How are targeted therapies developed?

Once a candidate target has been identified, the next step is to develop a therapy that affects the target in a way that interferes with its ability to promote cancer cell growth or survival. For example, a targeted therapy could reduce the activity of the target or prevent it from binding to a receptor that it normally activates, among other possible mechanisms.
Most targeted therapies are either small molecules or monoclonal antibodies. Small-molecule compounds are typically developed for targets that are located inside the cell because such agents are able to enter cells relatively easily. Monoclonal antibodies are relatively large and generally cannot enter cells, so they are used only for targets that are outside cells or on the cell surface.
Candidate small molecules are usually identified in what are known as "high-throughput screens," in which the effects of thousands of test compounds on a specific target protein are examined. Compounds that affect the target (sometimes called "lead compounds") are then chemically modified to produce numerous closely related versions of the lead compound. These related compounds are then tested to determine which are most effective and have the fewest effects on nontarget molecules.
Monoclonal antibodies are developed by injecting animals (usually mice) with purified target proteins, causing the animals to make many different types of antibodies against the target. These antibodies are then tested to find the ones that bind best to the target without binding to nontarget proteins.
Before monoclonal antibodies are used in humans, they are "humanized" by replacing as much of the mouse antibody molecule as possible with corresponding portions of human antibodies. Humanizing is necessary to prevent the human immune system from recognizing the monoclonal antibody as "foreign" and destroying it before it has a chance to bind to its target protein. Humanization is not an issue for small-molecule compounds because they are not typically recognized by the body as foreign.

How are targets for targeted cancer therapies identified?

The development of targeted therapies requires the identification of good targets—that is, targets that play a key role in cancer cell growth and survival. (It is for this reason that targeted therapies are sometimes referred to as the product of "rational" drug design.)    
One approach to identify potential targets is to compare the amounts of individual proteins in cancer cells with those in normal cells. Proteins that are present in cancer cells but not normal cells or that are more abundant in cancer cells would be potential targets, especially if they are known to be involved in cell growth or survival. An example of such a differentially expressed target is the human epidermal growth factor receptor 2 protein (HER-2). HER-2 is expressed at high levels on the surface of some cancer cells. Several targeted therapies are directed against HER-2, including trastuzumab (Herceptin®), which is approved to treat certain breast and stomach cancers that overexpress HER-2.
Another approach to identify potential targets is to determine whether cancer cells produce mutant (altered) proteins that drive cancer progression. For example, the cell growth signaling protein BRAF is present in an altered form (known as BRAF V600E) in many melanomas. Vemurafenib (Zelboraf®) targets this mutant form of the BRAF protein and is approved to treat patients with inoperable or metastatic melanoma that contains this altered BRAF protein.
Researchers also look for abnormalities in chromosomes that are present in cancer cells but not in normal cells. Sometimes these chromosome abnormalities result in the creation of a fusion gene (a gene that incorporates parts of two different genes) whose product, called a fusion protein, may drive cancer development. Such fusion proteins are potential targets for targeted cancer therapies. For example, imatinib mesylate (Gleevec®) targets the BCR-ABL fusion protein, which is made from pieces of two genes that get joined together in some leukemia cells and promotes the growth of leukemic cells.

What exactly are targeted cancer therapies?

Targeted cancer therapies are drugs or other substances that block the growth and spread of cancer by interfering with specific molecules ("molecular targets") that are involved in the growth, progression, and spread of cancer. Targeted cancer therapies are sometimes called "molecularly targeted drugs," "molecularly targeted therapies," "precision medicines," or similar names.
Targeted therapies differ from standard chemotherapy in several ways:

• Targeted therapies act on specific molecular targets that are associated with cancer, whereas most standard chemotherapies act on all rapidly dividing normal and cancerous cells.
• Targeted therapies are deliberately chosen or designed to interact with their target, whereas many standard chemotherapies were identified because they kill cells. 
• Targeted therapies are often cytostatic (that is, they block tumor cell proliferation), whereas standard chemotherapy agents are cytotoxic (that is, they kill tumor cells). 

Targeted therapies are currently the focus of much anticancer drug development. They are a cornerstone of precision medicine, a form of medicine that uses information about a person’s genes and proteins to prevent, diagnose, and treat disease.
Many targeted cancer therapies have been approved by the Food and Drug Administration (FDA) to treat specific types of cancer. Others are being studied in clinical trials (research studies with people), and many more are in preclinical testing (research studies with animals).

Targeted Cancer Therapies

• Targeted cancer therapies are drugs or other substances that interfere with specific molecules involved in cancer cell growth and survival. Traditional chemotherapy drugs, by contrast, act against all actively dividing cells.
• Targeted cancer therapies that have been approved for use against specific cancers include agents that prevent cell growth signaling, interfere with tumor blood vessel development, promote the death of cancer cells, stimulate the immune system to destroy cancer cells, and deliver toxic drugs to cancer cells.

Targeted Therapy for Breast Cancer

Women whose lab tests show that their breast cancer cells have too much HER2 protein may receive targeted therapy. The targeted therapies used to treat breast cancer block cancer cell growth by blocking the action of the extra HER2 protein.
These drugs may be given intravenously or as a pill. The side effects depend mainly on which drug is given. Possible side effects include nausea, vomiting, and diarrhea. The drugs may also cause heart damage, heart failure, and serious breathing problems. During treatment, your doctor will watch for signs of heart and lung problems.

Chemotherapy for Breast Cancer

Chemotherapy uses drugs to kill cancer cells. It may be given to women with Stage I, II, III, or IV breast cancer. Chemotherapy may be given before or after surgery.
The drugs for breast cancer are usually given directly into a vein (intravenously) through a thin needle or as a pill. You may receive a combination of drugs.
You may receive chemotherapy in a clinic, at the doctor's office, or at home. It's unusual for a woman to need to stay in the hospital during treatment.
The side effects depend mainly on which drugs are given and how much. Chemotherapy kills fast-growing cancer cells, but the drugs can also harm normal cells that divide rapidly:

• Blood cells: When drugs lower the levels of healthy blood cells, you're more likely to get infections, bruise or bleed easily, and feel very weak and tired. Your health care team will check for low levels of blood cells. If your levels are low, your health care team may stop the chemotherapy for a while or reduce the dose of the drug. There are also medicines that can help your body make new blood cells.
• Cells in hair roots: Chemotherapy may cause hair loss. If you lose your hair, it will grow back after treatment, but the color and texture may be changed.
• Cells that line the digestive tract: Chemotherapy can cause a poor appetite, nausea and vomiting, diarrhea, or mouth and lip sores. Your health care team can give you medicines and suggest other ways to help with these problems.

