RSS Feed
Twitter
11:27 AM
Unknown
Causes of Colon Cancer
Most colorectal cancers arise from adenomatous polyps. Such polyps are comprised of excess numbers of both normal and abnormal appearing cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.
People with certain genetic abnormalities develop what are known as familial adenomatous polyposis syndromes. Such people have a greater-than-normal risk of colorectal cancer.
In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
There are specific genetic abnormalities found in the two main forms of familial adenomatous polyposis.
The cancer usually occurs before age 40 years.
Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After 6 months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.
Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.
HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.
HNPCC syndromes are sometimes linked to tumors in other parts of the body.
Also at high risk for developing colon cancers are people with any of the following:
Ulcerative colitis or Crohn's colitis (Crohn's disease)
Breast, uterine, or ovarian cancer now or in the past
A family history of colon cancer
The risk of colon cancer increases 2-3 times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.
Other factors that may affect your risk of developing a colon cancer:
Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
Obesity: Obesity has been identified as a risk factor for colon cancer.
Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
Drug effects: Recent studies have suggested postmenopausal hormoneestrogen replacement therapy may reduce colorectal can cer risk by one third. Patients with a certain gene which codes for high levels of a hormone called 15-PGDH may have their risk of colorectal cancer reduced by one half with the use of aspirin.
Cancer of the colon and rectum can exhibit itself in several ways. If you have any of these symptoms, seek immediate medical help. You may notice bleeding from your rectum or blood mixed with your stool.
People commonly attribute all rectal bleeding to hemorrhoids, thus preventing early diagnosis owing to lack of concern over "bleeding hemorrhoids." New onset of bright red blood in the stool always deserves an evaluation. Blood in the stool may be less evident, and is sometimes invisible, or causes a black or tarry stool.
Rectal bleeding may be hidden and chronic and may only show up as an iron deficiency anemia.
It may be associated with fatigue and pale skin due to the anemia.
It usually, but not always, can be detected through a fecal occult (hidden) blood test, in which samples of stool are submitted to a lab for detection of blood.
If the tumor gets large enough, it may completely or partially block your colon. You may notice the following symptoms of bowel obstruction:
Abdominal distension: Your belly sticks out more than it did before without weight gain.
Abdominal pain: This is rare in colon cancer. One cause is tearing (perforation) of the bowel. Leaking of bowel contents into the pelvis can cause inflammation (peritonitis) and infection.
Unexplained, persistent nausea or vomiting
Unexplained weight loss
Change in frequency or character of stool (bowel movements)
Small-caliber (narrow) or ribbon-like stools
Sensation of incomplete evacuation after a bowel movement
Rectal pain: Pain rarely occurs with colon cancer and usually indicates a bulky tumor in the rectum that may invade surrounding tissue.
Studies suggest that the average duration of symptoms (from onset to diagnosis) is 14 weeks.
Any of the following symptoms warrants an immediate visit to your health care provider:
Bright red blood on the toilet paper, in the toilet bowl, or in your stool when you have a bowel movement
Change in the character or frequency of your bowel movements
Sensation of incomplete evacuation after a bowel movement
Unexplained or persistent abdominal pain or distension
Unexplained weight loss
Unexplained, persistent nausea or vomiting
Any of the following symptoms warrants a visit to the nearest hospital emergency department:
Large amounts of bleeding from your rectum, especially if associated with sudden weakness or dizziness
Unexplained severe pain in your belly or pelvis (groin area)
Vomiting and inability to keep fluids down
If you are having rectal bleeding or changes in your bowel movements, you will undergo tests to determine the cause of the symptoms.
Your health care provider may insert a gloved finger into your rectum through your anus.
This test, called a digital rectal exam, is a quick screen to make sure that any bleeding is actually coming from your rectum.
This is not painful, but it is mildly uncomfortable for some people. It takes only a few seconds.
You may have a test called a colonoscopy.
This is a test that allows a specialist in digestive diseases (a gastroenterologist) to look at the inside of your colon.
This test looks for polyps, tumors, or other abnormalities.
Colonoscopy is an endoscopic test. This means that a thin, flexible plastic tube with a tiny camera on the end will be inserted into your colon via your anus. As the tube is advanced further into your colon, the camera sends images of the inside of your colon to a video monitor.
Colonoscopy is usually done with sedation and is not an uncomfortable test for most people. You will first be given a laxative solution to drink that will clear most of the fecal matter from your bowel. You will be allowed nothing to eat for a short period before the test and a liquid diet only for a day before the test.
Flexible sigmoidoscopy is similar to colonoscopy but does not go as far into the colon. It uses a shorter endoscope to examine the rectum, sigmoid (lower) colon, and most of the left colon.
