How you perceive the cancer, how you see yourself, and how you
define your relationship with the cancer affects the outcome of
the disease. When youre first diagnosed it is tempting
just to focus on the disease and how to treat it. The importance
of understanding yourself and your relationship with the disease
may be less obvious. There are many different perspectives on
cancer. Doctors see it objectively as a biological process of
cell growth. Patients may see it more personally as a result of
heredity, diet or stress. Both points of view are valid. Both
should be considered in making decisions
is likewise important that you understand yourself. Knowing your
own strengths and weaknesses can help you plan an effective strategy
to treat the cancer.
you define yourself in relationship with the cancer is also important.
If you feel small and powerless compared to it then you may want
to develop ways to empower yourself to make the battle more even.
There is a cultural myth that pervades our approach to cancer
that can be limiting. You need not accept this myth. You can create
your own story and redefine your relationship with the cancer
so that you maintain hope.
to Ask Yourself
What is my relationship with my illness?
How do you perceive your cancer? Is it a result of stress? Is
it because of your diet? Did it happen because youve been
exposed to toxins? Is it a challenge or wake-up call? Is it fate?
Or is it simply a series of biological events? There are many
different ways to understand cancer. The following stories illustrate
some of these perspectives.
Margaret S. felt that she was destined to get breast cancer. Her
mother had developed breast cancer when she was 55 and now Margaret
was approaching her 55th birthday. She resembled her mother in
appearance and lifestyle and thought that the same things would
happen to her as had happened to her mother.
Margaret went for a physical her physician insisted that she get
a mammogram. She had avoided them before and at first Margaret
balked at the idea. Eventually she agreed. The X-ray showed microcalcifications
and a biopsy was recommended.
just know this is cancer. My mother got cancer when she was
55 and we are just alike. Ive known this was going to
happen for 30 years! Theyre going to cut off my breast
and Ill be left with a swollen arm just like my mother!
felt that it was inevitable that she get cancer. She knew that
breast cancer could be hereditary and assumed that since she looked
like her mother that she would get the same diseases her mother
did. What made the experience even more frightening for Margaret
was the image of her mothers body after she had had a radical
mastectomy. She didnt know that such deforming surgery is
no longer done and that current treatments may only remove a small
part of the breast.
Jeannie K. had different view of her breast cancer. She felt it
was an infection.
developed mastitis when she was nursing both of her children.
When she felt a lump in the same breast she assumed it was another
infection and went to her doctor to get an antibiotic. She was
shocked and frightened when he suggested she get a mammogram and
hinted that it might be cancer. She didnt get the mammogram
but began a year-long struggle to find the right vitamins and
supplements that would boost her immune system so it could fight
what she viewed as an infection.
she finally saw her doctor again the mass had begun to drain and
soil her bra. She told him:
need an antibiotic. My immune system must be too weak to fight
this infection. I cant believe this could be cancer. No
one in my family has had cancer.
was familiar with mastitis and didnt consider any other
explanation for the breast lump. She was suspicious of conventional
medicine and pursued various alternative treatments until she
was forced to see her doctor again.
Some patients identify stress as the cause of their cancer.
Tina B. was under considerable stress. She had recently lost her
mother to lung cancer. In addition to working 50 hours a week
she had to care for three teenage stepdaughters. When she developed
a cough it took her two months to find time to see her doctor.
The X-ray showed a suspicious mass and her doctor suggested biopsy.
When the biopsy showed cancer she asked if it could be due to
under a lot of stress. Taking care of my mothers estate
and trying to raise three teenagers is exhausting me. I havent
been sleeping well, either. I heard that stress causes cancer.
Its my own fault. I havent been taking very good
care of myself.
relationship between stress and cancer is complex. Tina was certainly
under a lot of stress. Her lung cancer, however, was more likely
to have been caused by second-hand smoke from her mother and husband
than by stress.
For some people the diagnosis of cancer is a wake-up call. They
are aware that they need to change their lives but dont
know how to start.
having an early colon cancer removed successfully Dwight E. commented
to his doctor:
not exactly glad I got colon cancer but it sure helped me stop
and look at my life. My diet has been rotten for a long time
and Ive been way too stressed. I think things happen for
felt his cancer was the result of a poor diet and a toxic lifestyle.