Some drugs used for breast cancer can cause tingling or numbness in the hands or feet. This problem often goes away after treatment is over.
Other problems may not go away. For example, some of the drugs used for breast cancer may weaken the heart. Your doctor may check your heart before, during, and after treatment. A rare side effect of chemotherapy is that years after treatment, a few women have developed leukemia (cancer of the blood cells).
If you have not yet gone through menopause, some anticancer drugs may damage the ovaries and cause hot flashes, vaginal dryness, and other menopause symptoms. Your menstrual periods may no longer be regular or may stop, and you may lose the ability to become pregnant. The older you are, the more likely that this damage to the ovaries will be permanent. Women who may want to get pregnant later on should ask their health care team about ways to preserve their eggs before treatment starts.
On the other hand, other anticancer drugs don't damage the ovaries and you may remain able to become pregnant during chemotherapy. Before treatment begins, talk with your doctor about birth control because many anticancer drugs given during the first trimester are known to cause birth defects.

Hormone Therapy

Hormone therapy can also be called anti-hormone treatment. If lab tests show that your breast cancer cells have hormone receptors, then hormone therapy may be an option. (See the part about Lab Tests with Breast Tissue.) Hormone therapy keeps the cancer cells from getting or using the natural hormones (estrogen and progesterone) they need to grow.
If you have not gone through menopause, the options for hormone therapy include…

• A drug that blocks estrogen's activity in the body (tamoxifen)
• Surgery to remove your ovaries (which make estrogen)
• A drug that reduces the amount of estrogen made by the ovaries (LH-RH agonist)

If you have gone through menopause, the options include…

• A drug that prevents the body from making estrogen (aromatase inhibitor)
• Tamoxifen

The side effects of hormone therapy depend on the type used. The most common side effects are hot flashes, vaginal discharge, and nausea.

Questions you may want to ask your doctor about radiation therapy

• Which type of radiation therapy can I consider? Are both types an option for me?
• When will treatment start? When will it end? How often will I have treatment?
• How will I feel during treatment? Will I need to stay in the hospital? Will I be able to drive myself to and from treatment?
• What can I do to take care of myself before, during, and after treatment?
• How will we know the treatment is working?
• Will radiation therapy harm my skin?
• How will my chest look afterward?
• Are there any lasting effects?
• What is the chance that the cancer will come back in my breast

Radiation Therapy can treat breast cancer in two ways

Radiation therapy uses high-energy rays to kill cancer cells. It affects cells only in the part of the body that is treated.
Radiation therapy may be used after surgery to destroy breast cancer cells that remain in the chest area. Women usually have radiation therapy after breast-sparing surgery, but it's sometimes used after mastectomy too.
You can get radiation therapy to treat breast cancer in two ways:

• Machine outside the body (external radiation therapy): The radiation comes from a large machine outside the body. You'll go to a hospital or clinic for treatment. Usually, women get treatment once a day, 5 days a week for 3 to 6 weeks. Each treatment session lasts only a few minutes. External radiation is the most common type used for breast cancer.
• Material inside the body (brachytherapy): The doctor will place one or more thin tubes inside the breast through a tiny incision. A radioactive substance is loaded into the tube. The treatment session may last for a few minutes, and the substance is removed. When it's removed, no radioactivity remains in your body. This method of radiation therapy may be repeated every day for a week.

Side effects depend mainly on the type of radiation and how much is given. Ask your health care team to describe what you can expect.
It's common for the skin in the treated area to become red, dry, tender, and itchy. Check with your doctor before using lotion, cream, or deodorant on the treated area. After treatment is over, the skin will slowly heal. However, there may be a lasting change in the color of your skin.
With either type of radiation therapy, your breast may feel heavy and tight. Internal radiation therapy may make your breast look red or bruised. These problems usually go away over time.
Bras and tight clothes may rub your skin and cause soreness. You may want to wear loose-fitting cotton clothes during this time.
You're likely to become tired during radiation therapy, especially in the later weeks of treatment. Although getting enough rest is important, most people say they feel better when they exercise every day. Try to go for a short walk, do gentle stretches, or do yoga.
You may wish to discuss with your doctor the possible long- term effects of radiation therapy. For example, radiation therapy to the chest may harm the lung or heart. Also, it can change the size of your breast and the way it looks. If any of these problems occur, your health care team can tell you how to manage them.

Questions you may want to ask your doctor about surgery

• What kinds of surgery can I consider? Is breast-sparing surgery an option for me? Is a skin-sparing mastectomy an option? Which operation do you recommend for me? Why?
• Will any lymph nodes be removed? How many? Why?
• How will I feel after the operation? Will I have to stay in the hospital?
• What are the risks of surgery?
• How many surgeries for breast cancer have you done?
• Will I need to learn how to take care of myself or my incision when I get home?
• Where will the scars be? What will they look like?
• If I decide to have plastic surgery to rebuild my breast, how and when can that be done? Can you suggest a plastic surgeon for me to contact?
• Will I have to do special exercises to help regain motion and strength in my arm and shoulder? Will a physical therapist or nurse show me how to do the exercises?

The Surgery Procedure for Breast Cancer

The surgeon usually removes one or more lymph nodes from under the arm to check for cancer cells. If cancer cells are found in the lymph nodes, other cancer treatments will be needed.
After mastectomy, you may choose to have breast reconstruction. This is plastic surgery to rebuild the shape of the breast. If you're considering breast reconstruction, talk with a plastic surgeon before having cancer surgery.
It's common to feel tired or weak for a while after surgery for breast cancer. The time it takes to heal is different for each woman.
Surgery causes pain and tenderness, and the skin where your breast was removed may feel tight. Your arm and shoulder muscles may feel stiff and weak, and your neck and back may hurt. Medicine can help control your pain. Before surgery, discuss the plan for pain relief with your health care team. After surgery, they can adjust the plan if you need more pain control.
Any kind of surgery carries a risk of infection, bleeding, or other problems. Tell your health care team right away if you develop any problems.
Removing the underarm lymph nodes slows the flow of lymph fluid. The fluid may build up in your arm and hand and cause swelling. This swelling is called lymphedema. It can develop soon after surgery or months or even years later.
Always protect the arm and hand on the treated side of your body from cuts, burns, or other injuries. Remind nurses not to measure your blood pressure or give you injections on the treated side of your body. Information about preventing and treating lymphedema is available on NCI's website at http://www.cancer.gov/cancertopics/coping and from NCI's Cancer Information Service at 1-800-4-CANCER (1-800-422-6237) or LiveHelp.
The doctor, nurse, or physical therapist can suggest exercises to help you regain movement and strength in your arm and shoulder. Exercise can also reduce stiffness and pain. You may be able to begin gentle exercise within days of surgery.
Because nerves may be injured or cut during surgery, you may have numbness and tingling in your chest, underarm, shoulder, or upper arm. These feelings may go away within a few weeks or months.