CT colonography is another way to examine the colon. Again, the stool must be cleared from the colon before the examination. Colonoscopy allows sample to be taken (biopsies) if an abnormality is found. Colonography does not allow that, as there is no direct visualization of the interior of the colon.
Air-contrast barium enema is a type of X-ray that can show tumors.
Before the X-ray is taken, a liquid is introduced into your colon and rectum through your anus. The liquid contains barium, which shows up solid on X-rays.
This test highlights tumors and certain other abnormalities in the colon and rectum.
Other types of contrast enemas are available.
Air-contrast barium enema frequently detects malignant tumors, but it is not as effective in detecting small tumors or those far up in your colon.
If a tumor is identified in the colon or rectum by a biopsy performed during a sigmoid or colonoscopy, you will probably undergo CT scan of your abdomen and a chest X-ray to make sure the disease has not spread.
The primary treatment of colon cancer is to surgically remove part of your colon. Suggestive polyps, if few in number, may be removed during colonoscopy.
Chemotherapy after surgery can improve your likelihood of being cured if your colon cancer has spread to nearby lymph nodes.
Radiation treatment after surgery does not improve cure rates in people with colon cancer, but it is important for people with rectal cancer.
Given before surgery, radiation may reduce tumor size. This can improve the chances that the tumor will be removed successfully.
Radiation before surgery also appears to reduce the risk of the cancer coming back after treatment.
Radiation plus chemotherapy before or after surgery for rectal cancer can improve the likelihood that the treatment will be curative.
Surgery is the cornerstone of treatment for colon cancer.
You will usually only need to have a portion of your colon removed for colon cancer. In rare circumstances such as in longstanding ulcerative colitis or in cases where large numbers of polyps are found, then the entire colon may need to be removed. Most colon cancer surgery will not result in a colostomy being necessary as the bowel having been cleaned out prior to surgery can then safely be reconnected after a portion is removed. In rectal cancer sometimes a colostomy is necessary if it is not safe or feasible to reconnect the portions of the rectum and anus that remain after the cancer involved area is removed.
Sometimes only a polyp is found to be cancerous, and removal of the polyp may be all that is necessary.
Surgery may also be done to relieve symptoms in advanced cancer such as when the cancer has caused a bowel obstruction. The usual procedure is bypass for obstructions that cannot be cured. Rarely a colon cancer presents with such severe blockage (obstruction) or is so massive that a resection cannot be done. Usually then a colostomy is formed after which other treatment is planned.
Sometimes a colorectal tumor can be surgically removed only by creation of a permanent colostomy.
This is a small, neatly constructed opening in your belly. As part of the surgery, the colon that is left in your body is attached to this opening.
Fecal matter will exit your body through this hole instead of through your anus.
You will wear a small appliance or bag, which attaches to your skin around the opening and collects fecal matter. The bag is changed regularly to prevent skin irritation and odor.
Your surgeon will attempt to preserve your rectum and anus whenever possible. Several surgical procedures have been developed that can preserve evacuation of fecal material through the anus whenever possible.
Whether you need a colostomy depends on individual circumstances.
In general, tumors on the right side of your colon or on the left side above the level of the rectum may not call for colostomy.
Tumors in the rectum may require removal of the rectum and anal sphincter and construction of a permanent colostomy to divert your bowel.
Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include, at minimum, the following:
Colonoscopy within 3 months after your surgery
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive
A screening tool-measurement of carcinoembryonic antigen (CEA) level-is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.
Blood CEA levels should be measured before colon cancer surgery and then, if elevated prior to surgery, it is appropriate to test it at intervals of 2-3 months for a time after surgery.
Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.
Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests.
You should discontinue screening tests if you develop new severe health problems that would make you unfit to undergo treatment for a recurrence of your colon cancer.
Most colorectal cancers arise from adenomatous polyps. Such polyps are comprised of excess numbers of both normal and abnormal appearing cells in the glands covering the inner wall of the colon. Over time, these abnormal growths enlarge and ultimately degenerate to become adenocarcinomas.
People with certain genetic abnormalities develop what are known as familial adenomatous polyposis syndromes. Such people have a greater-than-normal risk of colorectal cancer.
In these conditions, numerous adenomatous polyps develop in the colon, ultimately leading to colon cancer.
There are specific genetic abnormalities found in the two main forms of familial adenomatous polyposis.
The cancer usually occurs before age 40 years.
Adenomatous polyposis syndromes tend to run in families. Such cases are referred to as familial adenomatous polyposis (FAP). Celecoxib (Celebrex) has been FDA approved for FAP. After 6 months, celecoxib reduced the mean number of rectal and colon polyps by 28% compared to placebo (sugar pill) 5%.
