Cancer: a handbook

• 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.