Surgery, most common Treatment for Breast Cancer

Surgery is the most common treatment for breast cancer. There are several kinds of surgery.
Your surgeon can describe each kind of surgery, compare the benefits and risks, and help you decide which kind might be best for you:

• Removing part of the breast: Breast-sparing surgery is an operation to remove the cancer and a small amount of the normal tissue that surrounds it. This is also called breast-conserving surgery. It can be a lumpectomy or a segmental mastectomy (also called a partial mastectomy). A woman usually has radiation therapy after breast-sparing surgery to kill cancer cells that may remain in the breast area.
  
  Some women will have more tissue removed but not the whole breast. For these women, the surgeon will remove lymph nodes under the arm and some of the lining over the chest muscles below the tumor.

• Removing the whole breast: Surgery to remove the whole breast (or as much of the breast tissue as possible) is a mastectomy. In some cases, a skin-sparing mastectomy may be an option. For this approach, the surgeon removes as little skin as possible.
  • In total (simple) mastectomy, the surgeon removes the whole breast but not the underarm lymph nodes.
  • In modified radical mastectomy, the surgeon removes the whole breast and most or all of the lymph nodes under the arm. Often, the lining over the chest muscles is removed. A small chest muscle may also be taken out to make it easier to remove the lymph nodes.

The choice between breast-sparing surgery and mastectomy depends on many factors:

• The size, location, and stage of the tumor
• The size of your breast
• Certain features of the cancer
• How you feel about how surgery will change your breast
• How you feel about radiation therapy
• Your ability to travel to a radiation treatment center for daily treatment sessions

Might want that second Opinion

Before starting treatment, you might want a second opinion about your treatment plan. Some women worry that the doctor will be offended if they ask for a second opinion. Usually the opposite is true. Most doctors welcome a second opinion. And many health insurance companies will pay for a second opinion if you or your doctor requests it. Some companies actually require a second opinion.
If you get a second opinion, the second doctor may agree with your first doctor's treatment plan. Or, the second doctor may suggest another approach. Either way, you have more information and perhaps a greater sense of control. You can feel more confident about the decisions you make, knowing that you've looked at all of your options.
It may take some time and effort to gather your medical records and see another doctor. In most cases, it's not a problem to take several weeks to get a second opinion. The delay in starting treatment usually will not make treatment less effective. To make sure, you should discuss this delay with your doctor.

Your Doctors in your Treatment of Breast Cancer

Your health care team will include specialists. There are many ways to find doctors who treat breast cancer:

• Your doctor may be able to refer you to specialists.
• You can ask a local or state medical society, or a nearby hospital or medical school for names of specialists.
• NCI's Cancer Information Service can give you information about treatment centers near you. Call 1-800-4-CANCER (1-800-422-6237). Or, chat using LiveHelp, NCI's instant messaging service.
• Other sources can be found in the NCI fact sheet How To Find a Doctor or Treatment Facility If You Have Cancer.

Your health care team may include the following specialists:

• Surgeon: This type of doctor can perform surgery. You may want to find a breast cancer surgeon.
• Medical oncologist: A medical oncologist is a doctor who specializes in treating cancer with drugs, such as chemotherapy, hormone therapy, and targeted therapy.
• Radiation oncologist: A radiation oncologist is a doctor who specializes in treating cancer with radiation therapy.

Your health care team may also include a plastic surgeon or reconstructive surgeon, an oncology nurse, a physical therapist, a social worker, and a registered dietitian.
Your health care team can describe your treatment choices, the expected results of each treatment, and the possible side effects. Because cancer treatments often damage healthy cells and tissues, side effects are common. These side effects depend on many factors, including the type of treatment. Side effects may not be the same for each woman, and they may even change from one treatment session to the next.
Before treatment starts, ask your health care team about possible side effects and how treatment may change your normal activities.
You and your health care team can work together to develop a treatment plan that meets your medical and personal needs.
You may want to talk with your health care team about taking part in a research study (clinical trial) of new treatment methods. Research studies are an important option for women at any stage of breast cancer.

Treatment for Women with Breast Cancer

Women with breast cancer have many treatment options. Treatment options include…

• Surgery
• Radiation therapy
• Hormone therapy
• Chemotherapy
• Targeted therapy

You may receive more than one type of treatment.
The treatment that's best for one woman may not be best for another. The treatment that's right for you depends mainly on…

• The stage of breast cancer
• Whether the tumor has hormone receptors
• Whether the tumor has too much HER2
• Your general health

In addition, your treatment plan depends on…

• The size of the tumor in relation to the size of your breast
• Whether you have gone through menopause

At any stage of disease, care is available to control pain and other symptoms, to relieve the side effects of treatment, and to ease emotional concerns.

The Stages of Breast Cancer

The stage of breast cancer depends on the size of the breast tumor and whether it has spread to lymph nodes or other parts of the body.
Doctors describe the stages of breast cancer using the Roman numerals 0, I, II, III, and IV and the letters A, B, and C.
A cancer that is Stage I is early-stage breast cancer, and a cancer that is Stage IV is advanced cancer that has spread to other parts of the body, such as the liver.
The stage often is not known until after surgery to remove the tumor in the breast and one or more underarm lymph nodes.
Stage 0
Stage 0 is carcinoma in situ. In ductal carcinoma in situ (DCIS), abnormal cells are in the lining of a breast duct, but the abnormal cells have not invaded nearby breast tissue or spread outside the duct.
Stage IA
The breast tumor is no more than 2 centimeters (no more than 3/4 of an inch) across. Cancer has not spread to the lymph nodes
Stage IB
The tumor is no more than 2 centimeters across. Cancer cells are found in lymph nodes.
Stage IIA
The tumor is no more than 2 centimeters across, and the cancer has spread to underarm lymph nodes.
Or, the tumor is between 2 and 5 centimeters (between 3/4 of an inch and 2 inches) across, but the cancer hasn't spread to underarm lymph nodes.
Stage IIB
The tumor is between 2 and 5 centimeters across, and the cancer has spread to underarm lymph nodes.
Or, the tumor is larger than 5 centimeters across, but the cancer hasn't spread to underarm lymph nodes.
Stage IIIA
The breast tumor is no more than 5 centimeters across, and the cancer has spread to underarm lymph nodes that are attached to each other or nearby tissue. Or, the cancer may have spread to lymph nodes behind the breastbone.
Or, the tumor is more than 5 centimeters across. The cancer has spread to underarm lymph nodes that may be attached to each other or nearby tissue. Or, the cancer may have spread to lymph nodes behind the breastbone but not spread to underarm lymph nodes.
Stage IIIB
The breast tumor can be any size, and it has grown into the chest wall or the skin of the breast. The breast may be swollen or the breast skin may have lumps.
The cancer may have spread to underarm lymph nodes, and these lymph nodes may be attached to each other or nearby tissue. Or, the cancer may have spread to lymph nodes behind the breastbone.
Stage IIIC
The breast cancer can be any size, and it has spread to lymph nodes behind the breastbone and under the arm. Or, the cancer has spread to lymph nodes above or below the collarbone.
Stage IV
The tumor can be any size, and cancer cells have spread to other parts of the body, such as the lungs, liver, bones, or brain.

