Sunday, April 22, 2007

An Unwanted Journey: Day 0515 - Aha ... the Cancer Process!

Have you ever had an "aha" experience? You know what I mean - a situation where something finally clicks and your perception shifts. We've all had the experience of looking at a common image of an old woman and then ... aha ... we see the pretty young woman.

These perceptual shifts are usually found in books recommending some or other pop psychology phenomenon-of-the-month and can usually be dismissed as curious but insubstantial. But then, if we're lucky, we've also experienced far larger perception shifts in which our view of more significant realities has changed. It might be a religious conversion (or unconversion such as that of John Ruskin) experience, or it might be an intuitive grasp of a mathematical concept, or it might even be an awakening to the simple beauty of evolutionary processes. These are all marvelous, fleeting, gone-in-an-instant flashes of insight.

Well, yesterday evening, I had one such flash. I'm ashamed to say that it took almost 54 years to happen, 18 months of fighting the dreaded "cancer", and hundreds of blogs communicating my thoughts about my unwanted journey to get here. But that's just the way it is.

Yesterday afternoon, I listened to Dr. Robert Buckman talking about cancer, surviving, thriving, and matching one's ambitions with one's abilities...and even then it didn't click. But then as I began reading my autographed copy of his book Cancer is a word, not a sentence, the aha occurred.

What was the nature of that discovery?

Cancer is not a disease! It is a process. In the same way that infection, inflammation, and degeneration are not diseases but disease processes that cover a multitude of individual diseases of varying severity and danger to one's health, so too is cancer. There are over 200 known diseases that all originate with the cancer process, ranging from the largely benign basal or squamous cell carcinoma to the usually fatal pancreatic cancers.

Just as we wouldn't think to conflate a cold with the Ebola virus just because they both have an identical underlying viral infectious process, so too we shouldn't lump together all the cancers because they all have an identical underlying cancer process. The problem, of course, is words. We don't have separate words to identify the different cancers in the same way that common parlance discriminates between a cold and HIV/AIDS.

So this particular aha experience is difficult to communicate effectively. Common vocabulary won't do the work for us. But words are, nonetheless, terribly important. As Dr. Buckman says, without proper words to differentiate the various cancers and their wildly disparate prognoses, we're left with a diffuse fear. We just hear the word Cancer. And we all know that cancer invades the immune system, the bones, the lymphatic system, spreads throughout the entire body, and kills us in the most offensive and debilitating manner. We've all seen it with friends and loved ones.

When we are diagnosed with cancer, we don't react in the same way as when we are diagnosed with an inflammation. If our doctor tells us we have an inflammation, we immediately ask, "What kind of inflammation? How does it work? How will my body be affected? Is it serious?". We realize we need more information and that subsequent information is critical to predicting the course of the ailment. We put fear on hold until we get the facts.

But with the diagnosis of cancer, we immediately go into panic mode. I know I did.

"When predictability is lost, fear and panic rush in to fill the vacuum." - Dr. Robert Buckman

My aha experience yesterday has led to the realization that educating the public about the process of cancer is absolutely critical, especially if one of our goals is to alleviate fear and panic.

Here's a good place to start. Cold Spring Harbor Laboratory, after receiving a grant from NCRR of NIH, has prepared an animated web site explaining the process of cancer. It's fantastic! It's called Inside Cancer and it fills a huge gap in helping the educated layperson understand the process of cancer in the same way that we understand (to some extent at least) the processes of infection, inflammation, and degeneration. It is only when we start viewing cancer as a process, and not as a single disease, that we can alleviate some of the fear and panic associated with the vocabulary of cancer.

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