Cancer is the uncontrolled growth of abnormal cells anywhere in a body. These abnormal cells are called cancer, malignant, or tumour cells.

There are over 200 types of cancer. The most prevalent types of cancer are

 sarcoma, melanoma, lymphoma, and leukaemia.

7 Symptoms & Warning Signs of Cancer

• Change in bowel or bladder habits.
• A sore that does not heal.
• Unusual bleeding or discharge.
• Thickening or lump in the breast or elsewhere.
• Indigestion or difficulty in swallowing.
• Noticeable change in a wart or mole.
• Nagging cough or hoarseness.

Stages of Cancer

What is the meaning of ”stages of cancer”?

Stages describe how far cancer has spread in your body.  Stage 0 is the less severe stage, and Stage IV is the most advanced stage. When you are diagnosed, your doctor will tell you what stage you are at.

Why is it important to understand the stages of cancer?

It’s essential to understand your cancer stage for several reasons:

• Treatment: It helps your doctor decide which treatment will work best. Early-stage cancer may call for surgery, while advanced-stage cancer may need chemotherapy.
• Outlook: Your recovery will partly depend on how early the cancer is found. Your stage gives you an idea of your possible outcomes.
• Research: Most hospitals use a national database that tracks which treatments are used and how well they work. Researchers can compare similar cases to find the most effective treatments.

• Stage 0 means there’s no cancer, only abnormal cells with the potential to become cancer. This is also called carcinoma in situ (CIS). (CIS is a group of abnormal cells that are found only in the place where they first formed in the body)
• Stage I means the cancer is small and only in one area. This is also called early-stage cancer.
• Stage II and III mean the cancer is more extensive and has grown into nearby tissues or lymph nodes.
• Stage IV means cancer has spread to other parts of your body. It’s also called advanced or metastatic cancer.

What are the choices of care available to cancer patients?

The choices of care depend on the type of cancer, the stage of cancer and the patient’s goals for care. Basic options include:

Clinical trials—Patients with advanced cancer may be offered the option to participate in early-phase clinical trials designed to assess the safety of new treatments and their safe use. Some patients join trials hoping that the treatment will slow cancer growth or that the trials might eventually benefit future patients. The risks of trials must be explained fully to a patient.

Palliative treatment aims to reduce pain and help a patient feel more comfortable. An example would be removing a tumour pressing on specific nerves and causing pain.

Hospice care – Hospice care aims to help patients live each day fully and symptom-free. It doesn’t mean you gave up on life. It just means treatment goals are different. Services from hospice care may include nursing care, doctor’s services, medicine for pain management and symptom relief, counselling, grief counselling,  spiritual care and social work services.

Home care – is for patients who prefer to be treated and cared for at home. This may include cancer treatment and palliative care.

How do I cope with cancer?

Finding out you have cancer comes as a shock to anyone. We have learnt to associate cancer with impending death, and you may experience feelings of fear, uncertainty, denial, anger, guilt, stress, anxiety, loneliness, isolation, sadness and depression. It’s also expected to feel hope, relief, surprise, acceptance and determination. You may feel any or all of these emotions at some time or another.

Recognizing these emotions and not hiding or ignoring them is essential. Talk about your feelings and fears with your doctor, therapist, family members or pastor. Ignoring difficult emotions only allows them to become more substantial and more overwhelming. Your cancer journey includes treatments and follow-up tests – which may temporarily increase fear and anxiety at specific times  – much like a flashback of when you were first diagnosed.

If you can join a support group for patients with your specific cancer, do so. It helps to share what you experience with people who went through the same thing. They also allow you to exchange practical information and helpful suggestions. The group experience often creates a sense of belonging that helps survivors feel less alone and more understood.

Read up and learn as much as you can about your cancer. Most cancers have a predictable pattern of recurrence. But no one can tell you precisely what will happen in the future.  Knowing what to expect may help you stop worrying that every ache or pain means cancer has returned.

Ask about pain. You do not have to be in pain or discomfort from symptoms caused by cancer. Talk to your doctor and health care team about how you feel. It is okay to say you are in pain and to take medicine for it. A pain-free person can focus on enjoying the time they have left. A person in severe pain may be more tired and grumpy and isolate themselves more from activities around them.

It can be challenging for me as a doctor because I often see patients who want to know everything. Then, I have caregivers who don’t want me to tell the patient everything. Yet they know their bodies, so they know what’s going on. So sometimes I get a situation where everyone knows the truth but tries to keep it from the other person to protect them—Dr. Crawford.

How do you know when you need more help?

• Worry or anxiety is out of control and influences your life negatively.
• Feeling hopeless about the future.
• Having trouble sleeping or eating well
• Not participating in activities you used to enjoy
• Having trouble concentrating or making decisions
• Feeling that you have nothing to look forward to
• Being unusually forgetful

How do I cope with chemotherapy?

Chemotherapy is a type of cancer treatment that uses anti-cancer drugs to kill cancer cells to stop cancer from growing or spreading. It affects everyone differently. The most common side effects of chemotherapy include

• fatigue
• nausea, loss of appetite
• diarrhoea or constipation
• mouth & throat sores
• hair loss
• nails going black and falling off

Plan: A chemotherapy session may take only a few hours, but you might have side effects for days or weeks afterwards.

