July 27, 2022

Your Top Cancer Questions, Answered

This piece originally appeared on katiecouric.com

We spoke with an oncologist to get some clarity about your most common cancer concerns.

If you’re one of the millions of people in this country who has been diagnosed with cancer or knows someone who has, you’ve probably got a ton of questions. Figuring out which questions to ask can feel like it requires learning a whole new language, and at times you’ll probably feel like the only person in the world who can’t speak it. The truth is, almost everyone who has dealt with a cancer diagnosis knows the feeling of having more questions than answers. That’s why we asked Exact Sciences’ chief medical officer of precision oncology, Rick Baehner, MD, to answer some of the top questions about cancer.

My mother died of pancreatic cancer. Should I be concerned that I may eventually contract pancreatic cancer as well?

While it’s important to be aware of your family history for all cancers, it doesn’t guarantee that you’ll also get the disease. Family history is a risk for pancreatic cancer because some of the gene mutations that cause the disease can be passed down from parent to child. You may have heard of BRCA, the “breast cancer gene.” Some people are born with variations of this gene which may increase their risk of developing breast cancer as well as several other cancers, including ovarian and pancreatic cancer. Heritable genetic changes that increase the risk of pancreatic cancer has its own list of watch-out gene variations, which cause as many as 10 percent of cases.

Genetic testing can reveal if your DNA holds any of these variations. By examining the DNA for genetic changes that may cause illness, these tests provide information for diagnosing, treating, and preventing cancer. With that said, genetic testing is not recommended in all cases, and if a gene variation is detected, it only reveals risk, and does not necessarily mean cancer will occur. Your healthcare provider can help you decide if genetic testing is right for you. 

Lastly, it’s important to note that most people who get pancreatic cancer do not have a family history. In many cases, the gene mutations that cause the disease are acquired as we go through life, such as those resulting from tobacco use. Regardless of family history, it’s critical for everyone to manage the risk factors that we can control.

I had surgery to remove a tumor, and my doctor says I now need chemotherapy. Why do I still need chemotherapy if the tumor was removed? What are the long-term impacts of chemotherapy?

Although a successful surgery removes any visible cancer, small pieces of cancer may still be present in the body. Adjuvant therapy is the term for treatment given after surgery to reduce the chances of cancer returning. Chemotherapy is one form of adjuvant therapy used to kill remaining cancer cells throughout the body. Although additional treatment doesn’t guarantee your cancer won’t return, it can significantly reduce the risk.

Not all patients will need adjuvant chemotherapy. In the case of early-stage cancers that have not spread, the chance of the disease recurring may be minimal, and adjuvant therapy may not be beneficial. Your doctor can help determine what might be right for you based on several factors, including your type of cancer, stage of cancer, and other cancer-specific changes.

Chemo is intended to target fast-growing cancer cells, but it can damage fast-growing healthy cells too, which causes side effects. Common ones include fatigue, hair loss, easy bruising and bleeding, nausea and vomiting. Even after treatment, chemotherapy can continue to have a long-term impact on cancer survivors. Late effects of chemo may include neuropathy, dental problems, hearing loss, infertility, and heart problems. The experience of going through treatment can also leave a lasting imprint on a survivor’s mental health, as they may face anxiety, fear of recurrence, and depression.

It’s important to keep in mind that each person’s experience with chemotherapy is different. The severity of its side effects varies, and not everyone has every side effect. It’s equally important that you feel supported during every stage of your cancer journey, including your treatment planning. 

Undergoing chemotherapy and its potential side effects can be stressful for patients and their families, which is why it should only be prescribed if it’s necessary for your full recovery and to avoid potential recurrences. If you have any concerns at all, ask your doctor to explain in detail why they think this is the best course of action for you.

I am a breast cancer survivor and have been cancer-free for three years. What is the likelihood of my getting it again in my lungs, brain, or bones? And why am I not being scanned periodically for cancer?

After a patient has completed treatment and is free of any evidence of remaining cancer, there is a risk of a cancer recurrence. Sometimes, despite best efforts, cancer cells can persist in the body and continue to multiply after treatment. In this case, the cancer could either return in the same place it first started, or somewhere else in the body. Even if your cancer returns elsewhere, it is still named after where it started. For example, breast cancer that has spread to the lungs is still treated as breast cancer. The likelihood of a cancer returning depends on many factors, although most types of cancer have a common pattern of recurrence. Talk to your doctor to learn about your specific cancer type.

Once out of treatment, all cancer survivors should talk to their health care provider about follow-up care. These regular check-ups with your doctor might include tests and procedures that monitor for any health changes. Each patient will have a different follow-up care schedule based on the type of cancer and treatment received.  For some cancers, but notably not for breast cancer, periodic laboratory tests and body scans have been shown to help reduce overall mortality from the cancer by detecting a potentially curable recurrence earlier than symptoms would allow.  For breast cancer, it is important to continue with breast imaging (such as mammography) to detect a recurrence or a second breast cancer.  When you visit your doctor, don’t hesitate to ask questions about what plan makes sense for you. Common questions after treatment can include:

  • What symptoms should I watch out for?
  • What tests do I need? How often will I have them?
  • What is the chance that my cancer will return? How often should I be screened for recurrence?

Asking questions such as these can help you decide what follow-up care schedule and screenings are best for you.

I have recently been diagnosed with cancer and was told a stem cell bone marrow transplant is the best scenario for longer survival. What is a stem cell transplant and how does it work as a form of cancer treatment?

Stem cells are the body’s “master cells,” the blank slates from which all other cells in the body eventually develop. They are extremely important because they are the only cells in the body that have the natural ability to generate new, specialized cell types, such as red and white blood cells or nerve cells.

Stem cell transplants are used to treat cancers that impact bone marrow, which is the spongy tissue in the center of bones where all blood cells are produced. Cancer itself, as well as treatment from chemotherapy or radiation, can cause the bone marrow to produce insufficient numbers of normal blood cells and too many unhealthy cells that don’t function properly. Transplants work by replacing stem cells that have been destroyed by the cancer or during treatment.

Although stem cell transplants can work with certain cancers, they are not for everyone. Like any treatment, there are risks involved that you should discuss with your doctor before making the final decision about whether to receive a transplant. Make sure you are open and honest with your doctor about any questions or concerns when discussing this or any treatment option.  

The information provided on this site isn't intended as medical advice, and shouldn't replace professional medical treatment. Consult your doctor with any serious health concerns.