The suspicion that cancer is not merely a rumor is a an incomparable roller coaster ride taking patients on a psychological and emotional gauntlet from fear and panic on one hand as well as becoming embraced in love, deep understanding and  opportunities for insights and self reflection. Whether it be a lymph node found on physical exam, a new skin growth or lump in the breast of suspicious prostate ( and the list goes on), the not so routine highly suspicious  clinical complaint; the typical  “oh it’s nothing” becomes something and with it comes anxiety.

For millions each year, eventually some type of biopsy for tissue will be needed and in short time your “nothing”  is  something that puts your heart in your hand and a lump in your throat on the journey to the oncologist The oncologist may first enter the picture when the diagnosis is suspect but not confirmed. This is tricky and be dealt in a careful manner customized for the individual patient and family.

Irrespectively, there are some fundamental and universal ground rules when approaching that point where suspicions of a cancer diagnosis are dismissed or well founded founded. Perhaps the most important of rules is the time proven adage “Although Tumor Is the Rumor and Cancer May Be the Answer, Tissue Is the Issue and No Meat, No Treat”. Crude but spot ON..

Never, ever, label a patient with a diagnosis of malignancy without absolute certainty. Always have tissue confirmation from a biopsy of some manner unless it is simply too dangerous or not possible- both highly uncommon situations. It logically follows that one should never, ever, pronounce a recurrence without the same degree of certainty. When we suspect the diagnosis, oncologists often have to work quickly and carefully behind the scenes. A delicate balance must be struck as the entrance of the oncologist prior to the diagnosis being certain can understandably be quite evocative of enormous anxiety for the patient and family. Thus, it is essential that the primary or referring physician identify for the patient and family what roles many future consultants have. An individual who serves as the “quarterback” must be identified quickly with full consensus and understanding of their role by all.

This concept of focusing the attention on the right professionals applies to the family as well. It is the patient, not the family, who has the disease. The role of the family is enormously important. However, family and friends, the Internet and media as well as other health care providers, frequently inadvertently or overtly inundate the patient with stories that are either inappropriate or way off base. Their influence must be anticipated and never underestimated.

This is a time of reinforcing the message of the  autonomy and individual nature of the patient. Patients are individuals; they are not their diseases. It is never just another case of non-small cell lung cancer. The philosophic point raised above has enormous practical applications. Oncology isn’t a one size fits all endeavor.

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