He was able to respond to his diagnosis as a message to live a
more wholesome life rather than as a threat.
Some people view any illness as evidence that they have done something
V.s periods stopped when she was 47. Eight years later she
began to bleed again and saw her doctor. A biopsy showed cancer
of her uterus and she had a hysterectomy. Rosalie felt guilty
and confessed to her doctor:
feel like Im being punished. I did something stupid when
I was 18 and had an abortion. This must be Gods way of
telling me I sinned.
was raised in a religiously very conservative family. Although
she no longer went to church she retained many of the moral values
and judgments she was taught as a child.
some people it is preferable to believe that they did something
wrong to cause their cancer rather than to believe that it just
happened. They may subconsciously feel that it is better
to be guilty and have some influence in events than not to have
any control at all.
to Ask Yourself
do I perceive my disease?
do I think caused it?
I blame myself?
I feel I have the power to help it heal?
doctors view of cancer
Each of these patients has a view of cancer that makes sense to
them. Each perspective, however, is based upon half-truths and
oversimplifications. Cancer is a complex illness. Though much
is understood about how cancer develops, there are still gaps
in our knowledge.
can also be a gap between the way patients and doctors view the
same illness. If you have cancer, your perspective is from the
inside. Doctors view it more objectively from the outside.
a doctors point of view, cancer is a disease of control.
Cells are damaged in such a way that the normal controls over
cell growth, maturation, function and cell death no longer operate
acts as the cells master computer program. It can be damaged
in various ways by chemicals, viruses, random events, etc. Usually
the cell repairs the damage and no permanent harm is done. Sometimes,
however, the damage is in exactly the wrong place in the DNA and
is not corrected. For a cell to become transformed into cancer
usually requires many such injuries.
transformed, the cell can grow and multiply. Depending upon what
cell functions have been altered, this cell can damage the local
environment, spread to other sites (metastasize), or secrete substances
that damage the host.
biggest risk factor for cancer is aging. Almost all cancers are
more common as you get older. The older you are the more chances
for the DNA to have been damaged and for cells to have been transformed.
is responsible for about one third of all cancers. There are multiple
substances in tobacco smoke that directly damage cells or stimulate
already damaged cells to multiply. All the tissues that come in
contact with the smoke are susceptible, including the bladder,
where the various toxins are excreted. Certain individuals, because
of the way they metabolize these toxins, are more susceptible
to tobacco-related cancer. This helps to explain the paradox that
not everybody who smokes gets cancer.
diet is implicated in about one third of cancer. The best evidence
suggests that diets with too much animal fat and too few vegetables,
fruits and grains are responsible for this. Vitamins in fruits
and vegetables help limit damage to the cellular DNA. The increased
fiber from grains and produce reduces the time that cells lining
the intestines are in contact with possible toxic substances.
Though often recommended, there is not as much evidence that adding
vitamins to your diet prevents cancer as well as having a healthy
is a factor in many common cancers but is not as powerful a risk
factor as age, smoking, and diet. If you have one relative with
cancer, that does not necessarily mean that you are prone to cancer.
If, however, you have several relatives all with the same kind
of cancer (especially breast, ovarian, or colon) there may be
a genetic link. Even with breast cancer, which is known to have
a familial tendency, only 5% to 10% are felt to be due to breast
is not an infection though certain viruses can indirectly cause
cancer. Chronic infection with hepatitis B virus can damage liver
cells so that they eventually become cancerous. The AIDS virus
can weaken your immune system sufficiently that it can no longer
used to be believed that the white blood cells of your immune
system were the primary defense against cancer. That is no longer
held to be true. Your bodys response to cancer development
is complex and involves many other systems besides the immune
system. Having cancer is not a sign that your immune system is
is not inevitable. Even if you have breast cancer causing genes
not everyone with such genes develops cancer. Up to 80% of cancers
can be prevented, particularly with changes in lifestyle.
is a widespread belief that stress and cancer are linked. Well-controlled
studies dont show that psychological stress causes cancer.
