Many peoples first experience with cancer begins quite simply with the discovery of a symptom or sign known to be a possible cancer indicator. A lump, a sore that has changed in appearance or hasn’t healed properly, any persistent severe pain, the presence of unexplained blood, a sore throat or cough that persists -these are several of the most common signs. From this moment, the uncertainty of cancer begins. Could this symptom mean cancer, or can I assume it’s nothing?

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This moment, before the doctor has even been called or a single test has been done, often transforms a person’s life from one of general well being and confidence, to one of enormous anxiety and uncertainty about the future. This pervasive sense of uncertainty probably characterizes the journey with cancer more than anything else. It often lessens when things are going well, but it is a feeling that never completely goes away. This seems to be what people mean when they say, “The diagnosis completely changed my life.” That wonderful sense of certainty and expectation of continued life and health, a kind of denial that the bubble can ever burst, which we all start out with, is destroyed forever. Learning to live with uncertainty becomes the bottom line in dealing with cancer.

Many people who notice a “suspicious” symptom have encountered cancer before through the illness of a loved one, such as a parent or grandparent. If a symptom suggests that you might have the same type of cancer as your loved one had, you may become terrified. Fear that you might go through the same vividly recalled cancer experience as someone close to you did, can be overwhelming. In such cases, a person may be too frightened to go to a doctor. A sense of hopelessness (if it’s cancer, nothing can be done) or a feeling of panic can paralyze your ability to act. This can be the case for some who have seen family or friends with cancer. They can fear it so much, that they delay being treated, sometimes for something that isn’t even cancer.

Others have not had such personal experiences, but have seen cancer statistics in the media and are extremely afraid of “learning the worst.” They delay going to the doctor, even though most warning signs turn out to not be cancer. These feelings of fear, leading to the ostrich syndrome, wanting to put your head in the sand and thinking that the problem will just go away, can be both dangerous and foolhardy if the problem turns out to be cancer. As most people now know, a cancer diagnosed in the early stages is usually curable. So it is far better to overcome the fear or denial and see a doctor. The relief that follows finding out that it was nothing important allows life to get back to normal, and the fears can be laid to rest. If the problem does turn out to be cancer, you will get a head start on the treatment and improve your chances of cure.

If you are putting off checking out a suspicious symptom because of anxiety, it best to call your physician rather than letting your anxious feelings keep you from going through appropriate tests. Also, let your doctor know that you’re having a lot of anxiety about what is happening, and that you may need help to control the fears, especially if difficult tests like scans or sonograms, are ordered. If you have been troubled with anxiety in the past, or if you have feared cancer, it may be wise to ask your doctor for a referral to a mental health professional to help you get through the tests and procedures. The same advice holds for friends or loved ones who have these problems; you can play a pivotal role in ensuring they get help.

Before you go to the doctor, you may wish to make some notes to take with you so that you can give an accurate account of your symptom. You may also wish to have a family member or close friend accompany you, since it is sometimes hard to remember things when you feel nervous. Also, it is important to have family involved in the decision making process, and this way they will have all the information to do so.

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Once you have seen the doctor and had an examination, and the tests have been ordered such as biopsy or scans, your thoughts may alternate between “It’s probably nothing” and “I know it’s the worst.” Feelings of optimism and despair change from hour to hour. This is part of the response to the possibility of hearing bad news: anticipating what you may feel should it be cancer. For most people this is one of the most difficult times for them-waiting to hear the news.

Most tests today, including bone scans and sonograms, are generally performed on an outpatient basis rather than in the hospital, so it is good to take someone along to help you get home. You may not feel up to par if you’re drowsy from medication that was given with the procedure.

The diagnostic tests themselves may be difficult to tolerate if you have phobias-intense and overwhelming fears-of doctors, hospitals, needles, seeing blood, or claustrophobia during an MRI. If you have high anxiety or strong fears about any of the diagnostic procedures, your doctor may prescribe an anti-anxiety drug to help you through the process. It is important that you discuss your emotional state with him as well as your physical situation.

If you have had fears of being confined in a small space (claustrophobia), you may find magnetic resonance imaging (MRI) to be frightening. This scan requires being placed in a small cylinder surrounded by a large, noisy machine. About 20 percent of people find it hard to tolerate, and about 5 percent are unable to go through with it. There are ways to make it easier today, such as listening to music or relaxation tapes or taking a medication to reduce your anxiety during the procedure. Tapes with instructions for relaxation, guided imagery, and medication can be listened to ahead of time to help you become calmer. When you have an intense fear or phobia, it may seem so overwhelming that you cannot imagine overcoming it. But your doctor or a mental health professional can help you to relieve the fear to the point that you can get the medical tests you need.

The workup is important to determine the medical situation and to help you decide on a treatment course; therefore, any fears or phobias standing in the way must be looked into. Let your doctor know that you’re frightened, that this fear has troubled you in the past; you can receive mediation to be less anxious. Later, ask for a referral to a mental health professional to treat the phobia, so that you can get through future tests more easily.

The diagnosis

Many people describe the period of waiting between hearing the diagnosis-the dreaded words “You have cancer”-and the start of their treatment as the worst time in their illness. The anxiety begins to peak when the bad news is given, but there isn’t as yet any plan in place to move ahead and fight it. It is difficult to tolerate the feeling that there are cancer cells in your body and nothing is being done to destroy them. The unspoken fear that “I might die” may seem more overwhelming when you are not yet receiving treatment.

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