Breast cancer fact

Breast cancer is the most common type of cancer among women in the United States (other than skin cancer). In 2013, more than 232,000 American women will be diagnosed with breast cancer.
The most common type of breast cancer is ductal carcinoma. This cancer begins in cells that line a breast duct. About 7 of every 10 women with breast cancer have ductal carcinoma.
The second most common type of breast cancer is lobular carcinoma. This cancer begins in a lobule of the breast. About 1 of every 10 women with breast cancer has lobular carcinoma.
Other women have a mixture of ductal and lobular type or they have a less common type of breast cancer.

Breast cancer cells

Breast cancer cells can spread by breaking away from a breast tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
For example, breast cancer cells may spread first to nearby lymph nodes. Groups of lymph nodes are near the breast under the arm (axilla), above the collarbone, and in the chest behind the breastbone.
When breast cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if breast cancer spreads to a lung, the cancer cells in the lung are actually breast cancer cells. The disease is metastatic breast cancer, not lung cancer. For that reason, it's treated as breast cancer, not lung cancer.

Cancer Cells

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the breast.
Normal cells in the breast and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a lump, growth, or tumor.
Tumors in the breast can be benign (not cancer) or malignant (cancer):
Benign tumors:

• Are usually not harmful
• Rarely invade the tissues around them
• Don't spread to other parts of the body
• Can be removed and usually don't grow back

Malignant tumors:

• May be a threat to life
• Can invade nearby organs and tissues (such as the chest wall)
• Can spread to other parts of the body
• Often can be removed but sometimes grow back

What you need to know about Breast Cancer

Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the breast.
Normal cells in the breast and other parts of the body grow and divide to form new cells as they are needed. When normal cells grow old or get damaged, they die, and new cells take their place.
Sometimes, this process goes wrong. New cells form when the body doesn't need them, and old or damaged cells don't die as they should. The buildup of extra cells often forms a mass of tissue called a lump, growth, or tumor.
Tumors in the breast can be benign (not cancer) or malignant (cancer):
Benign tumors:

• Are usually not harmful
• Rarely invade the tissues around them
• Don't spread to other parts of the body
• Can be removed and usually don't grow back

Malignant tumors:

• May be a threat to life
• Can invade nearby organs and tissues (such as the chest wall)
• Can spread to other parts of the body
• Often can be removed but sometimes grow back

Breast cancer cells can spread by breaking away from a breast tumor. They can travel through blood vessels or lymph vessels to reach other parts of the body. After spreading, cancer cells may attach to other tissues and grow to form new tumors that may damage those tissues.
For example, breast cancer cells may spread first to nearby lymph nodes. Groups of lymph nodes are near the breast under the arm (axilla), above the collarbone, and in the chest behind the breastbone.
When breast cancer spreads from its original place to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary (original) tumor. For example, if breast cancer spreads to a lung, the cancer cells in the lung are actually breast cancer cells. The disease is metastatic breast cancer, not lung cancer. For that reason, it's treated as breast cancer, not lung cancer.

Breast Cancer

Definition of breast cancer: Cancer that forms in tissues of the breast. The most common type of breast cancer is ductal carcinoma, which begins in the lining of the milk ducts (thin tubes that carry milk from the lobules of the breast to the nipple). Another type of breast cancer is lobular carcinoma, which begins in the lobules (milk glands) of the breast. Invasive breast cancer is breast cancer that has spread from where it began in the breast ducts or lobules to surrounding normal tissue. Breast cancer occurs in both men and women, although male breast cancer is rare. 
Estimated new cases and deaths from breast cancer in the United States in 2014:

• New cases: 232,670 (female); 2,360 (male)
• Deaths: 40,000 (female); 430 (male)

Bone Metastasis...What it Means

When cancer spreads from the part of the body where it started (its primary site) to other parts of the body it is called metastasis. Metastasis can occur when cells break away from a cancerous tumor and travel through the bloodstream or through lymph vessels to other areas of the body. (Lymph vessels are much like blood vessels, except they carry a clear fluid called lymph back toward the heart.) Cancer cells that travel through the blood or lymph vessels can spread to other organs or tissues in distant parts of the body.

Many of the cancer cells that break off from the original tumor die without causing any problems. But some settle in a new area. There, they begin to grow and form new tumors. When cancer spreads, we say that it metastasizes. If there is only a single tumor, it’s called a metastasis or a metastatic tumor. When there are 2 or more metastatic tumors, it’s called metastases.

Sometimes metastatic tumors are found by tests done when the primary cancer is first diagnosed. In other cases, the metastasis is found first, causing the doctor to look for the place that the cancer started.

Sometimes, no metastases are seen when the cancer is first found. Instead, they are found later, after the patient has been treated and was thought to be cancer free. When a cancer has come back after treatment, it’s called recurrence. Recurrence is not the same as metastases – it can also occur at or near the place the cancer started. When it does come back as metastases, it’s called a distant recurrence. For a cancer to recur as metastatic disease, some cancer cells had to have broken off from the primary tumor and survived the initial treatment. These cells traveled through the body and started growing in new places.

Different cancers tend to spread to different sites, but some of the most common sites of distant recurrence include the bones, liver, brain, and lungs.

Is cancer treatment worse than cancer?

This is a common myth that can shorten lives. People who believe that cancer treatment is worse than cancer itself might not follow through with treatments that can prolong life or even cure their cancer.

It’s easy to understand the source of this myth. Often people diagnosed with cancer have never had any symptoms or pain. For others, the symptoms have just started and are not too bad yet. But once the treatment starts, they often begin to feel pretty sick. It’s true that chemo, radiation, and surgery can cause distressing and sometimes serious side effects. But most of them can be treated and will go away after treatment ends, and cancer treatment can be life-saving. If cancer is not treated at all, symptoms tend to become worse and worse.

There are times when every cancer patient questions their commitment to the difficult journey of treatment and its side effects. Sometimes they can get discouraged by the uncertainty of treatment and wonder if it’s worth it. This is normal. It may help to remember that every year cancer treatments get more and more effective, and doctors keep learning better ways to control treatment side effects.

Chemotherapy and Radiation therapy side effects

Short-term (and often treatable) side effects of chemo can include nausea and vomiting, loss of appetite, hair loss, and mouth sores. Because chemo can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. Low blood counts can cause certain side effects, such as:

• Higher risk of infection (from a shortage of white blood cells)
• Serious bleeding or bruising after cuts or injuries (from a shortage of blood platelets)
• Extreme tiredness or fatigue (sometimes from low red blood cell counts)

Cancer care teams carefully watch for and manage chemo side effects.