Another group of colon cancer syndromes, termed hereditary nonpolyposis colorectal cancer (HNPCC) syndromes, also run in families. In these syndromes, colon cancer develops without the precursor polyps.
HNPCC syndromes are associated with a genetic abnormality. This abnormality has been identified, and a test is available. People at risk can be identified through genetic screening.
Once identified as carriers of the abnormal gene, these people require counseling and regular screening to detect precancerous and cancerous tumors.
HNPCC syndromes are sometimes linked to tumors in other parts of the body.
Also at high risk for developing colon cancers are people with any of the following:
Ulcerative colitis or Crohn's colitis (Crohn's disease)
Breast, uterine, or ovarian cancer now or in the past
A family history of colon cancer
The risk of colon cancer increases 2-3 times for people with a first-degree relative (parent or sibling) with colon cancer. The risk increases more if you have more than one affected family member, especially if the cancer was diagnosed at a young age.
Other factors that may affect your risk of developing a colon cancer:
Diet: Whether diet plays a role in developing colon cancer remains under debate. The belief that a high-fiber, low-fat diet could help prevent colon cancer has been questioned. Studies do indicate that exercise and a diet rich in fruits and vegetables can help prevent colon cancer.
Obesity: Obesity has been identified as a risk factor for colon cancer.
Smoking: Cigarette smoking has been definitely linked to a higher risk for colon cancer.
Drug effects: Recent studies have suggested postmenopausal hormoneestrogen replacement therapy may reduce colorectal can cer risk by one third. Patients with a certain gene which codes for high levels of a hormone called 15-PGDH may have their risk of colorectal cancer reduced by one half with the use of aspirin.
Colon Cancer Symptoms
Cancer of the colon and rectum can exhibit itself in several ways. If you have any of these symptoms, seek immediate medical help. You may notice bleeding from your rectum or blood mixed with your stool.
People commonly attribute all rectal bleeding to hemorrhoids, thus preventing early diagnosis owing to lack of concern over "bleeding hemorrhoids." New onset of bright red blood in the stool always deserves an evaluation. Blood in the stool may be less evident, and is sometimes invisible, or causes a black or tarry stool.
Rectal bleeding may be hidden and chronic and may only show up as an iron deficiency anemia.
It may be associated with fatigue and pale skin due to the anemia.
It usually, but not always, can be detected through a fecal occult (hidden) blood test, in which samples of stool are submitted to a lab for detection of blood.
If the tumor gets large enough, it may completely or partially block your colon. You may notice the following symptoms of bowel obstruction:
Abdominal distension: Your belly sticks out more than it did before without weight gain.
Abdominal pain: This is rare in colon cancer. One cause is tearing (perforation) of the bowel. Leaking of bowel contents into the pelvis can cause inflammation (peritonitis) and infection.
Unexplained, persistent nausea or vomiting
Unexplained weight loss
Change in frequency or character of stool (bowel movements)
Small-caliber (narrow) or ribbon-like stools
Sensation of incomplete evacuation after a bowel movement
Rectal pain: Pain rarely occurs with colon cancer and usually indicates a bulky tumor in the rectum that may invade surrounding tissue.
Studies suggest that the average duration of symptoms (from onset to diagnosis) is 14 weeks.
When to Seek Medical Care
Any of the following symptoms warrants an immediate visit to your health care provider:
Bright red blood on the toilet paper, in the toilet bowl, or in your stool when you have a bowel movement
Change in the character or frequency of your bowel movements
Sensation of incomplete evacuation after a bowel movement
Unexplained or persistent abdominal pain or distension
Unexplained weight loss
Unexplained, persistent nausea or vomiting
Any of the following symptoms warrants a visit to the nearest hospital emergency department:
Large amounts of bleeding from your rectum, especially if associated with sudden weakness or dizziness
Unexplained severe pain in your belly or pelvis (groin area)
Vomiting and inability to keep fluids down
Exams and Tests
If you are having rectal bleeding or changes in your bowel movements, you will undergo tests to determine the cause of the symptoms.
Your health care provider may insert a gloved finger into your rectum through your anus.
This test, called a digital rectal exam, is a quick screen to make sure that any bleeding is actually coming from your rectum.
This is not painful, but it is mildly uncomfortable for some people. It takes only a few seconds.
You may have a test called a colonoscopy.
This is a test that allows a specialist in digestive diseases (a gastroenterologist) to look at the inside of your colon.
This test looks for polyps, tumors, or other abnormalities.
