The name “cancer” is no stranger to fear. According to the latest statistics in the West, cancer mortality has surpassed cardiovascular disease as the number one killer. However, the nature and effects of cancer are not well understood by most people. Cancer is essentially a disorderly and uncontrolled growth of cells that can occur in any part of the body. Cancer tissue expands to occupy “territory (both local and foreign)” and “pushes out” normal cells, rendering the body’s internal functions unsustainable. Despite the horror of cancer, many people are now doing well with treatment and more patients have a chance to return to normal life now than ever before. Cancer Basics Cancer is more than just a disease and encompasses many types that can originate in the lungs, breast, colon, prostate, or even blood. Cancers are similar in many ways, but different types have different growth and spread characteristics. How do cancers resemble each other? The cells in our body each have their own job to do. Normal cells divide in an orderly fashion, dying and being replaced by new cells as they age or become damaged. Cancer, on the other hand, breaks this program, with uncontrolled cell growth, constantly growing and making new cells and expelling normal cells. It then gradually causes problems in the body starting from the site of emergence. Cancer cells can also spread to other parts of the body, for example, lung cancer cells can “swim” to the bone and continue to grow there. This process is called “metastasis,” and when lung cancer metastasizes to the bones, it is still called lung cancer rather than bone cancer. To doctors, the cancer cells in the bones are exactly the same as the cells in the lung cancer. How are cancers different again? Some cancers grow very fast while others are slow, and some form lumps while others do not (leukemia, certain lymphomas). Different cancers respond differently to treatment, for example, some surgical procedures are best, while some chemotherapy is most effective. Combinations of two or more treatments achieve better results. For this reason, it is important for doctors to find out what type of cancer a patient has so that they can choose the best treatment. What about tumors? Most cancers form a lump and grow, but not all lumps are cancerous. To be sure, the doctor will remove a small piece of tissue to see if it is cancer. Non-cancerous lumps are called benign, while cancerous lumps are malignant. Cancers like leukemia do not form tumors, but grow in blood cells or other cells. Why is cancer staged? I’m sure you’ve heard that cancer is in the “early or late stages”, but this is only a vague popular interpretation. Doctors need to know whether or not the cancer can metastasize from the site of origin or how far it can metastasize, which is called staging, like when a patient is in stage 1 or stage 2. Doctors find the best treatment by knowing what stage the patient is at. For different types of cancer, staging is determined by a variety of different tests. Usually, if the cancer stage is low (like stage 1 or 2), metastasis is unlikely; however, high stage (stage 3 or 4) has a high incidence of metastasis. stage 4 is the highest stage. Knowing this will help you understand the meaning in communication with your doctor. How to treat cancer? The most common treatments for cancer are surgery, chemotherapy (chemotherapy) and radiation therapy (radiotherapy). Surgery is the removal of the cancer through an open incision or minimally invasive approach. The surgeon may also remove the part of the body that is affected by the cancer, such as removing all or part of the breast tissue during mastectomy or removing the entire prostate gland during surgery for prostate cancer. However, surgery is not effective for all cancers. The best treatment for hematologic malignancies is medication, such as leukemia. Chemotherapy is short for chemotherapy, which uses drugs to kill cancer cells or slow down their growth. Some chemotherapy is administered by intravenous infusion, and pills can also be taken by mouth. Since chemotherapy drugs are absorbed almost throughout the body, this modality is mostly used for cancers that have metastasized. There are quite a few side effects, such as hair loss. Of course, sometimes chemotherapy is given in conjunction with surgery. Chemotherapy before surgery is called neoadjuvant therapy, which aims to shrink the tumor to facilitate surgical removal; chemotherapy after surgery is called adjuvant chemotherapy, which controls the residual lesions. Radiotherapy is known as radiation therapy and can be used alone or in combination with surgery or chemotherapy. The radiation used in radiotherapy is mostly X-rays, which irradiate the cancer site to kill the tumor cells. Radiotherapy can now be adjusted in scope and intensity (3-D conformal and intensity modulation) according to the location and nature of the tumor, in order to maximize the killing of cancer cells while protecting important normal tissues. There are also radioactive “particles” implanted for specific cancers, called brachytherapy, which can be effective for patients with early stage prostate cancer, for example. Targeted therapy and immunotherapy, both of which are often used