What to Do When You or a Family Member Is Diagnosed with Cancer

The 2022 National Cancer Report released by China's National Cancer Center shows that China adds 4.88 million new cancer cases each year, meaning that about 13,000 people in China are diagnosed with cancer every day. Over a lifetime, roughly one in four to one in three people will eventually be diagnosed with cancer.

Although cancer is now a common disease that almost every household may encounter, when a person is diagnosed, the patient and family still cannot help panicking; some even become overwhelmed with grief and then rush from doctor to doctor indiscriminately. Drawing on many years of practical experience, I write this article in the hope of bringing some help to patients and their families.

First, what we must do is complete the examinations and determine the type and stage of the cancer. Most cancer patients are found during a physical checkup, or after incidental symptoms prompt relevant examinations at the hospital. Generally speaking, the initial examination report is only a preliminary result, not a comprehensive one; it cannot yet tell what type of cancer the patient has, nor at what stage. At this point, a doctor cannot give accurate treatment advice based on a preliminary result alone.

So completing the workup is the first step. Cancer patients need the following aspects of examination:

1. Imaging examinations

CT, contrast-enhanced CT, PET/CT, bone scan, MRI, B-ultrasound, and endoscopy (including gastroscopy, colonoscopy, bronchoscopy, hysteroscopy, etc.) are all imaging examinations; the oncologist will give appropriate recommendations. Imaging can detect whether there is a tangible tumor in the body and its basic development. The doctor can judge from this how far the tumor has progressed — for example, whether there is lymph node or distant metastasis — and stage the tumor accordingly.

Imaging is very important, because its result determines what treatment option is chosen first. After cancer is confirmed, the patient should consider a whole-body PET/CT to determine whether the cancer has metastasized. Only after understanding the patient's exact situation can the doctor give correct advice. Seeking a doctor's advice before the workup is complete is a waste of money and time.

For example, if the cancer is in the early stage with no lymphatic or distant metastasis, then the most ideal treatment will be surgery. Most early-stage cancer patients have a high surgical cure rate, reaching over 90%; certain carcinomas in situ can even achieve a near-100% cure rate with surgery. I need to remind all readers: do not miss the best surgical opportunity for early cancer, and do not listen to the nonsense of quacks and give up surgery for other options.

If the cancer has already metastasized but the spread is within a controllable range, the patient still has a chance of a curative surgical approach; it is just that the curative rate is relatively lower. Usually, patients with progressive-stage cancer need comprehensive treatment alongside surgery, including chemotherapy, radiotherapy, interventional therapy, immunotherapy, targeted therapy, and conservative TCM treatment.

If the tumor has already spread widely, then surgery generally has little value. At this point the patient should first choose chemotherapy, radiotherapy, immunotherapy, targeted therapy, interventional therapy or conservative TCM treatment, to improve quality of life and prolong survival as much as possible. In special cases, palliative surgery can be considered to relieve the most distressing symptoms; for example, a patient with obstruction can have it relieved by palliative surgery.

2. Pathological examination.

Pathological examination in cancer patients is divided into preoperative and postoperative types.

Preoperative pathology involves taking a biopsy needle sample from the tumor and examining the tissue sections. The pathologist observes the cancer cells under a microscope, analyzes their morphological features, and determines the tumor type, for the clinician's reference in deciding treatment.

Postoperative pathological analysis examines the resected tumor tissue after surgery; sometimes the postoperative report does not match the preoperative result, because preoperative testing only removes a small piece of tissue by needle and cannot fully reflect the whole tumor. So preoperative pathology often misses or misdiagnoses, and some patients even need multiple needle biopsies before cancer is confirmed.

Pathological examination can also analyze the tumor's immunohistochemistry. Immunohistochemistry detects specific proteins in tumor tissue to understand the origin and differentiation of tumor cells. Common IHC markers include cytokeratin, the tumor suppressor gene P53, and hormone receptors. IHC helps determine tumor type and predict treatment effect and prognosis.