It may be that people under chronic stress do not take as good
care of themselves or may have less of a desire to live. Chronic
stress does reduce the quality of life and generally reduces vitality.
Hence, stress may compromise the response to cancer once it is
the message of cancer
Cancer is a signal that something is wrong. On a biological level,
it is a problem with destructive cell growth. On a personal level,
you may have certain beliefs or behaviors that are not fully healthy.
These can contribute to the development of cancer or limit your
response to it. In order to live fully and to heal completely,
these must be addressed, too. Cancer is both a disease and a dis-ease.
On one hand, it is a biological disease that affects the body
and often can be cured with treatment. On the other hand, it is
a state in which you as a person are not at ease. The lack of
ease may have preceded the diagnosis or be caused by it. The dis-ease
affects the whole person.
order to cure cancer, you need to approach it as a biological
process. In order to heal yourself, you may need to understand
what prevents you from finding ease in your life. If you focus
only on cure, you may live longer, but not any better. If you
focus only on what distresses you, and confuse the dis-ease
with the biological disease, you may lose opportunities to eliminate
the threat to your life.
feeling of ease in life is a signal that you are in balance..
Canceror any other life-threatening illnessupsets
that balance and demands that you find a new one or face the possibility
you heed the message that the cancer provides, you can reestablish
a sense of ease in your life. Cancer's message can be different
for each person. Its message may not always be straightforward.
Yet, as the following stories show, the message provides the clues
you need to get well.
to Ask Yourself
Where do I experience dis-ease in my life?
message of empowerment
Jeannie K.s father had been a physician in Moscow where
she was born. He was an alcoholic and had emotionally abused Jeannie
until she came to the US in her 20s. Jeannie married a man much
like her father and had two children. They divorced when his alcoholism
became evident and he became abusive towards the children. Jeannie
remarried an engineer who strongly disapproved of alcohol and
drugs, but who was not particularly emotionally supportive. In
her diary Jeannie wrote:
feel so afraid. All my life Ive made the wrong choices.
Now Ive got to make a choice about chemotherapy and surgery?
Is it worth it? Is there enough to live for to go through all
few weeks later she wrote:
girls went to the support group with me today. Afterwards we
all cried together. I love them so much and they love me. I
dont know how Im going to do it but somehow Ill
have to be strong.
initial response to cancer was ambivalence. She had never felt
strong enough to survive on her own. She was almost willing to
accept dying as preferable to remaining in an unloving world.
message of forgiveness
Rosalie V. had grown up in an immigrant family in Southern California.
Her mother died when Rosalie was in college and she was torn between
her desire to finish school and her fathers demand that
she care for her four younger sisters.
age 18 she became pregnant. Rather than marry her boyfriend, she
decided to have an abortion and finish college. Eventually she
went to law school. Against her familys wishes she married
outside of the Catholic Church. In spite of numerous attempts
to have children she was never able to become pregnant again.
asked why she thought her cancer was punishment for her sins,
always been rebellious. I was never the good little girl my
father wanted. I couldnt see having a life like my mother
had, just having one child after another. When I turned my back
on the church, I thought God turned His back on me. I thought
that He punished me by preventing me from having any children.
been reading the Bible more recently. There is a forgiving God
as well as a vengeful one. Ive had this bitterness toward
Him for a long while. Maybe it is time for us to forgive each
had lived with the conflict between living the life she wanted
and the life expected of her by her family and culture. She interpreted
her cancer as a sign that healing was possible, even for old injuries.
message of opportunity
Dwight E. was able to use his cancer as an opportunity to change
could have gotten rid of all the crap in my life before this
but it took colon cancer to get my attention! My cancer was
discovered early and surgery was successful. I may not stay
a vegetarian forever, but I know Ill never go back to
eating the kind of junk I was eating before. My job was way
too stressful! It was literally killing me. I have cut back
on my hours even if it means I won't get the promotion I want.
in any crisis like cancer are both dangers and opportunities.