Because everyone’s body is different, people notice different effects from chemo. Most chemo side effects go away after treatment ends. For instance, hair lost during treatment nearly always grows back after treatment. In the meantime, most patients are able to use wigs, scarves, or hats to cover, warm, or protect their heads.

Radiation treatments are much like x-rays and are not painful. The most common side effects are skin irritation and severe tiredness (fatigue). Fatigue is especially common when treatments go on for several weeks. It’s a feeling of extreme tiredness and low energy, which often does not get better with rest. People also report fatigue caused by the daily trips to the hospital to get their radiation treatments.

"Many people are able to keep up their normal activities throughout the course radiation treatments, though it’s common for them to adjust their schedules or need more rest until they feel better."

What are the different types of cancer treatment?

If someone you know is being treated for cancer, you may want to learn more about what they’re going through. Surgery, chemotherapy, and radiation are the most common types of cancer treatment. Surgery is often the first treatment option if the tumor can be taken out of the body. Sometimes only part of the tumor can be removed. Radiation, chemotherapy, or both might be used to shrink the tumor before or after surgery. Doctors use chemotherapy (or “chemo”) to kill cancer cells. The term chemotherapy refers to the use of drugs to kill cancer cells. Usually, the drugs are given into a vein (or IV) or they’re taken by mouth. Chemo drugs then travel through the body in the bloodstream, reaching cancer cells that may have spread (metastasized) from the tumor to other places in the body. Radiation therapy uses high energy rays (like x-rays) to kill cancer cells and shrink tumors. The radiation may come from outside the body (external radiation) or from radioactive materials put right into the tumor (internal or implant radiation). Getting external radiation is much like getting an x-ray. The radiation itself is painless, but tissue damage may cause side effects. Other kinds of treatment you might hear about include hormone therapy, stem cell or bone marrow transplant, immunotherapy, and targeted therapy. Hormone therapy is sometimes used to treat certain kinds of prostate and breast cancers. Immunotherapy is treatment designed to boost the cancer patient’s own immune system to help fight the cancer. Targeted therapy is treatment that targets the cancer cells and causes less damage to healthy cells.

 You might know someone else being treated for the same type of cancer, but don’t assume that any two people will respond to treatment the same way. Each cancer is different, and each person’s response to treatment is unique. It’s best not to compare one person to another.

Cancer and Your Family

Cancer will not only change your life, but also the lives of those around you. It impacts families and friends in different ways.

• Talking about cancer can be hard for some families.
• Routines of family life may change.
• Roles and duties within the family will change.
• Relationships can be both strained and strengthened.
• Dealing with money and insurance often become hard.
• You may need to change where you live and with whom, at least for a while.

As you think about how cancer has changed your life and your family's life, think about reaching outside your family to get help.

• You may need help with household chores and errands.
• Respite care can give your regular caregivers a much-needed break.
• Counseling and support groups can help your family deal with the issues that cancer raises.

Most families find that being honest and open about the cancer, about the problems that arise, and about their feelings, helps them handle the changes that cancer causes.

Talking With Your Adult Children

It is important to talk about cancer with your adult children, even if they get upset or worry about you. Include them when talking about your treatment. Let them know your thoughts and wishes. They should be prepared in case you don't recover from your cancer.
Even adult children worry that their parents will die. When they learn that you have cancer, adult children may realize how important you are to them. They may feel guilty if they haven't been close with you. They may feel bad if they cannot spend a lot of time with you because they live far away or have other duties. Some of these feelings may make it harder to talk to your adult children. If you have trouble talking with your adult children, ask your doctor or nurse to suggest a counselor you can all talk with.
Make the most of the time you have with your adult children. Talk about how much you mean to each other. Express all your feelings--not just love but also anxiety, sadness, and anger. Don't worry about saying the wrong thing. It's better to share your feelings rather than hide them.

"One who conceals grief finds no remedy for it."

You and your Adult Children

Your relationship with your adult children may change now that you have cancer. You may:

• Ask them to take on new duties, such as making health care decisions, paying bills, or taking care of the house.
• Ask them to explain some of the information you've received from your doctor or to go with you to doctor's visits so they can also hear what the doctors are telling you.
• Rely on them for emotional support. For instance, you may ask them to act as "go-betweens" with friends or other family members.
• Want them to spend a lot of time with you. This can be hard, especially if they have jobs or young families of their own.
• Find it hard to receive--rather than give--comfort and support from them.
• Feel awkward when they help with your physical care, such as feeding or bathing.

As the adult daughter of a woman with ovarian cancer said,

"Mom was always the rock in the family. Whenever any of us had a problem, we could go to her for help. Now we had to help her. It was almost as though we were the parents and she was the child. To make it even harder, we had our own children to take care of and jobs to go to."

Teenagers and a Parent's Cancer

Teens are at a time in their lives when they are trying to break away and be independent from their parents. When a parent has cancer, breaking away can be hard for them to do. They may become angry, act out, or get into trouble.
Try to get your teens to talk about their feelings. Tell them as much as they want to know about your cancer. Ask them for their opinions and, if possible, let them help you make decisions.
Teens may want to talk with other people in their lives. Friends can be a great source of support, especially those who also have serious illness in their family. Other family members, teachers, coaches, and spiritual leaders can also help. Encourage your teenage children to talk about their fears and feelings with people they trust and feel close to. Some towns even have support groups for teens whose parents have cancer. Also, ask your social worker about Internet resources for this group. Many have online chats and forums for support.

What children of all ages need to know

About cancer

• Nothing your child did, thought, or said caused you to get cancer.
• You can't catch cancer from another person. Just because you have cancer does not mean that others in your family will get it, too.
• Just because you have cancer does not mean you will die from it. In fact, many people live with cancer for a long time.
• Scientists are finding many new ways to treat cancer.

About living with cancer in the family

• Your child is not alone. Other children have parents who have cancer.
• It is okay to be upset, angry, or scared about your illness.
• Your child can't do anything to change the fact that you have cancer.
• Family members may act differently because they are worried about you.
• You will make sure that your children are taken care of, no matter what happens to you.

About what they can do

• They can help you by doing nice things like washing dishes or drawing you a picture.
• They should still go to school and take part in sports and other fun activities.
• They can talk to other adults such as teachers, family members, and religious leaders.

How your Children may React

Children can react to cancer in many different ways. For example, they may:

• be confused, scared, or lonely
• feel guilty and think that something they did or said caused your cancer
• feel angry when they are asked to be quiet or do more chores around the house
• miss the amount of attention they are used to getting
• regress and behave as they did when they were much younger
• get into trouble at school or at home
• be clingy and afraid to leave the house

"Now that my Mom has cancer, everything has changed. I want to be with her, but I want to hang out with my friends, too. She needs me to help with my little brother, but what I really want to do is play football like I used to."

