervical dysplasia and oral leukoplakia

•a diet high in vitamin С and a protective effect against cancers of the esophagus, mouth, stomach, pancreas, cervix, rectum, breast, and possibly lung

•low blood levels of beta-carotene and an increased risk of lung cancer

•low blood levels of vitamin С and an increased risk of stomach cancer

These and other data certainly suggest that antioxidants protect against some types of cancer. Well-designed human studies are under way to determine definitively which antioxidants in what dose and form guard against which specific cancers.

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•learning to view cancer cells as the weak, abnormal cells that they are

•learning to regard your body as possessing powerful defenses against cancer cells (this is hard to do soon after cancer treatment: after all, your body allowed the cancer to grow in the first place, and it is weak from treatments)

• focusing on efforts to keep your body healthy and strong •concentrating on increasing your capacity for acceptance and hope, and decreasing your need for control and perfection

•learning to accept that this is an uncertainty with which you will have to live

We have learned from people who live long lives with certain types of incurable cancer that the threat to their health and life came less from their persistent cancer than from normal age-related changes and illnesses. Even though they had known cancer, their cancer had little effect on their life or longevity unless they let the knowledge of their cancer affect them emotionally in a negative way.

Remind yourself of the patient who was successfully treated for cancer and spent the next forty years physically healthy but worried sick about a possible recurrence. At the age of ninety-eight the patient said, “I guess 1 really was in remission all these years. I spoiled what could have been forty wonderful years worrying about something that never happened.”

Do not lose today by worrying about something you can never know (whether or not you have any leftover cancer cells) or about something that may never happen (recurrence).

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You may feel more concerned about your doctor’s feelings when you go for a second opinion after completing treatment than after your original diagnosis. After all, your doctor has invested time, energy, and emotions to help get you where you are. You do not want your actions to be interpreted as an expression of lack of satisfaction or trust.

Second opinions are part of cancer survivorship. You have a right to be as sure as possible about decisions that affect your life.

Depending on what kind of cancer you had, and what kind of therapy you had, your treatments can continue to have an effect on cancer cells for weeks to months. This activity against cancer cells is the “antitumor effect.”

Surgery itself has no further effect on your cancer once the operation is complete. However, the physical changes that accompany removing a cancer from the body and healing from the surgery may have an antitumor effect in some people. There is reason to believe that for some people the stimulation of the immune system during the healing process after surgery may also have an antitumor effect.

Chemotherapy continues to work for days to weeks after the drug is given. That is one of the reasons why the doses are spaced out over time.

Radiation therapy continues to have an antitumor effect for weeks after the last dose is given.

Immunotherapy continues to work over days to weeks—and possibly months to years, if it causes a self-perpetuating change in your immune system.

The exact duration of the antitumor effect is not predictable, but it can be estimated on the basis of

• the type of cancer

• the type of therapy

• the presence of concurrent therapy

• the duration and intensity of cancer therapy

• your body’s response to the cancer therapy

• your nutritional and circulation status

Do I Really Need to Have All of These Tests?

These tests are needed to determine whether you have received enough treatment and to be sure that no new problems are developing. Getting accurate information and making good decisions after treatment is just as important as doing so before treatment, as far as your long-term health goes.

What about the Risk to Me from Getting All These Scans and X Rays?

Your recent cancer poses a clear and present danger to your health. Making the best treatment decisions on the basis of complete and accurate information is critical to maximizing your health. Your risks from the X-ray exposure are far less than the risks of not evaluating adequately your cancer situation.

X rays should not be taken indiscriminately. You can minimize your exposure to X rays when there are acceptable alternative ways of getting the same information, such as sonograms. When you have doubts about the necessity of an X ray, ask your doctor

• what information will be obtained from the X ray

• how the information gained will affect your decision making

• whether you can get the same information without X rays

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