Colonoscopy is an endoscopic test. This means that a thin, flexible plastic tube with a tiny camera on the end will be inserted into your colon via your anus. As the tube is advanced further into your colon, the camera sends images of the inside of your colon to a video monitor.
Colonoscopy is usually done with sedation and is not an uncomfortable test for most people. You will first be given a laxative solution to drink that will clear most of the fecal matter from your bowel. You will be allowed nothing to eat for a short period before the test and a liquid diet only for a day before the test.
Flexible sigmoidoscopy is similar to colonoscopy but does not go as far into the colon. It uses a shorter endoscope to examine the rectum, sigmoid (lower) colon, and most of the left colon.
CT colonography is another way to examine the colon. Again, the stool must be cleared from the colon before the examination. Colonoscopy allows sample to be taken (biopsies) if an abnormality is found. Colonography does not allow that, as there is no direct visualization of the interior of the colon.
Air-contrast barium enema is a type of X-ray that can show tumors.
Before the X-ray is taken, a liquid is introduced into your colon and rectum through your anus. The liquid contains barium, which shows up solid on X-rays.
This test highlights tumors and certain other abnormalities in the colon and rectum.
Other types of contrast enemas are available.
Air-contrast barium enema frequently detects malignant tumors, but it is not as effective in detecting small tumors or those far up in your colon.
If a tumor is identified in the colon or rectum by a biopsy performed during a sigmoid or colonoscopy, you will probably undergo CT scan of your abdomen and a chest X-ray to make sure the disease has not spread.
Medical Treatment
The primary treatment of colon cancer is to surgically remove part of your colon. Suggestive polyps, if few in number, may be removed during colonoscopy.
Chemotherapy after surgery can improve your likelihood of being cured if your colon cancer has spread to nearby lymph nodes.
Radiation treatment after surgery does not improve cure rates in people with colon cancer, but it is important for people with rectal cancer.
Given before surgery, radiation may reduce tumor size. This can improve the chances that the tumor will be removed successfully.
Radiation before surgery also appears to reduce the risk of the cancer coming back after treatment.
Radiation plus chemotherapy before or after surgery for rectal cancer can improve the likelihood that the treatment will be curative.
Surgery
Surgery is the cornerstone of treatment for colon cancer.
You will usually only need to have a portion of your colon removed for colon cancer. In rare circumstances such as in longstanding ulcerative colitis or in cases where large numbers of polyps are found, then the entire colon may need to be removed. Most colon cancer surgery will not result in a colostomy being necessary as the bowel having been cleaned out prior to surgery can then safely be reconnected after a portion is removed. In rectal cancer sometimes a colostomy is necessary if it is not safe or feasible to reconnect the portions of the rectum and anus that remain after the cancer involved area is removed.
Sometimes only a polyp is found to be cancerous, and removal of the polyp may be all that is necessary.
Surgery may also be done to relieve symptoms in advanced cancer such as when the cancer has caused a bowel obstruction. The usual procedure is bypass for obstructions that cannot be cured. Rarely a colon cancer presents with such severe blockage (obstruction) or is so massive that a resection cannot be done. Usually then a colostomy is formed after which other treatment is planned.
Sometimes a colorectal tumor can be surgically removed only by creation of a permanent colostomy.
This is a small, neatly constructed opening in your belly. As part of the surgery, the colon that is left in your body is attached to this opening.
Fecal matter will exit your body through this hole instead of through your anus.
You will wear a small appliance or bag, which attaches to your skin around the opening and collects fecal matter. The bag is changed regularly to prevent skin irritation and odor.
Your surgeon will attempt to preserve your rectum and anus whenever possible. Several surgical procedures have been developed that can preserve evacuation of fecal material through the anus whenever possible.
Whether you need a colostomy depends on individual circumstances.
In general, tumors on the right side of your colon or on the left side above the level of the rectum may not call for colostomy.
Tumors in the rectum may require removal of the rectum and anal sphincter and construction of a permanent colostomy to divert your bowel.
Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include, at minimum, the following:
Colonoscopy within 3 months after your surgery
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive
A screening tool-measurement of carcinoembryonic antigen (CEA) level-is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.
Blood CEA levels should be measured before colon cancer surgery and then, if elevated prior to surgery, it is appropriate to test it at intervals of 2-3 months for a time after surgery.
Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.
Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests.
You should discontinue screening tests if you develop new severe health problems that would make you unfit to undergo treatment for a recurrence of your colon cancer.
Colon Cancer Prognosis
Recovery from colon cancer depends on the extent of your disease before your surgery.
- If your tumor is limited to the inner layers of your colon, you can expect to live free of cancer recurrence 5 years or more 80 to 95% of the time depending on how deeply the cancer was found to invade into the wall.