You need to recognize the danger to take steps to avoid it. You
need to notice the opportunities in order to make the best use
of the experience.
message of priorities
For Tina B. stress was almost a bigger problem than the newly
diagnosed lung cancer. She had learned early in life to put aside
her own needs and take care of other people. When her mother developed
lung cancer Tina wanted to take care of her at home. Her husband
and stepdaughters objected and she had to put her in a nursing
home with hospice care.
company she worked for downsized and Tina had to take on new responsibilities.
She often had to work six days a week and couldnt spend
as much time with her family. The relationships she had been developing
with her stepdaughters began to deteriorate. Tina told her therapist:
going crazy! Im trying to please everybody and nobody
is happy! I feel guilty about putting my mother in a home even
though hospice did such a good job caring for her. I feel I
didnt do enough for her before she died. Now I feel overwhelmed
by all the paperwork in her estate.
stress at work is getting to everybody. Half the people are
ready to quit since we reorganized. I get headaches every day
and my stomach is on fire at night.
13-year-old stepdaughter Denise is a handful. She never got
over her fathers divorce and takes it out on me. We were
just beginning to get along but then my mother got sick and
I had to take care of her. Denise felt abandoned and she wont
let me get close again.
know I havent been taking care of myself, either. I havent
been eating regularly and Ive lost eight pounds. I dont
sleep very well, either. I think Im depressed.
her therapists advice, Tina took a medical leave of absence
from work and had surgery. She went on antidepressants and continued
to work with her therapist on recognizing her own needs.
message of genuine identity
Margaret always felt overshadowed by her mother. Her mother had
gone to Vassar and become a very successful publisher. When Margaret
was born, her mother assumed that she would follow in her footsteps.
Because of their physical resemblance this assumption seemed to
ring true. Margaret grew up with the expectation that she would
be just like her mother. When she did not get into Vassar she
went to a state school and majored in journalism, but her mother
was unable to hide her disappointment.
her journal Margaret wrote:
never had a chance to just be myself. Ive always been
a shadow of my mother. The cancer is just more darkness she
has cast upon me. So many of my friends have had it and went
through therapy and died anyway. What I really want is to have
my own life! Will I ever get it?
read several books about breast cancer and saw doctors for second
opinions. When she decided to have a lumpectomy she told her doctor:
say that history repeats itself but Im going to rewrite
my history. I dont want to go through the rest of my life
with only one breast like my mother
to Ask Yourself
Where do I experience dis-ease in my life?
Considering cancer from the perspective of a relationship between
you and the disease opens up options you might not have considered.
The goal of the cancer-patient relationship is to cope successfully
with the cancer and eventually overcome it. You want a relationship
in which you are larger and more powerful than the cancer. Conventional
treatments are designed to diminish the power of the cancer. Complementary
efforts enhance your power. Both shift the balance in your
value of considering cancer in terms of relationship is the possibility
of personal growth. As you are able to use the cancer as a challenge
to change, you can become different from the person in whom the
cancer occurred. You can develop yourself so you are no longer
a fertile ground in which cancer can happen.
any other relationship, the cancer-patient relationship is a process
and continues to evolve. The nature of the relationship changes
over time. Where you are now in it will be different at some later
date. There is always the opportunity to change your relationship
to one that is in your favor.
vs. destructive growth
On a cellular level, cancer is a subversion of the normal
growth process into a destructive one. The life force that allows
cells to develop and grow has been distorted and now damages the
person. In some respects, cancer acts like a parasite. It redirects
blood vessels to nourish the tumor. It consumes energy that otherwise
would be available to you. It can damage normal tissues and prevent
them from functioning properly.
the self who is ill at ease in life is growing in a destructive
way. Self-destructive attitudes and activities distract your mind
and direct your attention in nonproductive ways. Your energy is
used up and no longer available for growing in a healthy direction.
If your life force has been diverted into unwholesome beliefs
or activities, it can be redirected constructively.
immune system as a relationship
The popular vision of the immune system is that of a series of
white blood cells which fight infection or cancer. This is a crude
oversimplification. On a biological level, the immune involves
not just different kinds of lymphocytes but antibodies and cytokines
(chemicals that act like hormones and communicate between cells).
Their interactions are incredibly complex. Cells talk
to each other and influence how they respond to cancer.
can imagine the interaction of your immune system and the cancer
in terms of a relationship between them. The immune system recognizes
the cancer and responds to it. Under optimal conditions, the relationship
favors the immune system, allowing it to eliminate the cancer.