Talking to your Children about Cancer

Believe this or not, but children as young as 18 months old begin to think about and understand what is going on around them. It is important to be honest and tell your children that you are sick and the doctors are working to make you better. Telling them the truth is better than letting them imagine the worst. Give your children time to ask questions and express their feelings. And if they ask questions that you can't answer, let them know that you will find out the answers for them.
When you talk with your children, use words and terms they can understand. For example, say "doctor" instead of "oncologist" or "medicine" instead of "chemotherapy." Tell your children how much you love them and suggest ways they can help with your care. Share books about cancer that are written for children. Your doctor, nurse, or social worker can suggest good ones for your child.
Let other adults in your children's lives know about your cancer. This includes teachers, neighbors, coaches, or other relatives who can spend extra time with them. These other adults may be able to take your children to their activities, as well as listen to their feelings and concerns. Your doctor or nurse can also help by talking with your children and answering their questions. Or you can ask them if there's a child-life specialist on staff. This is a person who can help children understand medical issues and also offer psychological and emotional support.

"What the family talks about in the evening, the child will talk about in the morning."

Time away and your Childrens feelings

Your spouse or partner needs to keep a sense of balance in his or her life. He or she needs time to take care of personal chores and errands. Your partner will also need time to sort through his or her own feelings about cancer. Most importantly, everyone needs time to rest. If you don't want to be alone when your loved one is away, think about getting respite care or asking a friend to stay with you.

Even though your children will be sad and upset when they learn about your cancer, do not pretend that everything is okay. Even very young children can sense when something is wrong. They will see that you don't feel well or aren't spending as much time with them as you used to. They may notice that you have a lot of visitors and phone calls or that you need to be away from home for treatment and doctor's visits.

Sharing Information and Staying Close with your Partner or Spouse

Including your spouse or partner in treatment decisions is important. You can meet with your doctor together and learn about your type of cancer. You might want to find out about common symptoms, treatment choices, and their side effects. This information will help both of you plan for the future.
Your spouse or partner will also need to know how to help take care of your body and your feelings. And, even though it's not easy, both of you should think about the future and make plans in case you don't survive your cancer. You may find it helpful to meet with a financial planner or a lawyer.
Everyone needs to feel needed and loved. You may have always been the "strong one" in your family, but now is the time to let your spouse or partner help you. This can be as simple as letting the other person fluff your pillow, bring you a cool drink, or read to you.
Feeling sexually close to your partner is also important. You may not be interested in sex when you're in treatment because you feel tired, sick to your stomach, or in pain. But when your treatment is over, you may feel like having sex again. Until then, you and your spouse or partner may need to find new ways to show that you care about each other. This can include touching, holding, hugging, and cuddling.

Respite care for Spouses and Partners

Just as you need time for yourself, your family members also need time to rest, have fun, and take care of their other duties. Respite care is a way people can get the time they need. In respite care, someone comes to your home and takes care of you while your family member goes out for a while. Let your doctor or social worker know if you want to learn more about respite care.

"I was scared when my husband got cancer. He had always taken care of me and we did everything together. I was afraid I wouldn't be strong enough to help him through his treatment. I was afraid that he might not recover. And I was afraid to talk about my fears with him because I didn't want to upset him."

Your husband, wife, or partner may feel just as scared by cancer as you do. You both may feel anxious, helpless, or afraid. You may find it hard to be taken care of by someone you love.
People react to cancer in different ways. Some cannot accept that cancer is a serious illness. Others try too hard to be "perfect" caregivers. And some people refuse to talk about cancer. For most people, thinking about the future is scary.
It helps if you and the people close to you can talk about your fears and concerns. You may want to meet with a counselor who can help both of you talk about these feelings.
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Developing a Plan for Daily Activities

You may need help with duties such as paying bills, cooking meals, or coaching your children's teams. Asking others to do these things for you can be hard. A young father in treatment for colon cancer said, 

"When I came home from the hospital, I wanted to be in charge again but simply didn't have the energy. It was so hard to ask for help! It was easier to accept help when I realized that my kids felt that they were contributing to my recovery."

Even when others offer to help, it's important to let people know that you can still do some things for yourself. As much as you're able, keep up with your normal routine by making decisions, doing household chores, and working on hobbies that you enjoy.
Asking for help is not a sign of weakness. Think about hiring someone or asking for a volunteer. You might be able to find a volunteer through groups in your community.
Paid help or volunteers may be able to help with:

• physical care, such as bathing or dressing
• household chores, such as cleaning or food shopping
• skilled care, such as giving you special feedings or medications

Living Each Day to it's Fullest

Living with cancer will more than likely be the biggest challenge you have ever faced. For most people, it certainly is. Dealing with cancer and facing thoughts of death is a life-changing event for most people. For many, it can be a time to minimize regrets and make new priorities.

"My cancer made me take a closer look at how I spend my days. Realizing that they might be limited, I was determined to make them as good as possible. I vowed to use my time in ways that were good for me or brought me pleasure."

Try to live each day as normally as you can. Enjoy the simple things you like to do such as petting your cat or watching a sunset. Take pleasure in big events such as a friend's wedding or your grandson's high school graduation.

"One who conceals grief finds no remedy for it."

Changes to Your Roles in the Family

When someone in a family has cancer, everyone takes on new roles and responsibilities. For example, a child may be asked to do more chores or a spouse or partner may need to help pay bills, shop, or do yard work. Family members sometimes have trouble adjusting to these new roles.
Money. Cancer can reduce the amount of money your family has to spend or save. If you're not able to work, someone else in your family may feel that he or she needs to get a job. You and your family may need to learn more about health insurance and find out what will be covered and what you need to pay for. Most people find it stressful to keep up with money matters.
Living arrangements. People with cancer sometimes need to change where they live or whom they live with. Now that you have cancer, you may need to move in with someone else to get the care you need. This can be hard because you may feel that you are losing your independence, at least for a little while. Or, you may need to travel far from home for treatment. If you have to be away from home for treatments take a few little things from home with you. This way, there will be something familiar even in a strange place.

Your Family's Reaction to your Cancer may vary

Some families find it easy to talk about cancer. They may easily share their feelings about the changes that cancer brings to their lives. Other families find it harder to talk about cancer. The people in these families may be used to solving problems alone and not want to talk about their feelings.
Families that have gone through divorce or had other losses may have even more trouble talking about cancer. As one woman with lung cancer said,

"Talking about my cancer was rough at first. My husband and I divorced five years ago, so my mom had to move in and help me with the boys. Eventually, I was able to tell my ex-husband about my cancer, and he helped the boys understand. Our family has been through a lot, and we'll get through this, too. To me, the only constant in life is change."

If your family is having trouble talking about feelings, think about getting some help. Your doctor or nurse can refer you to a counselor who can help people in your family talk about what cancer means to them. Many families find that, even though it can be hard to do, they feel close to each other when they deal with cancer together.