- If cancer has spread to your lymph nodes adjacent to the colon, the chance of living cancer free for 5 years is 30 to 65% depending upon the depth of invasion of the primary tumor and the numbers of nodes found to have been invaded by colon cancer cells.
- If the cancer has already spread to other organs, the chance of living 5 years drops to 8%.
- If the cancer has reached your liver but no other organs, removing part of your liver may prolong your life with as many as 20 to 40% of patients living cancer free for 5 years after such surgery.
Follow-up
Once your cancerous colon has been removed and you receive any other treatment recommended by your cancer care team, you will see your gastroenterologist or cancer specialist (oncologist) regularly for follow-up visits. These visits will allow your team to see if the cancer has spread and to detect newly formed cancers.
These follow-up visits should include, at minimum, the following:
Colonoscopy within 3 months after your surgery
Colonoscopy 1 year after surgery and every 3 years after that.
Test for occult (hidden) blood in your stool every year, followed by colonoscopy if the test result is positive
A screening tool-measurement of carcinoembryonic antigen (CEA) level-is available to test for cancer recurrence following cancer surgery.
CEA is a protein normally found in trace amounts in your bloodstream but is present in increased amounts in people with colon cancer. It is referred to as a tumor marker.
Blood CEA levels should be measured before colon cancer surgery and then, if elevated prior to surgery, it is appropriate to test it at intervals of 2-3 months for a time after surgery.
Increasing levels of serum CEA may indicate that colon cancer has come back and that you should seek further evaluation.
Once you have had several blood tests with negative results, you probably don't need to continue the tests indefinitely. However, no one is sure how long you should continue to have the tests.
You should discontinue screening tests if you develop new severe health problems that would make you unfit to undergo treatment for a recurrence of your colon cancer.
Prevention
Your best prevention is to detect colon cancer and treat it early in its formation. People who have regular screening for colon cancer, including fecal occult blood tests,sigmoidoscopy or colonoscopy, and polyp removal, greatly reduce their risk of having a colorectal cancer.
Other things you can do to lower your risk include the following:
Quit smoking. Smoking cigarettes has been clearly linked with higher risk of colon cancer (as well as many other conditions).
Take an aspirin or baby aspirin every day. Because of potential side effects, this is not recommended for everyone. Talk to your health care professional first.
Take a safe dose of folic acid (for example, 1 mg) every day.
Engage in physical activity every day.
Eat a variety of fruits and vegetables every day.
The US Agency for Health Care Policy and Research recommends screening for colon cancer in people older than 50 years who have an average risk for the disease and in people aged 40 years and older who have a family history of colorectal cancer. The agency recommends that one of the following screening techniques be used:
Fecal occult blood testing every year combined with flexible sigmoidoscopy every 5 years
Double-contrast barium enema every 5-10 years
Colonoscopy every 10 years: Colonoscopy remains the most sensitive test for detecting colon polyps and tumors.
Once polyps have been identified, they should be removed. After you have had polyps, even one polyp, you should begin to have more frequent colonoscopies.
Appropriate preventive screening for people with ulcerative colitis includes the following:
Colonoscopy every 1-2 years in the following cases:
If you have known you have the disease for 7-8 years
If the cancer involves the entire colon
Beginning 12-15 years after the diagnosis of left-sided colitis
Random colon biopsies taken during colonoscopy
In people with ulcerative colitis in whom biopsies show premalignant changes, it is recommended they undergo surgical removal of their colons.
Support Groups and Counseling
Living with cancer presents many new challenges, both for you and for your family and friends.
You will probably have many worries about how the cancer will affect you and your ability to "live a normal life," that is,to care for your family and home, to hold your job, and to continue the friendships and activities you enjoy.
Many people feel anxious and depressed. Some people feel angry and resentful; others feel helpless and defeated.
For most people with cancer, talking about their feelings and concerns helps.
Your friends and family members can be very supportive. They may be hesitant to offer support until they see how you are coping. Don't wait for them to bring it up. If you want to talk about your concerns, let them know.
Some people don't want to "burden" their loved ones, or prefer talking about their concerns with a more neutral professional. A social worker, counselor, or member of the clergy can be helpful if you want to discuss your feelings and concerns about having cancer. Your gynecologist or oncologist should be able to recommend someone.
Many people with cancer are profoundly helped by talking to other people who have cancer. Sharing your concerns with others who have been through the same thing can be remarkably reassuring. Support groups of people with cancer may be available through the medical center where you are receiving your treatment. The American Cancer Society also has information about support groups all over the United States.
Posted in 
0 comments:
Post a Comment