Challenging Assumptions About Cancer and Its Treatments

There are over two hundred types of cancer, but even so, many people — especially those fortunate enough to have no personal experience with it — assume that all cancers, all cancer treatments, and all cancer outcomes are the same.

I have follicular lymphoma, a form of blood cancer that is considered very treatable, but chronic and incurable. It’s currently in remission, but it could come back any time; it’s been five years since I finished treatment, so the risk is lower than it was, but still higher than the general population.

A lot of people don’t really understand that; in a recent conversation, someone told me that she hoped soon I could say I’d had cancer but no longer have cancer. The line between have and had is pretty thin; even with cancers considered curable, the risk of relapse, or of developing another kind of cancer, is higher than in the general population. It’s something I wish more people understood.

Preconceptions lead to assumptions, and they are often based on how cancer is presented by various media — video ads showing cancer patients with no hair, hooked up to tubes and wires, looking pale and tired, and then suddenly healthy, with no mention of the process in between — are a common one.

Sometimes treatment is a lot easier to take than the way it’s portrayed in such videos (mine was, thankfully), and sometimes it’s a lot worse. Then, too, you don’t just wake up one day suddenly healthy because treatment is over. For many medications — and especially cancer treatments — the adage that “the dosage makes the poison” is true. I remember one day in treatment when a nurse asked how I was doing, and I said I was waiting for her to pump poison into me to kill the cancerous cells; she just looked at me.

I appreciate the wishes of people who hope that my experience with cancer will remain completely in the past; it’s what I wish myself. I wish more people understood that many forms of cancer recur. I wish more people understood that cancer treatments are themselves a risk factor for future cancers. Cancer treatments work by targeting cancerous cells in one way or another, to kill mutated cells that escaped the body’s immune system, but such treatments often cause peripheral damage to cells near the cancerous cells, or changes to the person’s immune system that leave the person at greater risk for developing cancer, the same kind or another.

I also wish that more people understood that not all cancer treatments are the same. The primary forms of treatment — chemotherapy, immunotherapy, radiation, and surgery — are not used in all treatments, and even within a single type of cancer, not every person receives the same treatment. It depends on the type of cancer, the grade (how fast it grows), and the stage (how much it’s spread).

It also depends on what is available, what the oncologist decides will be most effective, and what insurance will cover. A lot of people — even people who’ve had other kinds of cancer — start by asking what type of surgery I had, and seem surprised that I haven’t had any. Others are really surprised my hair didn’t fall out — one even accused me of making up my diagnosis for attention, because “everyone knows” that chemotherapy makes your hair fall out (it doesn’t).

This piece reflects the author’s personal experience and perspective. For medical advice, please consult your health care provider.

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