Cancer will change your life and the lives of people around you.

• Your routines may be altered.
• Roles and duties may change.
• Relationships can be strained or strengthened.
• Dealing with money and insurance can cause problems.
• You may need to live with someone else for a while.
• You may need help with chores and errands.

Most people find that if they, their friends, and family talk about the cancer and how it makes them feel, they feel closer to each other.
Families are not all alike. Your family may include a spouse (husband or wife), children, and parents. Or maybe you think of your partner or close friends as your family. In this book, "family" refers to you and those who love and support you.
Cancer affects the whole family, not just the person with the disease. How are the people in your family dealing with your cancer? Maybe they are afraid or angry, just like you.
When you first find out you have cancer and are going through treatments, day-to-day routines may change for everyone. For example, someone in your family may need to take time off work to drive you to treatments. You may need help with chores and errands.

The Strange Feeling of Gratitude

"I do have a lot of bad days, but you know, I don't talk about them or focus on them. Instead I think about all the good things. I have a lot of nice times when I'm with my grandchildren, when I go to church, and when I'm with my friends."

Some people see their cancer as a "wake-up call." They may realize the importance of enjoying the little things in life. They go places they've never been. They finish projects they had started but put aside. They spend more time with friends and family. They mend broken relationships.
It may be hard at first, but you can find joy in your life. Take note of what makes you smile. Pay attention to the things you do each day that you enjoy. They can be as simple as drinking your morning coffee, sitting with a pet, or talking to a friend. These small, day-to-day activities can give you comfort and pleasure.
You can also do things that are more meaningful to you. Everyone has special things, both large and small, that bring meaning to their life. For you, it may be visiting a garden in your city or town. It may be praying in a certain chapel. Or it could be playing golf or some other sport that you love. Whatever you choose, embrace the things that bring you joy when you can.

The Effect of Loneliness

People with cancer often feel lonely or distant from others. You may find that your friends have a hard time dealing with your cancer and may not visit. Some people might not even be able to call you on the phone. You may feel too sick to take part in the hobbies and activities you used to enjoy. And sometimes, even when you are with people you love and care about, you may feel that no one understands what you are going through.
You may feel less lonely when you meet other people who have cancer. Many people feel better when they join a support group and talk with others who are facing the same challenges.
Not everyone wants or is able to join a support group. Some people prefer to talk with just one person at a time. You may feel better talking to a close friend or family member, a social worker or counselor, or a member of your faith or spiritual community.

The Feeling of Guilt

Many people with cancer feel guilty. For example, you may blame yourself for upsetting the people you love. You may worry that you are a burden to others, either emotionally or financially. Or you may envy other people's good health and be ashamed of this feeling. You might even blame yourself for lifestyle choices that could have led to your cancer. For example, that lying out in the sun caused your skin cancer or that smoking cigarettes led to your lung cancer.
These feelings are all normal. One woman with breast cancer said,
"When I start to feel guilty that I caused my illness, I think of how little children get cancer. That makes me realize that cancer can just happen. It isn't my fault."
Your family and friends may also feel guilty because:

• they are healthy while you are sick
• they can't help you as much as they want
• they feel stressed and impatient

They may also feel guilty when they don't think they can give you all the care and understanding you need.
Counseling and support groups can help with these feelings of guilt. Let your doctor or nurse know if you, or someone in your family, would like to talk with a counselor or go to a support group.

Sadness and Depression

Many people with cancer feel sad or depressed. This is a normal response to any serious illness. When you're depressed, you may have very little energy, feel tired, or not want to eat.
Depression is sometimes a serious problem. If feelings of sadness and despair seem to take over your life, you may have depression. The box below lists eight common signs of depression. Let your health provider know if you have one or more of these signs almost every day.
Depression can be treated. Your doctor may prescribe medication. He or she may also suggest that you talk about your feelings with a counselor or join a support group with others who have cancer.

Early Signs of Depression

Check the signs that are problems for you:

• a feeling that you are helpless and hopeless, or that life has no meaning
• no interest in being with your family or friends
• no interest in the hobbies and activities you used to enjoy
• a loss of appetite, or no interest in food
• crying for long periods of time, or many times each day
• sleep problems, either sleeping too much or too little
• changes in your energy level
• thoughts of killing yourself. This includes making plans or taking action to kill yourself, as well as frequent thoughts about death and dying.

Control and Self-Esteem

When you first learn that you have cancer, you may feel as if your life is out of control. You may feel this way because:

• you wonder if you will live or die
• your daily routine is disrupted by doctor visits and treatments
• people use medical words and terms that you don't understand
• you feel like you can't do things you enjoy
• you feel helpless
• the health professionals treating you are strangers

Even though you may feel out of control, there are ways you can be in charge. For example, you can:

• Learn as much as you can about your cancer. You can call 1-800-4-CANCER (1-800-422-6237). You can also go online at http://www.cancer.gov and click on "Live Help" on the home page.
• Ask questions. Let your health providers know when you don't understand what they are saying, or when you want more information about something..
• Look beyond your cancer. Many people with cancer feel better when they stay busy. You may still go to work, even if you need to adjust your schedule. You can also take part in hobbies such as music, crafts, or reading.

As one woman with cancer commented,
"Once I started to feel better, I found myself looking for new outlets for creativity. I had always promised myself that some day I would take a photography course. Having a new hobby helped me feel better about other areas of my life as well."

Pain Scales and Pain Journals

Pain scales or pain journals are tools that you can use to describe how much pain you feel. These tools can also help your doctor, nurse, or pharmacist find ways to treat your pain.
You are the only person who can talk about the pain you feel. When it comes to pain, there is no right or wrong answer. On many pain scales, you are asked to rate your pain as a number from 0 to 10. For example, you would rate your pain as "0" if you feel no pain at all. You would rate your pain as "10" if it is the worst pain you have ever felt in your life. You can pick any number between 0 and 10 to describe your pain.
When you use a pain scale, be sure to include the range. For example, you might say, "Today my pain is a 7 on a scale from 0 to 10."
A pain journal or diary is another tool you can use to describe your pain. With a journal or diary, you not only use a pain scale but also write down what you think causes your pain and what helps you feel better

Dealing with the Pain

Even though almost everyone worries about pain, it may not be a problem for you. Some people don't have any pain. Others have it only once in a while. Cancer pain can almost always be relieved. If you're in pain, your doctor can suggest ways to help you feel better. These include:

• prescription or over-the-counter medicines
• cold packs or heating pads
• relaxation, like getting a massage or listening to soothing music
• imagery, such as thinking about a place where you feel happy and calm
• distraction, like watching a movie, working on a hobby, or anything that helps take your mind off your pain