• Ask someone to drive you to and from treatments.
• Talk with your employer. You might need time off work after a chemo session.
• Clear your schedule. Don’t plan to go to any events or do activities in the hours after chemo.
• Arrange for help with meals and child care. It might be tough to cook dinner or take care of the kids if you’re dealing with side effects like fatigue or nausea.
• Plan how to handle waste if you are nauseous or have diarrhoea after chemotherapy. This includes soiled linens and clothes.

This booklet might be helpful if you or someone near you is getting chemotherapy.

https://www.ouh.nhs.uk/patient-guide/leaflets/files/110908sideeffectschemo.pdf

How do I support a loved one with cancer?

“What can I say to a newly diagnosed loved one?”

LISTEN without judging or taking over the conversation.  Sitting and listening is probably one of the most significant contributions you can make to your loved one’s well-being. It is not a good time to share a story about your health. The cancer patient often has to make profound decisions – sharing them with you helps to organise and structure overwhelming thoughts and feelings.

GIVE ADVICE ONLY WHEN ASKED. It can be helpful to the person, but most of the time, the amount of advice people offer is overwhelming. Don’t say, “You ought to try this” or “You should do that.” Instead, let your loved one know you’ve done the research and allow your loved one to decide if they want to learn more.

EDUCATE YOURSELF ABOUT CANCER.  It helps to know what to expect. Doctors often do not describe the details of the cancer journey – patients and loved ones will find value in learning how this usually plays out. Patients and their family members need to understand that if they choose not to do chemo or some other aggressive therapy, there are other options where they will receive support, comfort care, and assistance from the health care team.

SUPPORT YOUR LOVED ONE’S TREATMENT DECISIONS. While you may be in a position to share decision-making, ultimately, it is your loved one’s body and spirit that bears the impact of cancer. There may also come when you must make decisions for your loved one because he can’t anymore. It’s essential to understand how he feels about this before it happens. How would he like to deal with it?

SUPPORT THE PERSON WHO CARES FOR THE PATIENT. The spouse, partner, parent, or adult child of the person with cancer now performs additional roles with which they might appreciate the help, such as driving, food preparation, care for the patient, hospital visits, and many more.

KEEP CONTACT CONSISTENTLY.  A journey with cancer is usually a lengthy one, and people with cancer often note that friends and family “don’t call anymore” after the initial crisis of diagnosis. Checking regularly over the long haul is tremendously helpful and meaningful for the person with cancer.

TRY TO KEEP LIFE NORMAL.  For some people, being able to do things like cook dinner or continue working can lessen the sense that cancer is taking over their lives. Your loved one may not want to discuss their cancer, and it might be helpful to make conversation that doesn’t involve their diagnosis. Keep a balance with visitors. A cancer patient usually feels fatigued and needs enough rest.

STILL, BE THERE WHEN TREATMENT IS OVER. This is often when people begin to process what they have been through. While your loved ones may no longer need help getting through treatment, they may still need your emotional support.

BE THERE.  Think about how you’ve helped each other feel better during a difficult time. This could be as simple as sitting with your loved one during treatments. Do whatever works for you both, and don’t be afraid to try something new.

How do I cope when finding out a loved one has cancer?

Remain calm

It is expected to experience a range of emotions similar to grief – denial, anger, bargaining, depression and ultimately, acceptance. Allow yourself to feel the complex emotions and process the trauma of the diagnosis on your own. If you fall apart, you cannot help the patient.  Once you are calm, remaining calm to assist and support your loved one on their journey is crucial.

Focus on facts, not on fear.

Being positive in every way is crucial to coping with and combating cancer. You might be overwhelmed by what you read and hear online or from friends, but remember that individual journeys differ.

Accompany the patient when they have a doctor’s appointment.

Having someone at your side and not facing difficult times alone is comforting. It’s your job to listen, take notes, ask pertinent questions, organize paperwork, and help the patient stay as calm as possible.

Ask questions, and stay informed.

Learn what you can about cancer. If in doubt – ask the doctor or therapist. It is essential to “take it one step at a time, try to remain grounded in the present and not jump to the future.”

Listen

Listen much more than you talk without judgment or interference.

Support their decisions

Whatever the decision about their journey with cancer or treatment – it is their life and their choice. Respect their decisions.

Ask how you can support them.

Don’t make assumptions or take over. Ask how you can help and support. Typically, most patients do not want to be viewed as a burden. Keeping their independence as long as possible is encouraging for their self-worth. Discuss ways of assisting.

Cancer affects the whole family.

Talking to Children About Death

Children deserve to be told the truth about a poor prognosis. Hiding the truth from them leaves them unprepared for the loved one’s death and can prolong the grief they will feel. And if you don’t talk about the loved one’s condition or don’t tell the truth about it, you risk your children having difficulty trusting others when they grow up. By including children in the family crisis, you can guide them toward healthy coping methods and help them prepare for their impending loss in healing ways.