These examination data are crucial for the doctor's medication choice; different cancer types have very different treatment plans. For example, for lung cancer, small-cell lung cancer and lung adenocarcinoma are treated differently; for gastric cancer, gastric adenocarcinoma and signet-ring cell carcinoma are also treated differently.

Another very important examination in pathology is molecular genetic testing, i.e. what we commonly call genetic testing. Genetic testing analyzes genetic changes or mutations in tumor cells to understand the tumor's characteristics and drug sensitivity; the report provides an important basis for the clinician to prescribe precisely. Genetic testing includes DNA sequencing, protein expression analysis and genomic alteration detection. It helps design individualized treatment; results help doctors choose the most suitable targeted drugs and predict treatment effect.

3. Tumor marker examination

Tumor markers are substances specific to malignant tumor cells, or abnormally produced by them, or produced by the host in response to the tumor; their appearance usually indicates the host has some kind of tumor. Tumor markers exist in the tissues, body fluids and excreta of cancer patients and can be detected by immunological, biological and chemical methods. They reflect tumor occurrence and development and are one of the important bases for clinically monitoring the tumor's response to treatment.

Common tumor markers include alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), prostate-specific antigen (PSA), human chorionic gonadotropin (HCG), and various cancer antigens (such as CA-125, CA-199). For those cancer patients in whom markers can be detected, the marker is an important reference for treatment effect. Of course, not every cancer patient has detectable markers; many have normal tumor markers.

Patients can monitor the rise or fall in marker levels to judge whether the current treatment is working; if a treatment lowers the marker or slows its rise, it may be effective. Of course, this is not absolute: in some advanced patients the markers may keep rising or rising faster, yet imaging shows the tumor shrinking significantly during treatment and the patient's physical condition clearly improving; this also happens clinically, and in fact such patients are being effectively treated. So tumor markers must be combined with other findings, especially imaging.

4. Body fluid, secretion and excretion examinations

Tumor patients need blood routine, liver and kidney function, coagulation function and urine routine; sometimes stool routine or vaginal secretion testing is also needed to judge the patient's overall condition. The doctor must comprehensively analyze these results before giving meaningful, safe and reliable medical advice. For example, some patients have abnormal liver or kidney function, which prevents certain treatments from proceeding smoothly.

Cancer is a chronic disease that does not progress extremely fast; patients have enough time to complete all examinations, and most examination costs can be reimbursed through medical insurance. Patients and families need not panic; patiently completing the workup is an important part of treatment. Many patients, before the examinations are even finished, urgently expect the doctor to give treatment advice. This is actually irrational; under such circumstances doctors cannot give the best advice either, and can only offer psychological comfort while advising the patient to complete the workup and then decide based on the specific situation once all results are in.

So after the results are out, how should we choose a treatment? The current medical consensus is that tumors require multidisciplinary comprehensive treatment. On the Western medicine side, the WHO has issued guideline recommendations for various tumors, and these guidelines are constantly adjusted according to new clinical results. Most patients should first consider following standard, standardized treatment protocols.

I need to specifically mention the role of TCM in treating tumors, because I mainly research TCM anti-cancer and have some social influence in this field, so many patients and families may value my opinion here most.

First I must make clear: TCM has some help for cancer patients, but cancer patients absolutely should not rely on TCM alone. There is no need to belittle TCM's value, nor to overestimate its role. An early-stage cancer patient who skips surgery for pure conservative TCM treatment is gambling with their life; a patient for whom Western treatment is already effective who abandons ongoing treatment for pure TCM is likewise gambling with their life. If examinations show a treatment highly suited to the patient — for example, a patient with a gene mutation highly sensitive to a certain targeted drug — the patient should without hesitation choose that highly precise approach rather than TCM.

TCM treatment can run through the whole course of cancer treatment, but if the patient is about to undergo surgery, taking Chinese medicine before surgery is not recommended. Because preoperative TCM may carry unpredictable risks, such as abnormal liver or kidney function that prevents the surgery from proceeding as planned. After surgery, during recovery, or when side effects arise during chemoradiotherapy or targeted therapy, an experienced TCM physician can be consulted for symptomatic supportive treatment. After standardized treatment ends, Chinese medicine can also be taken to prevent recurrence.