in combination with other methods or in advanced stages of the disease. Targeted therapy is the application of drugs or other substances to block cancer by interfering with specific molecules (also known as molecular targets) that interfere with tumor growth, proliferation, and metastasis. Targeted therapy is also known as molecularly targeted therapy or precision therapy. Immunotherapy is based on fighting cancer through the body’s immune system, either by activating the immune system to attack cancer cells more vigorously and effectively or by increasing the enhancement of exogenous immune system components, such as artificial immune proteins. The recent emergence of PD1-PDL1 inhibitors (which we will have the opportunity to describe later) is considered a new star in the fight against cancer and is expected to change the current treatment paradigm. Which is the best treatment? This is the key question on every cancer patient’s mind, which is actually determined by the type and stage of cancer the patient has, and of course, the doctor’s knowledge and skill. Some cancers work well with surgery, while others respond better to radiotherapy. Understanding the type of cancer is the first step in finding the best treatment. The stage of the cancer can also help the doctor choose the most appropriate approach. If it is already a stage 3 or 4 condition, systemic treatment, like chemotherapy, should be chosen. The patient’s health status and treatment preferences will also play an important role in treatment decisions. Not all treatments are appropriate for a particular patient, and it is important to ask the doctor about how many other specific options are available, that treatments do have side effects, and to ask about the problems that can occur with each treatment. Don’t worry about asking questions; it’s a patient’s right to do so, and specific and detailed questions can help figure out which treatment is most likely to benefit. “How could it be me?” Cancer patients often ask “What did I do wrong?” , “Why me?” . Doctors often don’t know what caused the cancer, at which point the patient will always try to figure out why. Patients may relate to being “punished” for something they did or did not do in the past and feel uncertain. Such feelings are not at all uncommon and are common among cancer patients. In Dr. Zhang Yi’s previous observations of patients with urological malignancies, he found that many patients were depressed or even depressed after learning of their cancer. In fact, cancer is not a punishment for one’s past behavior, and one does not need to focus on blaming oneself for looking for ever possibly preventing cancer from occurring. Cancer is not anyone’s fault, and it is almost impossible to find a specific cause; it is right to focus on how to cope and take care of yourself. How do I talk about it to my loved ones? Talking about cancer is not easy, even with your loved ones. Knowing you have cancer can stir up all sorts of feelings, including sadness, anger and fear. Sometimes it can even be overwhelming, not to mention how to talk about it with others. It can also be difficult for a patient’s relatives to talk about it, not knowing what to say that would be helpful or help ease the emotions. The following are some helpful tips, although they are suggestions in the context of Western society, we are also converging and integrating, and people are more autonomous and independent, so you may want to see if they can help: 1. Tell close family and friends about your condition as soon as you know, sooner or later they will know, and for not hearing from you they may feel disappointed that they are not trusted. 2. If it is clear, inform them of the type of cancer you have and what treatment you will receive, there is no longer anything anyone can do to keep you from getting cancer. This way they may get into a position to help you as soon as possible. 3. Clearly inform them that you need help from family and friends. If help is needed to carry you to the doctor or hospital, let them know. If you need help at home, inform them as well. Sometimes you’re not sure what help you need, no problem, let them know you’re not sure, but will notify them when you need it. 4. Tell your nearest and dearest how you feel. Although not easy, you can get support when you need it most. In developed countries, if a patient does not choose family or friends, they can seek help from cancer support organizations or mental health counselors. 5. If friends or family members only say “cheer up” after telling them, you can let them act as listeners instead of asking you how you feel. Talking about what’s bothering you doesn’t necessarily require advice in return. 6.If you find that the person you are talking to is not the right person, don’t be upset, there is always someone to listen. 7. If you find out that you can do something before cancer, you may not be able to do it now, let your family and friends know. 8.It is better to let your family and friends do the same as they did before you got cancer, so they don’t need to feel guilty. 9.If you are having a hard time depressing yourself, family and friends may not be able to help. Professional doctors, nurses or religious people can confide in you.