Commonly Asked Questions After Mesothelioma Treatment

There are some questions that will be on the mind of mesothelioma patients after the finish their course of therapy.The common questions are:

1-Can I be assured the cancer will never come back?

No, it is not possible to guarantee that once you have completed cancer treatment your cancer will never come back. Although your doctor may say, "Your cancer is gone" or "I think I removed all the cancer" or "I see no evidence of any cancer," the fact remains that there is always a chance that there are some cancer cells left in your body that survived, even though they cannot be seen or found with any test used today. These cells can begin to grow over time and cause your cancer to recur.

And while you don't want to ever think about the chance of having a second cancer, it is possible. Having one cancer doesn't make you immune to having a second or even a third different cancer.

Some people find it very hard to get this thought out of their minds. While it is useful to take measures to prepare for the chance that the cancer can return, for some people the thought can become a fear that interferes with daily life. Some people deal with these thoughts by distraction, or by focusing on what is most important to them on a day-to-day basis. Others must take further measures, such as joining a peer support group or seeing a mental health professional. After the stress of cancer, the way you deal with the emotional pain can be key to moving on with your life.

2-Is a "no-cancer guarantee" possible?

Cancer is not predictable. The outlook for mesothelioma cancer in p[articular is very dismal, most people do not survive beyond 1 year so no doctor can guarantee cancer will stay gone forever.

A recurrent cancer starts with cancer cells that the first treatment didn't fully remove or destroy. Some clusters of cancer cells may have been too small to be detected in follow-up tests, scans, or blood work. This does not mean that you got the wrong treatment. It does not mean that you did anything wrong after treatment, either. It means that a small number of cancer cells survived the treatment you had. Over time, these cells grew into tumors or cancer that your doctor could finally detect as a recurrence.

Just as it happened the first time, there is also a chance that your normal cells may, for any number of reasons, develop the same damage in their DNA. (DNA holds genetic information on cell growth, division, and function.) This damage then causes a gene (a small section of DNA) to change (mutate). When genes mutate, they can become oncogenes, which allow cells to become cancer cells that divide quickly and out of control.

There is also something called a tumor suppressor gene, which tells cells when to repair damaged DNA and when to die (a normal process called apoptosis, or programmed cell death). This gene is like the brake pedal on a car. Just as a brake keeps a car from going too fast, a tumor suppressor gene keeps the cell from dividing too quickly. When tumor suppressor genes are mutated or turned off – that is, when the brakes fail – the cells divide very fast, allowing cancer cells to develop. Changes in tumor suppressor genes can be inherited (you are born with them), or they can happen during your life.

Not all of the growth factors for cancer cells have been found yet. Even though treatment may seem to have gotten rid of all of the cancer, there may be just one tiny cancer cell left someplace in the body. This cell may not cause any harm for many years. Suddenly, something can happen that will change the immune system and the cell becomes active, grows, and makes other cells. The result is a cancer recurrence.

-What should I look for if I am worried about a recurrence?

It is easy to obsess about every ache and pain if you are worried about your cancer returning. But in reality, there are few major symptoms that could mean serious problems. If you have any of the problems listed below, tell your doctor at once.

* return of the cancer symptoms you had before (for example, a lump or new growth where your cancer first started)
* new or unusual pain that seems unrelated to an injury and does not go away
* weight loss without trying
* bleeding or unexplained bruising
* a rash or allergic reaction, such as swelling, severe itching, or wheezing
* chills or fevers
* headaches
* shortness of breath
* bloody stools or blood in your urine
* lumps, bumps, or swelling
* nausea, vomiting, diarrhea, loss of appetite, or trouble swallowing
* cough that doesn't go away
* any other signs mentioned by your doctor or nurse or any unusual symptoms that you just can't explain

Whenever you have a symptom, your first thought might be that your cancer has returned. Remember that there are illnesses and medical problems that have nothing to do with your previous cancer. You can still get colds, infections, arthritis, heart problems, etc. – just like anyone else. As with any illness, your doctor is the best person to find the cause of your symptoms.