If the relationship is dysfunctional, then the cancer either escapes
detection or is resistant to the immune system's attempts to eliminate
larger view of the immune system is that it comprises all the
ways your body responds to cancer. Part of your response includes
the cellular and chemical immune system. Other biological parts
include your circulation, your nervous system, and your metabolism.
In this perspective, the relationship is about how the body either
nourishes or withholds nourishment from the cancer.
even broader view of the immune system is that it includes everything
you do to respond to cancer. This includes your thoughts, feelings,
social relationships and other behaviors that involve the cancer.
This is the broadest form of relationship with you as a person.
The cancer, after all, is a threat not just to your body but to
your whole existence. It is a relationship you cannot safely ignore.
attitudes and beliefs about cancer and your self can be a metaphor
for how your body responds. This relationship can vary from you
being protective toward yourself to being permissive of harm.
Your attitudes and beliefs can change as your relationship with
cancer evolves. Its important to consider what your relationship
is now so that you can strengthen portions of it that may need
of the cancer-patient relationship
The patient, his disease, and the relationship between the two
make up a system. Each person envisions his own relationship with
the disease differently. For example, some people see themselves
as much larger than the problem of the disease. Some people see
greater distance between themselves and the disease. Some see
the disease as within them, not separated.
In the relationship, first there is the person, who is put into
the role of patient. You dont stop being all the other things
you are just because you also are a patient. All of your history,
your strengths and weaknesses, likes and dislikes, all your other
relationships stay with you. The second part is the disease. The
disease in this situation is cancer, though it could be heart
disease, multiple sclerosis, AIDS, or any other dis-ease
you might have. It is important to understand the nature of that
illness, its mechanism of harming your body, its possible
treatments, and everything else you can find out about it that
might help you overcome it.
third element is the relationship between you and your disease.
Do you see yourself separate from it? Is the disease inside or
outside of you? Does it seem much bigger than you or are you equally
matched? Do you see it as an enemy to fight and possibly beat?
cannot ignore any of the elements in the cancer-patient relationship.
If you look only at the disease, you may get a treatment that
ignores the needs of the patient. This is one of the criticisms
of conventional medicine. Conversely, if you only treat the person
and ignore the effect on the disease, you may lose the opportunity
to be cured. This is one of the criticisms of alternative medicine.
The middle path, that considers disease, person and relationship,
gives the best chances of success.
to Ask Yourself
What is my relationship with my illness?
the cancer-patient relationship
Regardless of where you are now, you can redefine your relationship
with the disease. You need not be bound by cultural myths
that can limit your response. You may find, as the following
patients did, a way to use the cancer to your advantage.
myth of cancer
Our culture has a myth about cancer, and as one patient pointed
out, "Cancer has a bad reputation." In this myth cancer
is seen as dark, evil, mysterious and malevolent. It is perceived
as inevitably fatal. Somehow the person, however competent and
innocent before, becomes a powerless victim of the cancer. In
many ways cancer has replaced the devil as a dark force in our
we may scoff at such stories, either consciously or unconsciously
we accept this myth. It shapes our language and attitudes about
cancer. It gives power to the cancer and it creates limits to
our own power to respond to cancer. Such myths can convince you
that it is futile even to try to overcome the cancer. Such stories
can leave you feeling drained of any vitality.
treacherous part of this myth is the element of truth hidden among
the fearful fantasies. Cancer may appear
little warning. Though much is known, there are still mysteries
to solve. People do die of cancer. Some people do become frail
and waste away.
The deceit rests in seeing only these facts and not the other
equally valid truths. Cancer can be prevented. It can be detected
early. Cancer can be cured, if not all of the time then at least
some of the time. Even advanced cancers can be cured. Patients
are not powerless but can take an active role in their recovery.
do not have to let the cultural myth determine what happens to
Margaret S. had accepted the cultural stereotypes of cancer but
was able to confront them. After getting a second opinion that
she could have a lumpectomy for her breast cancer Margaret told
took me a while to believe that I didnt need a radical
mastectomy. It was even more surprising to find out the statistics
are in my favor. The chances are very good that Ill live
another 30 years!
begun to realize that I am different from my mother. She doesnt
have control over my life. I enjoy my writing but dont
want to become a famous person. Im happy here in my own
community. I do a lot of volunteer work at the hospital and
the homeless shelter. I make a difference in peoples lives,
one person at a time.
only was Margaret able to see through the myth of cancer but she
went beyond her personal myths about who she was supposed to be.
