If, even then, you cannot find a dose that relieves your pain without unpleasant side effects, you should stop taking it altogether and change to a different painkiller. The alternative would be to add a second painkiller while continuing to take unsatisfactory doses of the first. If you do this, you are likely to finish up With much more troublesome side effects for the same degree of pain relief. It is better to find the single painkiller that suits you best and take effective doses of that.

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A gene probe is a new and exciting laboratory tool that identifies an abnormality in the genes of the tumor cells or the normal cells. These abnormalities are related to the development of certain
types of cancer. In research settings, the gene probe is being used to

• help make specific cancer diagnoses

• help better assess the prognosis

How Will Gene Probes Help Cancer Patients?

When gene probes become available in nonresearch settings, they will have an enormous impact on

• how various cancers are diagnosed and staged

• how the best therapy is chosen for each individual

• what treatment options are available

Knowing which cancers are likely to be cured with relatively little treatment and which are likely to act very aggressively alb ear the doctors to fit the treatment to the cancer better. Patients whose gene probe predicts that they will do well with little treatment will be spared overtreatment. Patients whose gene probe predicts that the only chance is with very aggressive treatment will perhaps be
spared recurrence or a poor outcome from treatment that was not aggressive enough.

Gene probes may allow more sensitive follow-up of cancer, making possible earlier detection of recurrence and, therefore, earlier treatment. Most important, it is hoped that gene probes will provide the path to safe, effective, curative therapy by permitting replacement of defective genes that cause cancer.

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Epidemiologic studies have shown that people whose culture is characterized by a diet rich in fruits and vegetables have a lower risk for certain types of cancer than those whose diet is lacking in these foods. In addition, when people who normally eat few fruits and vegetables add fruits and vegetables to their diet, they appear to lower their risk of developing certain cancers. The relationship between eating fruits and vegetables and reducing risk is not an association; these foods actually do cause changes in the Ь that protect against cancer.

We do not know whether the benefit is due to the antioxidants in the fruits and vegetables or to some other substances, not present in synthetic supplemental antioxidant pills.

In the United States the National Institute of Health (NIH. conducting many studies in humans to look at the role dietary and
supplemental antioxidants play in protecting against future cancers. However, no well-controlled human studies have yet given a definitive answer to the question about the benefit of supplemental antioxidants.

Your doctor can tell you the plan for your follow-up schedule. For example, you may be scheduled for checkups with your doctor every three months and scans every six months for the first year, then for checkups every six months and scans every twelve months for the next two years, and then for annual checkups and scans. This rough schedule will be adapted to your individual needs. If you have ongoing medical problems, or if you develop new ones, you will need to be seen more often than is usual for a post treatment patient.

Your doctor can tailor your follow-up to your circumstances only if you keep him or her informed of your progress, problems, and questions. When you develop new problems between checkups, notify your doctor or nurse so that the timing of your next visit can be moved up if necessary.

You play a key role in optimizing the timing and efficiency of your follow-up by keeping your doctor well informed of your condition.

Get a list of signs and symptoms about which your oncologist wants to be notified right away. If you develop something not on your list and if you are uncertain about whether you should call, call your doctor’s office and ask whether you should

•wait for your scheduled appointment to discuss the question or problem

• talk to the doctor on the telephone

•come in earlier than your scheduled appointment to see the doctor

When in doubt about calling your doctor, call. It is better to sound a false alarm than to have a treatable problem get out of control о cause unnecessary discomfort or anxiety. You owe it to yourself and your family not to take chances.

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Many types of cancer have a good short-term prognosis but a poor long-term prognosis. For example, your cancer may be incurable with current forms of therapy, but is so slow growing that you are expected to survive for many years. Or your type of cancer may be expected to respond well to initial treatments, but has a high rate of recurrence and loses this responsiveness.

Prognosis may be described in general statements such as “Your prognosis is very good” or “Your prognosis is poor.” Oftentimes, when you want to hear something more specific, you will be given a percentage, such as “Your prognosis for a five-year survival is 60 percent.”

To say that you have a 60 percent chance of staying in remission for at least five years means that for every 100 persons with your type of cancer who received your type of treatment and achieved remission, 60 will stay in remission for at least five years and 40 will develop recurrent cancer. In five years each individual patient will either be in 100 percent remission or have a recurrence.

To say that you have a 60 percent chance of surviving for at least five years means that for every 100 persons in your situation, 60 will be alive in five years. Some of those 60 will be disease-free, some will have had recurrent disease and be back in remission, and some will be living with active cancer.

Your prognosis after treatment may be different from that when you were first diagnosed. This is because your doctors have two important pieces of information that were unavailable before you were treated: they know whether your cancer responds to treatment, and they know how healthy you are after treatment.

For illustration, let us say that when you were originally diagnosed, you were told that you had a 50 percent chance of surviving at least five years. If you did well with treatment, you may now be told that you have a 95 percent chance of surviving at least five years. This improvement in your chance of survival has occurred because the original figure of 50 percent included those people who would not respond to the therapy as well as those who would die of complications before achieving remission. At the time of your diagnosis, doctors knew your chance of responding, but could not know how your cancer would in fact respond. The figure of 95 percent given to you after your treatment is derived from information showing that, of the people who did as well as you did, 95 percent were alive five years later.

One thing to keep in mind is that your prognosis keeps changing as your situation changes. The prognosis given to you when you were first diagnosed is not as relevant or meaningful as the prognosis based on your current situation.

Factors that help determine your prognosis include

• your type of cancer

• the stage of your cancer at the time you were diagnosed

• your cancer’s response to treatments

• your level of physical fitness

• the presence or absence of other medical conditions

• available indicators specific for your type of cancer, such as tumor markers and hormone receptors

• many factors that we cannot measure, such as your “will to live”

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