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Fighting Cancer with Knowledge and Hope Yale University Press Health & Wellness A Yale University Press Health & Wellness book is an authoritative, accessible source of information on a health-related topic. It may provide guidance to help you lead a healthy life, examine your treatment options for a specific condition or disease, situate a health care issue in the context of your life as a whole, or address questions or concerns that linger after visits to your health care provider. Joseph A. Abboud, MD, and Soo Kim Abboud, MD, No More Joint Pain Thomas E. Brown, Ph.D., Attention Deficit Disorder: The Unfocused Mind in Children and Adults Patrick Conlon, The Essential Hospital Handbook: How to Be an Effective Partner in a Loved One’s Care Richard C. Frank, MD, Fighting Cancer with Knowledge and Hope: A Guide for Patients, Families, and Health Care Providers Marjorie Greenfield, MD, The Working Woman’s Pregnancy Book Ruth H. Grobstein, MD, PhD, The Breast Cancer Book: What You Need to Know to Make Informed Decisions James W. Hicks, MD, Fifty Signs of Mental Illness: A Guide to Understanding Mental Health Steven L. Maskin, MD, Reversing Dry Eye Syndrome: Practical Ways to Improve Your Comfort, Vision, and Appearance Mary Jane Minkin, MD, and Carol V. Wright, PhD, A Woman’s Guide to Menopause and Perimenopause Mary Jane Minkin, MD, and Carol V. Wright, PhD, A Woman’s Guide to Sexual Health Arthur W. Perry, MD, FACS, Straight Talk about Cosmetic Surgery Catherine M. Poole, with DuPont Guerry IV, MD, Melanoma: Prevention, Detection, and Treatment, 2nd ed. E. Fuller Torrey, MD, Surviving Prostate Cancer: What You Need to Know to Make Informed Decisions Barry L. Zaret, MD, and Genell J. Subak-Sharpe, MS, Heart Care for Life: Developing the Program That Works Best for You with Fighting Cancer Knowledge & Hope A Guide for Patients, Families, and Health Care Providers RICHARD C. FRANK, MD Illustrations by Gale V. Parsons Yale University Press New Haven & London Disclaimer: Some images in the printed version of this book are not available for inclusion in the eBook. Published on the foundation established in memory of William Chauncey Williams of the Class of 1822, Yale Medical School, and of William Cook Williams of the Class of 1850, Yale Medical School. Copyright © 2009 by Richard C. Frank, MD. All rights reserved. This book may not be reproduced, in whole or in part, including illustrations, in any form (beyond that copying permitted by Sections 107 and 108 of the U.S. Copyright Law and except by reviewers for the public press), without written permission from the publishers. Designed by Nancy Ovedovitz and set in Simoncini Garamond type by Tseng Information Systems, Inc. Printed in the United States of America. Library of Congress Cataloging-in-Publication Data Frank, Richard C., MD. Fighting cancer with knowledge and hope : a guide for patients, families, and health care providers / Richard C. Frank ; illustrations by Gail V. Parsons. p. cm. —(Yale University Press health & wellness) Includes bibliographical references and index. ISBN 978-0-300-15102-2 (paperbound : alk. paper) — ISBN 978-0-300-14926-5 (clothbound : alk. paper) 1. Cancer—Popular works. I. Title. II. Series. [DNLM: 1. Neoplasms—Popular Works. QZ 201 F828f 2009] RC263.F695 2009 616.99´4—dc22 2008048917 A catalogue record for this book is available from the British Library. The information and suggestions contained in this book are not intended to replace the services of your physician or caregiver. Because each person and each medical situation is unique, you should consult your own physician to get answers to your personal questions, to evaluate any symptoms you may have, or to receive suggestions for appropriate medications. The author has attempted to make this book as accurate and up to date as possible, but it may nevertheless contain errors, omissions, or material that is out of date at the time you read it. Neither the author nor the publisher has any legal responsibility or liability for errors, omissions, out-of-date material, or the reader’s application of the medical information or advice contained in this book. This paper meets the requirements of ANSI/NISO Z39.48-1992 (Permanence of Paper). 10 9 8 7 6 5 4 3 2 1 To my patients, who have granted me the great privilege of being their oncologist In memory of my mother, Nina Frank, for a lifetime of encouragement, inspiration, and supreme love The journey of a thousand miles begins with a single step. —Lao Tzu Contents Foreword by Edmundo Bendezu ix Preface xiii Acknowledgments xvii PA RT I Exposing Cancer 1 Understanding Cancer 3 When First Diagnosed: What You Need to Learn • The Three Essential Properties of Cancer • Understanding How Cancer Spreads 2 Diagnosis, Staging, Curability 23 Making a Diagnosis of Cancer • Determining the Extent or Stage of Cancer • Estimating Curability 3 Understanding Specific Cancers 54 Carcinomas • Blood and Lymph Cancers • Sarcomas • Brain Tumors Contents 4 Why Cancer Develops 85 Cancer and the Blueprint for Life • Family Cancers • Cancer and the Environment • Why Do Only Some People Get Cancer? PA RT I I Attacking Cancer 5 How Cancer Grows: The Basis of Cancer Treatments 117 Cancer Develops over Decades • Cancer Grows by Organized Chaos • Cancer Can Grow Unpredictably • Cancer Is Survival of the Fittest • The Devil Is in the Details 6 Cancer Treatments Revolve around Metastasis 129 After Surgery: “Why Do I Need Chemo If I’m Cancer Free?” • Eye on the Prize: Complete Cancer Eradication • When Surgery Is Not the First Step • Metastatic Disease: Cure versus Control • How a Treatment Strategy Is Chosen • Cancer in the Older Individual • The Role of Surgery in Metastatic Cancer • The Role of Radiation Therapy in Metastatic Cancer 7 Cancer Treatments at Work 159 A New Era of Hope • Targeting the Lifelines of Cancer • Chemotherapy • Targeted Therapies • Hormone Therapies • Radiation Therapy • Why Do Cancer Treatments Sometimes Fail? 8 Get Prepared to Survive 191 Survivorship and the Power of People LMNOP • Final Thoughts • Survival Is Spelled Appendix 1 Types of Cancer Medicine 205 Appendix 2 For More Information 209 Glossary 213 References 219 Index 236 viii Foreword Fighting Cancer with Knowledge and Hope provides you with the information you need to survive cancer. But above everything else, Dr. Frank gives you the wisdom to knock out the despair and depression brought on by cancer. He gives you a needed dose of tranquillity. Dr. Frank does something very important in this book, and that is to truly demystify cancer. I am not in favor of using that word without an explanation. Demystification evaporates the mystery of cancer, so that you can see clearly and stand courageously wherever you are. Fear disappears, because you finally come to understand the old syllogism: “A human being is mortal. I am a human being. Therefore, I am mortal.” Being mortal can be a blessing if we believe an old Greek myth. In that story, a man who did not want to die begged the gods to grant him immortality and eternal youth. Tired of his pestering, they gave him his request. He grew old, watched his family die, and saw his friends pass away. The people he loved were gone, leaving him lonely and in despair. He again begged the gods, this time to allow him to die. They agreed, and he died the happiest man on earth. In James Hilton’s novel Lost Horizon (as well as in the film starring ix