-What about future health problems I might get from cancer treatment?

You should also know that some cancer treatments may cause health problems later on. These problems may not appear right away and some don't show up until years after treatment. Ask your doctor:

* if the treatment you had will put you at risk for short- or long-term problems
* what those problems are and how you can recognize them
* what you should do if you notice them
* what you should do to take care of your health

-What does "5-year survival rate" mean?

The 5-year survival rate refers to the percentage of patients who are alive at least 5 years after their cancer is diagnosed. Many of these people live much longer than 5 years after diagnosis. The 5-year rate is used as a standard way to discuss prognosis or the survival outlook.

You may also hear the term 5-year relative survival rate. Relative survival compares survival among cancer patients to that of people not diagnosed with cancer, but of the same age, race, and sex. It is used to adjust for normal life expectancy when cancer is not present. 5-year relative survival rates are considered to be a more accurate way to describe the prognosis (long-term outlook) for groups of patients with a certain type and stage of cancer. But they cannot be used to predict individual cases.

Keep in mind that 5-year rates are based on patients who were diagnosed and first treated more than 5 years ago. These statistics may no longer be accurate because improved treatments often result in a better outlook for those who were diagnosed more recently.

There is another point to remember when talking about survival rates. Survival rates look at survival only, not whether the person is cancer-free 5 years after diagnosis. They are based on a group of people of all ages and health conditions diagnosed with a certain type of cancer. These statistics include people diagnosed early and those diagnosed late. As with any statistics, they should only be used to get an idea of the overall picture. They cannot be used to predict any one person's outcome.

-Why won't the doctor say, "You are cured"?

Most doctors avoid using the term "cure" because it means that your cancer is totally cured. As we have discussed, this is almost impossible to say in any case of mesothelioma cancer. The best a doctor can do is say that they can find no signs of cancer in your body at this time. This is most often stated as "No evidence of disease." Your doctor may continue to follow you closely for many years and do tests to watch for any signs of cancer recurrence. There is no harm in assuring yourself that you are cancer-free if that's what all the evidence shows. Enjoy the feeling that you do not have cancer. But always remember that it is still possible for cancer to come back even after you have been cancer-free for 5 years or more.

-What does it mean if the doctor says, "Your cancer is controlled"?

A doctor may use the term "controlled" if your tests or scans show that your cancer is not changing over time. Another way of defining control would be calling the disease "stable." Controlled means that the tumor does not appear to be growing. Some tumors can stay the same for a long time, even without any treatment. Some stay the same size because of the cancer treatment and they are watched by the doctor to be sure that they don't start growing again.

-What does it mean if the doctor says, "Your cancer has progressed"?

If the cancer does grow, the status of your cancer would change and your doctor might say that your cancer has progressed. Most clinical trials define a tumor as progressive when there is a 25% measured growth in the tumor. (See the section "What is cancer recurrence?" for more on the difference between recurrence and progression.)

-How is treatment response described?

When a treatment completely gets rid of all tumors that were able to be measured or seen on a test in some way, it is called a complete response. The decrease in tumor size must last for at least 1 month to count as a response.

In general, a partial response means your cancer responded somewhat to your cancer treatment, but still has not gone away. If you are in a clinical trial this usually is defined more precisely. A partial response is most often defined as at least a 50% reduction in measurable tumor. The reduction in tumor size must last for at least 1 month to qualify as a response.

-How long is treatment given before the doctor can tell if there is a response?

The treatment that is first prescribed is based on the last 20 to 30 years of clinical experience in treating that kind of tumor. But no 2 cases are exactly alike, and response to treatment cannot always be predicted.

Standard practice is to wait for 2 full cycles of treatment before looking for any response to it. This usually takes about 2 to 3 months. Response is checked by repeating the tests that show the cancer. If the tumor fails to respond to the first treatment, changes will be made, perhaps to a chemotherapy combination that has shown promise in similar cases.

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