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Filed on January 22, 2020

Following the first episode last week, here is more information on managing and seeing yourself through the journey of cancer treatment. What you need to know about your treatments? What do you as your doctor? When you are guided by an expert you are more aware and win half the battle with confidence.

Here are some inputs from Dr. Fadi Alnehlaoui, Specialist Surgical Oncologist in Zulekha Hospital Sharjah and Dr. Pranay Girdhari Taori, Specialist Medical Oncology in Zulekha Hospital Dubai.

1. Exactly what kind of cancer do I have and where is the cancer located? Has the cancer spread beyond where it started?

Cancer has many types and depends on the organ and tissue it came from, cancer can arise from any site in the body hence we called it primary cancer. In advanced stages when it starts spreading out of the primary organ, it is called secondary cancer or metastasis. Here we can see it in one or multiple organs out of the original organ.

2. What's the treatment? What are my chances of survival, based on my cancer as you see it? What is your advice?

Cancer treatment is not of one type, usually we use many kind of options like surgery, chemotherapy, radiation therapy, hormonal therapy, targeted therapy and synthetic lethality. The choice of therapy depends upon the location and grade of the tumor and the stage of the disease, as well as the general state of the patient . Detecting and treating the disease at an early stage can significantly improve an outlook and reach the cure.

3. What are the tests we need to undergo? Should I check in other countries for better options?

Most of cancers are diagnosed by the tissue biopsy which is important to give us an idea about the type and degree of cancer, after that and before any kind of treatment, we have to complete the imaging study to identify the staging which allows us to know the extent of cancer presence in the body. After that we will be able to plan treatment, which will be different from patient to patient. The treatment decision will be taken by the tumor board (a committee of oncologists) which is following the most updated international treatment guidelines, ensuring the treatment plan will be the same worldwide. Today, all kinds of new treatments and techniques are available with good expertise in UAE.

4. Are we sure the cancer will not recur after treatment? What can I do if it comes back? How long will I live?

Recurrence is one of the common problems we face during and after cancer treatment, the most important prognostic factor to determine the recurrence is which stage the cancer was in at the time of diagnosis. The earlier the diagnosis, the lower are chances of recurrence and the greater cure rate. If cancer recurs it does not mean the end as even recurrent and metastatic cancer can be treated and controlled.

5. How do we finance the treatments? For how long should I take treatment? What risks and side effects should I expect?

In most cases medical insurance covers the treatment. For patients who have no insurance and have finance difficulties we could take assistance from supportive sources to help cancer patients with discounts. The treatment period varies in time depending on the type and stage of cancer, some cases need short time to finish the treatment while other could need months or years. The side effects also vary depending on the type of treatment.

6. What about my lifestyle? Do I need to keep away from people? Can I work? How are my looks going to be affected with hair loss and do I regain the hair?

All kinds of cancer treatments are well tolerated and don't affect normal life in the long term. In some stages of treatment taking rest and keeping away from people could be required especially during chemotherapy to avoid possibility of negative impact on some organs like the immune system, hair and skin. But all side effects are temporary and end once the treatment is complete.

7. Can I use my regular cosmetics once detected with cancer?

Cosmetics contain harmful chemicals and chemicals normally are carcinogenic. Excessive and regular use of cosmetics may definitely lead to cancer. Cosmetics must be used in limits. As far as possible simple living is the key to good health. Anything in excess even the cosmetics can cause cancer. Natural products can be used and limited use of good quality or even branded cosmetics is recommended.

8. Will this treatment affect my ability to have children? How can I prevent or treat side effects?

Cancer treatment can cause infertility especially chemotherapy. However all chemotherapy agents do not cause infertility. Whenever we are giving chemo agents which can cause infertility we will definitely go for sperm preservation in males and oocyte preservation in females. This cannot be generalized. However with the fear of infertility, patients should not miss their cancer treatment. They should clearly discuss with the doctor and now there are various available means to combat infertility.

9. What is the 'stage' of the cancer? What does this mean?

Cancer being a systemic disease tends to spread through blood and lymphatic system. Hence when it advances, it tends to spread through blood and lymphatics to liver, lung or brain. Accordingly if it is localized cancer it is in early stage or locally advanced as per extension locally. If it is spread to distant organs it is at stage 4. As staging advanced prognosis becomes poorer and treatment becomes more morbid and complicated. Stage of disease can be determined clinically and later on radiologically through imaging. Pet scan is the recent modality to stage many cancers especially lymphoma or testicular cancer.

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