She found meaning in her life on her terms, not those she was
taught as a child.
a new relationship
Jeannie K. viewed her life in terms of her ability to defend herself
against threats. She had to protect herself from abuse as a child
and the cancer seemed to be another threat. She joined a support
group and gained from the perspective of other women. She shared
in the group:
my life Ive had to fight for what I needed. I never felt
I was strong enough to win. With your support, I feel like Ive
got a chance. Im so grateful! Youve helped me see
that I dont have to fight the cancer by myself. My daughters
are with me. Ive found a doctor I can trust and Im
willing to work with him.
better, Im learning to trust myself. I always thought
it was my fault that my father and ex-husband were drunks. It
wasnt me, it was them!
of all, Im learning to love and protect myself. I practice
sending love to my immune system. I dont put up with my
husbands ignoring meI ask for the attention I want!
past is past. Im working on my future.
was able to become stronger and grow bigger in relationship to
her cancer. She was able to reclaim some of the power she had
lost earlier in her life
There is no courtroom judge that is stricter than the one that
may be inside you. The cultural myth supports this self-judgment
since cancer is often seen as a judgment or punishment for wrongdoing.
It is like the story of Job in the Bible where all his friends
tell him he must have done something wrong to cause his misfortunes.
The sense of guilt that can accompany cancer can keep you small
and prevent you from imagining yourself free of cancer.
surgery Rosalie V. told her doctor,
had to pray before I could have the operation. I had to be forgiven.
It was fortunate that I found a sympathetic pastor who could
help me see my life differently.
pointed out that my life is a work in progress. I have made
mistakes, like any other human being. But Ive learned
from them. Ive made some good decisions, too. I could
not be doing what I am now if I had not defied my fathers
expectations and completed school.
have made a career of fighting injustice against my people.
Ive learned that bitterness doesnt help my cases.
Ive learned from this cancer that my bitterness against
the church doesnt help my case, either.
still think about the abortion and Ill always wonder why
I got cancer. But I know now that its not because I committed
Tina had been out of touch with her own needs for a long time.
It became clear in therapy that her depression was the accumulation
of her chronic stress, her grief for her mother, her loss of joy
in life because of overwork, and even the loss of her health because
of the cancer and surgery. During her convalescence she wrote
a letter to her therapist:
been rummaging around in that dark closet of my life and decided
to do a bit of cleaning. There are some old clothes
that I may want to get rid of. Im discarding some dress
for success suits and power hats and changing
to a less stressful job.
stepdaughter Denise and I are taking a train trip to Utah to
go skiing. I may not do much skiing but I want to spend time
with her and get to know her as a person.
wanted to spend more time with my photography and I found my
old Nikon from college. Im going to dust off the old photographs
of my parents families and put together the story of my
familys migration from Sweden. Ill put it on CD
so the rest of the family can know them.
most important thing I found in that closet is a mirror. I polished
it and from now on Im going to look in it first and ask
me what I want before I say yes to someone else.
Seizing the opportunity
It can be difficult to look at cancer as an opportunity. In the
crisis of fighting for your life you may not have much time to
look at anything else. Dwight did examine his life and commented
to his doctor:
Its like that old joke about getting the elephants
attention by hitting him in the head with a 2x4. Cancer sure
got my attention!
began to observe myself, living my life. I noticed that it wasnt
the kind of life I wanted. I was going through each day as if
I were asleep. I never paid attention to the people around me,
or to what I was doing. I realized that if I dont pay
attention now, I may never wake up. After all, how many times
does opportunity knock?
is always an opportunity to heal. When you take the time to pay
attention, you can find it.
to Ask Yourself
How do I want to re-define my cancer-patient relationship?