There are many ways to control pain. Your doctor wants and needs to hear about your pain. As soon as you have pain you should speak up. Dealing with your pain can also help you deal with the feelings discussed in this section.
When you describe your pain to your health care providers, tell them:

• where you feel pain
• what it feels like (sharp, dull, throbbing, steady)
• how strong the pain feels
• how long it lasts
• what eases the pain and what makes it worse
• what medicines you are taking for the pain and how much they help

Dealing with the Stress

Your body may react to the stress and worry of having cancer. You may notice that:

• your heart beats faster
• you have headaches or muscle pains
• you don't feel like eating or you eat more
• you feel sick to your stomach or have diarrhea
• you feel shaky, weak, or dizzy
• you have a tight feeling in your throat and chest
• you sleep too much or too little
• you find it hard to concentrate

Stress can also keep your body from fighting disease as well as it should.
You can learn to handle stress in many ways, like:

• exercising
• listening to music
• reading books, poems, or magazines
• getting involved in hobbies such as music or crafts
• relaxing or meditating, such as lying down and slowly breathing in and out
• talking about your feelings with family and close friends

If you're concerned about stress, talk to your doctor. He or she can suggest a social worker or counselor. You could also find a class that teaches people ways of dealing with stress. The key is to find ways to control stress and not to let it control you.

Fear and Worry

"The word 'cancer' frightens everyone I know. It's a diagnosis that most people fear more than any other."
It's scary to hear that you have cancer. You may be afraid or worried about:

• being in pain, either from the cancer or the treatment
• feeling sick or looking different as a result of your treatment
• taking care of your family
• paying your bills
• keeping your job
• dying

Your family and close friends may also worry about:

• seeing you upset or in pain
• not giving you enough support, love, and understanding
• living without you

Some fears about cancer are based on stories, rumors, and old information. Most people feel better when they know what to expect. They feel less afraid when they learn about cancer and its treatment. As one man with prostate cancer said,
"I read as much as I can find about my cancer. Imagining the worst is scarier than knowing what might happen. Having all the facts makes me much less afraid."

Anger

Once you accept that you have cancer, you may feel angry and scared. It's normal to ask "Why me?" and be angry at:

• the cancer
• your health care providers
• your healthy friends and loved ones

And if you are religious, you might even be angry with God.
Anger sometimes comes from feelings that are hard to show--such as fear, panic, frustration, anxiety, or helplessness. If you feel angry, don't pretend that everything is okay. Talk with your family and friends about it. Most of the time, talking will help you feel a lot better

Denial

When you were first diagnosed, you may have had trouble believing or accepting the fact that you have cancer. This is called denial. It can be helpful because it can give you time to adjust to your diagnosis. Denial can also give you time to feel hopeful and better about the future.
Sometimes, denial is a serious problem. If it lasts too long, it can keep you from getting the treatment you need. It can also be a problem when other people deny that you have cancer, even after you have accepted it.
The good news is that most people (those with cancer as well as those they love and care about) work through denial. By the time treatment begins, most people accept the fact that they have cancer.

The overwhelming feelings of Hope

Once people accept that they have cancer, they often feel a sense of hope. There are many reasons to feel hopeful.

• Cancer treatment can be successful. Millions of people who have had cancer are alive today.
• People with cancer can lead active lives, even during treatment.
• Your chances of living with--and living beyond--cancer are better now than they have ever been before. People often live for many years after their cancer treatment is over.

Some doctors think that hope may help your body deal with cancer. Scientists are looking at the question of whether a hopeful outlook and positive attitude helps people feel better. Here are some ways you can build your sense of hope:

• Write down your hopeful feelings and talk about them with others.
• Plan your days as you have always done.
• Don't limit the things you like to do just because you have cancer.
• Look for reasons to hope

Learning That You Have Cancer

"I heard the doctor say, 'I'm sorry; the test results show that you have cancer.' I heard nothing else. My mind went blank, and then I kept thinking, 'No, there must be some mistake.'"
Learning that you have cancer can come as a shock. How did you react? You may have felt numb, frightened, or angry. You may not have believed what the doctor was saying. You may have felt all alone, even if your friends and family were in the same room with you. These feelings are all normal.
For many people, the first few weeks after diagnosis are very hard. After you hear the word "cancer," you may have trouble breathing or listening to what is being said. When you are at home, you may have trouble thinking, eating, or sleeping.
People with cancer and those close to them experience a wide range of feelings and emotions. These feelings can change often and without warning.
At times, you may:

• be angry, afraid, or worried
• not really believe that you have cancer
• feel out of control and not able to care for yourself
• be sad, guilty, or lonely
• have a strong sense of hope for the future

Cancer Will Change Your Life

Millions of Americans alive today have a history of cancer. For them, cancer has become a chronic (on-going) health problem, like high blood pressure or diabetes.
Just like everyone, people who have cancer must get regular checkups for the rest of their lives, even after treatment ends. But unlike other chronic health problems, if you have cancer you probably will not need to take medicine or eat special foods once you have finished treatment.
If you have cancer, you may notice every ache, pain, or sign of illness. Even little aches may make you worry. You may even think about dying. While it's normal to think these thoughts, it's also important to focus on living. Although some people do die of it, many with the disease are treated successfully. Others will live a long time before dying from it. So, try to make the most of each day while living with cancer and its treatment.

Coping with your feelings during cancer treatment

There are many things you can do to cope with your feelings during treatment so they do not ruin your appetite. Here are some ideas that have worked for other people.

• Eat your favorite foods on days you do not have treatment. This way, you can enjoy the foods, but they won’t remind you of something upsetting.
• Relax, meditate, or pray. Activities like these help many people feel calm and less stressed
• Talk with someone you trust about your feelings. You may want to talk with a close friend, family member, religious or spiritual leader, nurse, social worker, counselor, or psychologist. You may also find it helpful to talk with someone who has gone through cancer treatment.
• Join a cancer support group. This can be a way to meet others dealing with problems like yours. In support group meetings, you can talk about your feelings and listen to other people talk about theirs. You can also learn how others cope with cancer, treatment side effects, and eating problems. Ask your doctor, nurse, or social worker about support group meetings near you. You may also want to know about support groups that meet over the Internet. These can be very helpful if you cannot travel or there is no group that meets close by.
• Learn about eating problems and other side effects before treatment starts. Many people feel more in control when they know what to expect and how to manage problems that may occur.
• Get enough rest. Make sure you get at least 7 to 8 hours of sleep each night. During the day, spend time doing quiet activities such as reading or watching a movie.
• Do not push yourself to do too much or more than you can manage. Look for easier ways to do your daily tasks. Many people feel better when they ask for or accept help from others.
• Be active each day. Studies show that many people feel better when they take short walks or do light exercise each day. Being active like this can also help improve your appetite.
• Talk with your doctor or nurse about medicine if you find it very hard to cope with your feelings.