Some cancer patients who have lost the surgical opportunity and are insensitive to or intolerant of chemoradiotherapy and targeted therapy may choose pure conservative TCM treatment. But most cancer patients should not consider pure TCM, because such a single approach has too low an effective rate and is a gross irresponsibility toward life. Patients or families who make such a choice usually regret it deeply as the patient approaches death.

When choosing TCM, one can follow principles such as professionalism and proximity. Cancer is a special disease, and the common side effects of cancer treatment are also special; in modern society physicians are highly specialized, and TCM doctors who specifically research cancer have richer clinical experience with cancer and its common treatment-related side effects, so seeking such a physician may be better.

Besides professionalism, the physician's sense of responsibility and professional ethics are also important. I believe most clinicians have good professional competence and a sense of responsibility. What patients and families really need to guard against are those who exaggerate and charge exorbitant fees: anyone who lightly claims to cure cancer and charges tens or hundreds of thousands is a fraud. Such people are no different from scammers; the media often reports such cases, and most people can tell them apart. The few who are fooled should also reflect on whether their own judgment is mature. The people I have seen in real life who are fooled usually would not listen to others' advice beforehand, and they tend to be rigid and paranoid in daily life as well.

Cancer treatment is a long process; patients and families should seek medical care rationally. Where medical insurance reimbursement is available, use it; for non-insurance drugs, make sure the long-term cost is affordable. Many Chinese patent medicines within medical insurance can be used to treat cancer — for example, Xihuang Wan, Sanjieling capsules, Fufang Banmao capsules, Huachansu tablets, Fufang Hongdoushan capsules, Xiaoaiping, Pingxiao capsules, and Fulepian tablets. These patent medicines all have some efficacy and are convenient for patients. Patients with limited means should first choose drugs available on medical insurance to save costs.

When buying drugs out of pocket, one should not buy expensive Chinese medicines or patent medicines either. At current price levels, the monthly cost of commonly used anti-cancer drugs can basically be kept within several thousand yuan; some considerate doctors will find every way to save the patient money, sometimes keeping the monthly outlay to one or two thousand or even a few hundred yuan. Any medication costing over five thousand yuan per month deserves caution.

I have heard of patients who, after seeking treatment from some so-called "TCM masters," lost their entire family fortune. These masters routinely use expensive ingredients like cordyceps, natural musk and bezoar to inflate drug prices, imposing high treatment costs on patients. Such so-called TCM practitioners should be kept far away from; they are more like murderers for profit. Moreover, practice shows they have no real efficacy, and most delay the patient's treatment. They are also usually skilled at brainwashing patients and families into rejecting modern medicine.

One should be wary of TCM practitioners with extreme views; they may be frauds or cognitively impaired. Such people easily voice extreme opinions and are emotionally volatile. Views that clearly contradict social common sense and logic should not be readily accepted.

Today search engines and AI are both highly developed; patients and families can also acquire more professional knowledge through internet platforms. Patient and family members with patience can even buy professional books closely related to their disease to read. Usually, when you enter the keyword of a disease on an online shopping platform, the books with the most buyers and most editions are the authoritative works in that field; reading them is most helpful.

Fighting cancer is a long process; the more knowledge you learn, the fewer detours you will take on the road of seeking treatment. Although AI is advanced now, from my own experience using it, discussing professional questions with AI only gives you a superficial grasp. To learn more comprehensively, it is best not to be lazy but to systematically read some professional books.

Having cancer is unfortunate, but it may also bring a major turning point to our lives. As we learn all kinds of cancer-related knowledge, our minds grow, and our outlook on life and the world undergo beneficial shifts. The other side of suffering is a turning point; I believe that as we walk this path, we will come to a new understanding of happiness, and perhaps our quality of life will even improve as a result. Because the vanities we once cared about now become insignificant, the noise in our hearts will be greatly reduced, and our lives will become more meaningful through settling in suffering.