Cancer Care Associates

Click on a question to see the answer.

The body is made of individual units called cells that coalesce to form organs and other body structures. A cancer is an abnormal growth of cells that have the unique properties of unchecked growth and the ability to spread to other areas of the body. Cancer cells are characterized by uncontrolled growth which if unchecked eventually causes damage by direct invasion of organs and by secondary spread, a process termed metastasis. Normal cells have an internal mechanism that stops growth at the appropriate time. The internal signal is contained within the cell’s DNA or genetic material. Normally all cells to varying degrees continue to reproduce themselves by dividing and making identical copies. In order to maintain a status quo, other similar cells must automatically die. This process of normal cell death is called apoptosis. Cancer cells are different because they have abnormal DNA and apoptosis, the programmed stop signal, doesn’t work. As the cancer cells continue to divide, the cancer grows and at some time during this process metastasis occurs and cancers cell get into the lymph or blood system and go to other parts of the body. The vast majority of cancers are derived from organs such as breast, lung, prostate, colon, etc., and are called carcinomas. Cancers of the lymph and blood systems are called lymphomas and leukemias. Much more rare are sarcomas which are derived from the supportive tissues of the body such as muscle, cartilage, and bone.

The only way a cancer is diagnosed with certainty is by biopsy. In this process a small piece of the cancer is removed and examined under the microscope by an expert physician called a pathologist. Cancer cells have special characteristics that are consistently recognizable when viewed microscopically. Often the pathologist can also determine the specific cancer type with the aid of special stains. He can identify whether the cancer is primary (the cancer is starting in the area biopsied) or if the cancer is a metastasis (the cancer originates in another organ and has spread to the area biopsied). Cancers are named for their site of origin. For example, a patient who has had a colon cancer removed and subsequently develops a relapse in the liver does not have liver cancer, but colon cancer with liver metastasis. Lung cancer is a cancer, starting in the lung, not a cancer which has spread to the lung. (see Laboratory and Radiology Tests).

Usually not. Cancers are much more often a sporadic spontaneous event rather than an inherited disorder. For example, contrary to popular belief, more than 80% of new breast cancer patients do not have anyone in the family who has had breast cancer. This is also true of most other cancer types. When cancers do occur within a family, they generally are similar in type so that there are many family members within different generations who have had the same type of cancer. These inherited cancers generally have a 50/50 chance of passing the tendency from parent to offspring so that there is a significant chance that the cancer will occur in each generation.

No. Cancer is not transmitted from person to person with extremely rare exception. The only cases of catching cancer from another patient have occurred in patients who have had organ transplants from a donor who unknowingly had cancer. As a result of medications needed to stop organ rejection by the immune system, the cancer grew and spread in the person receiving the transplant.

No. Cancers generally are not growing because of a defective immune system. There are exceptions to this like in uncontrolled AIDS. However, sophisticated testing of cancer patients usually show normal immune function. The main problem is not a damaged or inadequate immune system, but the inability of the immune system to recognize that the cancer should not be there in the first place. This occurs because the cancer comes from the patient’s normal cells and therefore the cancer has on its cell surface all of the characteristics of normal cells. The cancer may have slight unique differences compared to normal cells but they tend to be well hidden. The cancer behaves very much like a spy within an army wearing a stolen uniform and the immune system cannot recognize that it shouldn’t be there. Much cancer research is now focusing on exaggerating the small differences between cancer and normal cells by unmasking the cancer to the immune system. These types of treatments are termed immunotherapies and include cancer vaccines and monoclonal antibodies.

Most expert researchers say that stress doesn't cause cancer. By the time a cancer becomes detectable, it usually has been present and growing for a number of years. For example, for a breast cancer of 1 cm in size (about the size of a blueberry), the first cancer cell started growing 7-8 years previously. That is the length of time it took to go from 1 cell to 1 billion cells which is how many cancer cells it takes to become 1 cm. Therefore stressful events like a divorce or family tragedy occurring within 1 or 2 years prior to detection of the cancer cannot be blamed as a cause.

No. This is a subject that has been extensively researched and there is no reliable scientific evidence that stress will affect the outcome of the cancer by lowering cure rates. Patients who report a higher level of stress in their lives have not been shown to have a higher relapse rate. However, stress undoubtedly affects the quality of a patient’s life so from that standpoint, stress is bad because it makes the effects of cancer and cancer treatment more difficult to handle. Patients with less stress report a better quality of life so that stress reduction in generally is a good idea. But stress does not make cancer grow. Learn more >

This refers to the location and extent of cancer as determined the amount of cancer discovered at the time of surgery, as well as abnormalities on Xrays or scans. There are different methods for staging different types of cancer. Lower stages generally indicate that the cancer is more limited to the site of initial growth while higher stages generally indicate that the cancer is more extensive and has metastasized. Each type of cancer is staged differently and stages have different significance in different cancers. The cancer stage is important because it reflects the way that cancer specialists report the results of treatments and therefore can be used to help direct the most optimal treatment and also help to predict the outcome of the treatment.

Prognosis refers to an estimate of outcome. This can be determined by the specific cancer type and stage. Outcomes of cancer treatment are analyzed with those two characteristics in mind. Patients who undergo an established treatment can have an estimate of treatment outcome based upon other patients with similar cancer and stage receiving the same treatment on clinical trials. It must be recognized that this is only an estimate and not a prediction. Just as it is not possible to predict with accuracy at what level the Dow Jones Index will be 2 years from now or how many inches of rain will fall in Los Angeles in February next year, estimations of cure and life expectancy have similar inaccuracies. It's important that the given prognosis be taken as only as an estimate, an educated guess, rather than as an infallible prediction of the future.

The term cure refers to the elimination of cancer without it ever coming back. Patients who are cured can be expected to have a normal life expectancy. Determination of potential curability is based on scientific studies. They report outcomes for patients with the same cancer and same stage using current available treatments. Well-established and repeatable studies show that patients with certain stages of a certain type of cancer are not cured with existing treatment. This does not mean that these patients cannot live a long time, as some types of incurable cancers grow very slowly and other types of cancers are kept in check with treatment. Some patients don’t wish to be informed of their prognosis. They don't want to know whether or not their cancer is curable. 25 years ago patients were often not given this type of information. However, more and more patients and family members are now requesting this information because it allows them to plan their future in a more meaningful way and make more realistic personal and business decisions.

Q: I have been informed that my cancer is not curable and that my prognosis is poor. My neighbor told me that his sister’s friend who had my same condition was told the same thing and yet he lived 15 years. Why is that?

A: Stories like that fortunately do happen, but infrequently. That is because any given prognosis is not a prediction but an estimate. It is similar to lottery tickets. Experts will say that buying lottery tickets is a waste of money because there’s no real chance to win. Are the experts wrong? No, because the vast majority of people buying a ticket do not win the jackpot. However aren't there jackpot winners almost every week somewhere in this country? It’s simply that the odds are very much against it happening. Fortunately jackpot winners also occur in medicine and not just in the field of cancer treatment.