Children of all ages may wonder about dying, life after death, and what happens to the body. It’s essential to answer all of their questions. If not, they may imagine things that are worse than reality. Let them know everything is being done to keep their loved ones comfortable. Tell them that you will keep them updated. And provide opportunities for them to say goodbye.

Get and accept help

Many people want help but do not know whether they need or want help. Many caregivers wish they asked for help sooner because they took on too much themselves.

You have to learn that if people offer, let them do something. Tell them what you need to have done because they don’t know.  You must be willing to let go of your pride and let them help you. -Lynn

Accepting help from others isn’t always easy. People tend to pull away when facing tough times, and you may need to remind others that you still need help.

I have been the primary caregiver the whole time. At first, we had emotional support from the church and friends, but they faded over time. I have been stressed beyond belief. – Marion

How can others help you? Here are a few ideas:

• Help with household chores – from swimming pool backwash to laundry.
• Listen when you talk and share your feelings.
• Help drive your loved ones to and from appointments.
• Picking up kids from school.
• Pick up prescription groceries.
• Prepare a meal for the family.

What do you need to plan for if a loved one is dying?

• Finances – who will be the legal power of attorney
• Coping with work issues
• Living arrangements for a patient who lives alone
• Living arrangements for a partner that stays behind.
• Wishes the patient have for when the time comes that communication is impossible
• Wishes for burial
• The patient’s last will.
• Insurance issues must be cleared up.
• List all important papers and original documents and where to find them.

A worksheet of personal affairs is on page 48 of the following document

https://www.thelist.com/44592/ways-cope-someone-love-gets-diagnosed-cancer/

Signs that death is near and what you can do

• A person is exhausted, sleeps more and is becoming more unresponsive.
• Becomes confused about time and place / or does not recognize family members
• Become more withdrawn
• Less need for food or liquids
• Loss of bladder or bowel control
• dark urine or decreased amount of urine
• skin becomes cold to the touch or bluish
• Irregular breathing – slow, shallow, and sometimes long between breaths.

Stay with the patient. Be calm. You can whisper to reassure him/her of your presence. You can hold their hand or wipe their forehead with a cool cloth. Make sure the person is pain-free. Curb noise around the room and limit visitors by letting in one or two people at a time. Some patients lose consciousness and can no longer eat, drink or communicate. Ensure the person is kept dry and comfortable (for example, keep their lips moist with a lip balm, turn them to the side every four hours, and check if they are dry. Please note that although the patient’s skin feels cool, he/she is probably unaware of being cold. You may close the eyes of the patient if they stop blinking).  The person might still be able to hear from you. They seem to float between this world and the next world and might even smile now and then.  Keep lighting in the room soft. You may turn the patient’s head towards a light source and tell the patient it is okay to let go.

Grief after cancer death

Loss is experienced by people differently – some make peace quickly; others get stuck in grief for years.

People’s emotions are feelings of guilt, hopelessness, sadness or worry about the future, anger, anxiety or depression and intense grief. Understand that all these feelings are normal.

Acknowledging your feelings and allowing yourself to grieve in your way is essential. Sometimes, the loss of a loved one triggers more losses than you have experienced during your lifetime. There is no right way to grieve – some people throw themselves into work; others freeze up and stay for a while. But eventually, we move through the grief with or without help, and we carry on with life.

Suggestions to move through grief:

• Talk about it—tell people around you who care how you feel. Talk about the journey you were on and the ups and downs of the journey. When asked how you are doing, it is okay to say that you are not OK.
• Find something every day for which you are thankful. Start new. Each new moment and new day gives you the chance to try again.
• Keep a journal about your feelings. It can help to relieve negative thoughts and feelings.
• Let yourself laugh. It is still the best antidote for depression.
• Connect with other people. Isolation causes depression.
• Let go of mistakes. No one is perfect. Forgive yourself and others. Get some rest.
• Join a support group if you feel comfortable sharing your feelings with others—in person, by phone, or via social media. It can help to share your experience and get advice from people who have been through the same thing.
• Take care of yourself  – take a nap, exercise, try a hobby, go on a road trip, see a movie, buy something new, and treat yourself to a haircut. 

More reading:

https://www.mobieg.co.za/mental-health/grief/

Coping With Grief On Significant Dates And Holidays

Coping with ”Woundedness” & Loss after Trauma

Resources:

What are the most common symptoms of cancer? https://facts-all.com/en/Q&A/page=27df2cf0a2aed8f638b004003a10a820

The Stages of Cancer According to the TNM System. https://www.webmd.com/cancer/cancer-stages

Fear of recurrence – Coping with the fear and living with uncertainty. https://surviveandthrive.ie/coping-psychologically/fear-of-recurrence/

“What Can I Say to a Newly Diagnosed Loved One?” – Oncology Nurse Advisor. https://www.oncologynurseadvisor.com/home/for-patients/fact-sheets/what-can-i-say-to-a-newly-diagnosed-loved-one/

Ways To Cope When Someone You Love Gets Diagnosed With Cancer. https://www.thelist.com/44592/ways-cope-someone-love-gets-diagnosed-cancer/

Plans and Decisions for End-of-Life Care as a Cancer Caregiver – NCI. https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning