T gether We Care
decision
making
Guiding you through cancer treatment
A
Special Edition for Cancer Care
Dear Readers, In collaboration with the National Cancer Council Malaysia (MAKNA) and CCM Pharmaceuticals, HealthToday is pleased to present to you TOGETHER WE CARE, a series of booklets exclusively produced to act as a vital resource about cancer and to offer practical advice on how to effectively cope with it. Our goals are to promote public awareness of cancer, as well as to improve cancer care among patients and caregivers. Following the first booklet entitled ‘Guiding you through life after cancer diagnosis’, Guiding you through cancer treatment-decision making, is the second in the series, providing information on different types of cancer treatment and common issues encountered during treatment. We hope that this booklet will be useful for people who are planning for treatment as well as those undergoing treatment. Similar to the first booklet, you can also discover how other people with cancer get through their cancer fighting journey at the end of the booklet. Our thoughts and prayers are with you or your loved one during this journey to recovery. We hope you will also find the last and third booklet in this series, coming soon, useful. Chai Pui Fun Editor
Our Partners: Publisher Yasunobu Sakai
Head of Marketing Violet Lew
Editorial Advisor Lim Teck Choon Mok Shi-Lynn
Business Team Lead Choong Miew Ling
Editor Chai Pui Fun
Business Manager Sharlyn Tan
Designer Ho Kan Keong Production Coordinators Pramila Lingam Ho Kan Keong
is published by MIMS.
PP9626/12/2012 (031440) (Malaysia)
With cancer or any other disease for that matter, it has always been the case that collaboration from various segments of society is a necessary ingredient for breakthrough. As a society, our fight against cancer needs to be a concerted effort with different individuals and organizations bringing to the table their own expertise and capacities – which will allow for the efficient use of resources towards addressing the cancer challenge with successful results. This cancer information series, a result of the collaboration between HealthToday, CCM Pharmaceuticals Sdn Bhd and MAKNA, is a fine example of putting forward one’s expertise to contribute towards tackling a larger issue. For more than two decades of fighting cancer, MAKNA has worked with numerous cancer patients, survivors, families, caregivers, hospitals, government agencies, companies, NGOs, individuals, researchers and the general public. Our approach is focused on these partnerships and in the bringing together of different segments of society who can contribute best in different areas, towards the cancer cause. There are currently a number of programs that MAKNA carries out in collaboration with other organizations, such as our cancer centre jointly run with Pusat Perubatan Universiti Kebangsaan Malaysia, our bursary assistance program which receives referrals from 92 government hospitals via the Department of Medical Social Work – the success of each program depends on the strength of MAKNA and its partners’ teamwork. As clichéd as it may sound, together, we achieve more. The support from MAKNA as helpful as it is only covers but a fraction of the cancer incidences in the country. It is therefore fortunate that there are many other organizations that also support the cause against cancer. Yet, still many cancer patients are facing a lonely battle against cancer, unaware of the support available to them. Awareness and outreach are therefore still very much of a challenge for us here in Malaysia. In light of this, I wish to thank you, the reader, for taking the important step of picking up this booklet and making the decision to learn more about cancer. By raising your own awareness and reaching out to someone who might benefit from the information in this booklet, you are making a significant difference.
DATO’ MOHD FARID ARIFFIN Founder and President
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Foreword by MAKNA
Foreword by MAKNA
Getting ready for treatment
2
treatment plan Understanding your
D
espite the various types of cancer treatment available, your doctor will need some time to plan for your treatment, to ensure that you can get the best treatment outcome. You can take this time to learn more about your cancer.
How is treatment planned? Your doctor will decide your treatment plan based on the following factors: • Your type of cancer • The stage of your cancer • Your age, overall health, lifestyle, financial situation and personal preferences
Goal of treatment The World Health Organization states that cancer diagnosis and treatment
programme are designed to cure or considerably prolong the life of patients and to ensure the best possible quality of life to cancer survivors. You should ask your doctor about your goals of treatment before commencing any treatment plan. Ask your doctor if your treatment is to cure the cancer, control it or treat the problems it is causing you. This knowledge will help you make further decisions with regards to your treatment. The goals of your cancer treatment may change over time.
Know what to ask your healthcare providers Your doctor and other healthcare professionals (eg, nurses) in the cancer care team are the ones who can lead and help you through your cancer treatment journey. So, do not
be shy to let them know how they are able to help you.
• When will the cancer-cell killing
Here are some questions you may want to find out from your doctor and/or the cancer care team: • Do I need any other tests before we decide on treatment?
• What are the treatment follow-ups
• How often do you treat this type of cancer?
• Am I going to die? • What treatment do you suggest and why?
• What are the advantages and disadvantages of the recommended treatment?
• What is the goal of my treatment? • Who else will be involved in my cancer care plan?
• Are there other treatments I should consider?
• How soon will the treatment start? • What can I do to be ready for treatment?
• Do I need to stay in the hospital during the treatment?
• What are the possible risks or side effects?
• What should I do if I experience uncommon side effects?
• How can I manage the side effects?
• How long will my treatment go on for and how much will it cost?
activity start after treatment initiation? often are they? and how often?
• What happens if I miss a treatment? • What kind of physical changes will I need to anticipate during and after the treatment?
• Will I need any other drugs or treatments, on top of the one you have suggested?
• How do you assess whether the treatment is working?
• What are the chances of recovery with this treatment and will the cancer recur in the future?
• Are there any food or lifestyle restrictions after my treatment has started?
• How can I contact you or other healthcare officers after hours and outside of medical appointments?
• How long will the side effects last? • How long would the side effects last after the treatment ends? Apart from these, you may have other new questions that arise throughout your cancer care journey. Do not hesitate to ask. Try to understand and remember the details with regard to your cancer and treatment. Take down notes, bring a family member or friend, and/or record the conversations if you need to.
Getting ready for treatment
3
Understanding cancer treatment
4
S
Surgery
urgery is a procedure performed under anaesthesia to remove a tumour (either completely or partially), some normal tissues from around the cancer, and sometimes, the lymph nodes nearest to the cancer. The tissues that are being removed will be sent to a laboratory for further examination, which will allow your doctor to decide if you need any further treatment (eg, chemotherapy, radiotherapy) to reduce the risk of cancer recurrence. Surgery may cure cancer that is fully contained in one area and has not spread to other body parts.
Possible risks of surgery
• Bleeding. Can occur either inside or outside the body when a blood vessel was not sealed off during the surgery or if a wound opens up. Bleeding is a part of any surgery and can usually be controlled.
• Blood clots. • Damage to nearby tissues or other organs. • Drug reactions. Can occur if your body is unable to tolerate anaesthesia or any other medicines used during the surgery. However, your doctor will monitor your heart rate, breathing rate, blood pressure and other vital signs closely to avoid the occurrence of low blood pressure as a result of drug reactions. • Pain. Surgical pain may occur after a surgery, but it can be treated with painkillers. • Infection at the site of incision. The risk can be reduced with wound care; however, if an infection occurs, your doctor can prescribe antibiotics for it.
• Slow recovery of other body functions (eg, bowel activity). You can reduce the risk by trying to move around as early as possible after your surgery. Consult your doctor for moere information.
R
Radiation therapy
adiation therapy is a treatment that uses high doses of radiation to kill cancer cells and shrink tumours. It can be given in two ways: • External radiotherapy, which comes from a machine that sends radiation to the affected part of your body from many directions. • Internal radiotherapy, which is given in the form of a liquid drink that gets absorbed by cancer cells. Radiation therapy does not immediately kill the cancer cells; it will take days or weeks of treatment before the cancer cells start to die. After the therapy ends, cancer cells will continue to die over a span of
several weeks or months. Radiotherapy could also kill normal cells, but they are better at repairing themselves than the cancer cells. Radiotherapy is usually given daily in small doses for five times a week over several weeks. This treatment may be recommended if the cancer has spread. It may be the only treatment needed for some people, whereas other people may also need other treatments, such as surgery and chemotherapy. Do go for regular follow up with your doctor for a progress review and take the medicine that is given to ease your pain. Take extra rest to allow your body to recover.
Potential side effects Acute • Nausea and vomiting • Digestive problems • Swelling • Mouth ulcers
Late • Dryness in eyes and mouth • Fibrosis • Depression in cognitive abilities (especially in small kids) • Hair loss • Heart disease • Infertility
Understanding cancer treatment
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Understanding cancer treatment
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Chemotherapy
C
hemotherapy can be used to cure cancer, reduce the chance of recurrence, or stop or retard its growth. It can also be used after surgery/ radiation therapy to kill any cancer cells that are left behind, or before surgery/radiation therapy to shrink tumours. It may only involve a single type of drug (monotherapy) or more often, multiple drugs (combination therapy). In combination therapy, different drugs are used together in different ways to kill more cancer cells. Combination therapy also helps reduce the chance for cancer cells to develop resistance to these drugs.
Your doctor will schedule treatment for you at regular intervals known as cycles. A cycle may be a dose of one or more drugs followed by a period of rest to allow your body to recover from drug side effects.
Treatment schedule may vary among individuals; your doctor will determine one for you based on your needs. It is important for you to stay on the treatment schedule, so that you can get the full dose and full course of chemotherapy. By doing this, you will have higher chance to get maximum benefit out of the treatment. Potential side effects Chemotherapy is effective against cancer, but it can also damage healthy cells and cause side effects such as fatigue, hair loss, mouth sores, vomiting and nausea. However, do not worry as these side effects often improve after treatment. If you are experiencing fatigue, arrange for someone to drive you to and from chemotherapy. Also, plan to have a good rest on the day of and the day after chemotherapy.
Targeted
T
therapy
argeted therapy treats cancer by interfering with specific proteins that help tumours grow and spread throughout the body. Targeted therapy work by any of the following ways: • Block or turn off chemical signals that cause the cancer cells to grow or divide; • Alter proteins within cancer cells, leading to their death; • Stop production of new blood vessels that feed the cancer cells; • Trigger the body’s immune system, so that the immune system can kill the cancer cells; and • Transport toxins directly to the cancer cells to kill them. The two main types of targeted therapy are monoclonal antibodies, which are given using a drip, and small-molecule drugs, which are taken orally. Targeted therapy can be used as the main treatment for some cancers, but in most cases it is
combined with other treatments such as chemotherapy, surgery, and/or radiation therapy. Targeted therapy is complicated and the chances of successful outcome can be influenced by many factors. Therefore, it is important for you to understand that: • A targeted therapy may not work for everyone because not all tumours have the same targets. Hence, testing of the tumour tissue may be needed prior to therapy to determine the presence of an appropriate target; • Your tumour may not necessarily respond to the treatment even if the target is present; and • There is a possibility that the drug might stop working after some time. Potential side effects Targeted therapy has fewer side effects than chemotherapy. Still, side effects that may occur include diarrhoea and problems associated with the liver, skin, hair, nails and/or eyes.
Understanding cancer treatment
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Understanding cancer treatment
8
Stem cell transplant
S
tem cells are immature blood cells in the bone marrow. In healthy individuals, stem cells develop into one of the following three types of blood cells: • Red blood cells, which carry oxygen throughout your body; • White blood cells, which are a part of your immune system and help your body fight infection; and • Platelets, which help the blood to clot. Stem cell transplant is a treatment option most often used for cancers affecting the blood or immune system, such as leaukaemia, lymphoma or multiple myeloma. It also helps to recover the body’s ability to produce stem cells after treatment with very high doses of radiation therapy and/or chemotherapy. In a stem cell transplant, healthy blood-forming stem cells will be given through an intravenous line, similar to a blood transfusion. These healthy stem cells can be taken from the bone
marrow, bloodstream or umbilical cord of the same individual, a donor who may or may not be a blood relative, or an identical twin (if any). Upon entering the bloodstream, the stem cells travel to the bone marrow to replace cells that were destroyed by the treatment. After a transplant, your doctor will monitor you for any signs of cancer or complications from the transplant. Potential side effects If you receive stem cells from someone else (not identical twin), you are at risk of developing graft-versus-host disease, which arises when white blood cells from the donor (the graft) recognize cells in the body (the host) as foreign and attack them, causing damage to the skin, liver, intestines and many other organs. Graft-versushost disease can occur a few weeks after the transplant (sometimes much later), and it can be treated with steroids or other drugs that suppress the immune system. However, the chance of having graft-versus-host disease is reduced if the donor’s stem cells closely match the recipient’s.
Immunotherapy
I
mmunotherapy boosts the ability of your body’s immune system to fight cancer.
There are several types of immunotherapy, including: • Monoclonal antibodies, which are drugs that bind to specific targets in the body. Monoclonal antibodies can induce an immune response to destroy cancer cells.
• Non-specific immunotherapy/ cytokine treatment, which helps to boost the immune system using cytokines such as interleukins and interferons.
• Cancer vaccines, boost the immune system’s response to cancer cells. The vaccines are usually made from a person’s own tumour cells or from substances produced by tumour cells.
• T-cell therapy. In this approach, some T cells (a type of white blood cell) are collected from the blood and genetically modified to express a protein that allows them to attach to specific proteins on the surface of the cancer cells. Upon binding to the cancer cells, the modified T cells become activated and subsequently, will destroy the cancer cells. Currently, T-cell therapy is only available in clinical trials.
• Oncolytic virus therapy. This is a new type of immunotherapy that uses genetically modified viruses to kill cancer cells. It was first
approved by the U.S. Food and Drug Administration for treating melanoma (a type of skin cancer) in year 2015.
Immunotherapies may be given in different ways – intravenous (that goes directly into the vein), oral, topical (that rubs onto your skin; may be used in very early skin cancer), intravesical (that goes directly into the bladder), or injection – depending on the types of therapy one will be receiving. Immunotherapy may be given every day, week, month, or in cycles (ie, a period of treatment followed by a period of rest), depending on the type of cancer and how advanced it is, the type of immunotherapy you get, and your body’s response to treatment. Similar to other cancer treatments, immunotherapy can be used alone or combined with other types of treatment. Immunotherapy is not yet available in Malaysia, but extensive research has been ongoing in local research institutes. Possible side effects The most common side effects are skin reactions at the needle site. Some people may also experience flu-like symptoms. Other side effects might include swelling, weight gain from retaining fluid, heart palpitations, sinus congestion, diarrhoea, and infection. Severe allergic reactions are possible, but rare.
Understanding cancer treatment
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Understanding cancer treatment
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Complementary and alternative therapies
C
omplementary and alternative therapies are treatments that use any kinds of products, practices, and systems not belonging to part of standard care to manage cancer. Complementary therapy is used alongside with conventional medical treatment to help relieve symptoms and improve quality of life during cancer treatment. Some examples include aromatherapy, acupuncture, herbal medicine, massage therapy and visualization. On the other hand, alternative therapy is the use of any unproven methods (eg, special diets, fruit extracts, special electronic devices) to treat cancer. Usually, these methods have not been scientifically proven to be effective for cancer management.
Most of the time, complementary and alternative therapies are used for the following reasons: • To reduce the side effects of cancer treatment
• To ease worries and stress associated with cancer treatment
• To play an active role in improving self health and wellness
• Personal preference
Although using complementary and alternative therapy is a personal decision, it is important for you to discuss with your doctor before starting any alternative or complementary therapy. This is to ensure that the treatment does not cause any harm to you. Stopping your regular cancer treatment and using an alternative method is strongly not advisable.
Living with treatment
C
ancer and cancer treatments can cause side effects; however, these side effects vary among individuals, because they are affected by many factors including the type of treatment, the frequency of the treatment, age and other health conditions. Even if the same type of treatment is given, some people can still have very few side effects while others can experience many. Do not worry. There are always ways to manage these side effects (if it happens). Anaemia is a condition where the body has an abnormally low level of red blood cells. It may leave you feeling weak or tired. You can improve this condition by eating more foods that are high in iron (eg, almonds, red meat, beans or legumes, raisins) or folic acid (eg, asparagus,
spinach, lima beans). Foods such as broccoli and enriched breads and cereals are high in both iron and folic acid. Your doctor may also prescribe some medications or vitamin/mineral supplements. If your anaemia is severe, your doctor may recommend a blood transfusion. Appetite loss (which can lead to weight loss) You may not feel like eating, but it is important for you to obtain good nutrition for recovery. Try these: • Eat several small meals a day • Eat nutritious snacks, preferably high in calories and protein (eg, dried fruits, nuts and nut butters, yoghurt, cheeses, eggs, milkshakes, ice cream, cereal, pudding, protein bars, granola bars)
Managing treatment-related issues
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Managing treatment-related issues
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• • •
•
Go for nutritious or filling drinks (eg, milk, nutritional milkshakes, smoothies) Spice up your food with spices and condiments. It will make your food more appealing Try food that is cold or at room temperature, because the odour or taste that may make you nauseous can be reduced Try some light exercises 1 hour before meals to stimulate your appetite (but ask your doctor first before you start any exercise program)
Memory or concentration problems Apart from medications and cognitive therapy that may be prescribed by your doctor, you can also use the following strategies to help you overcome your attention, thinking and memory difficulties: • Make notes, create to-do lists and set reminders (you can make use of a calendar, daily planner or sticky notes) • Avoid multitasking and distractions • Be prepared early for upcoming tasks • Perform your favourite activities (eg, walking, swimming, gardening, yoga, meditation) to help you relax and improve mental alertness • Try solving crosswords or puzzles, painting, playing a musical instrument or learning something new. These can help improve your cognitive function • Keep things at the same place so that you can find them easily • Get extra rest and plenty of sleep at night. If rest during the day is needed, take short naps of less than 1 hour. Avoid long naps because it can make it more difficult to sleep at night.
Nausea and vomiting If you are experiencing nausea and vomiting, your doctor may prescribe medications for you to control them. You may also try the following:
• Drink clear liquids (eg, ginger ale, •
• • • •
apple juice, broth, tea) served cold and sipped slowly. Try sour foods or small amounts of foods high in calories that are easy to eat (eg, pudding, ice cream, sherbets, yogurt, milkshakes) several times a day. Suck on hard candy with pleasant smells, such as lemon drops or mints. Avoid fatty, fried, spicy or very sweet food. After each meal, rest quietly while sitting upright for at least 1 hour. Distract yourself with soft music or a favourite TV program.
Oral problems Cancer treatments may cause dental, mouth, and throat problems. If these happen, you can manage it by: • Choosing to eat foods that are soft, wet and easy to swallow •
Avoiding foods and drinks that can irritate the mouth, such as crunchy, salty, spicy or sugary foods
•
Rinsing or gargling with a solution of saltwater and baking soda. Some mouthwashes may also be helpful. Ask your doctor about that.
•
Cleansing your mouth gently
Pain Your doctor may prescribe pain medicines for you; take it according to your doctor’s instructions and tell your doctor if your pain doesn’t relieve. He/ she can suggest other approaches to manage your pain or discomfort.
•
Cutting your hair short (or shaving it)
•
Wearing a cap or scarf (this will make you look cool too)
Furthermore, there are ways to help protect your scalp, such as: • Wearing a hair net at night •
Being gentle towards your hair. Use a wide-tooth comb and avoid too much brushing or pulling
•
Using a hat to protect your scalp from the sun
Skin and nail changes Dry and itchy skin can be managed with moisturizers. Your doctor may also prescribe medications for you if the condition is severe. Your nails may also be affected, causing them to lift or break. So, it is better to keep your nails clean and short. You can also wear gloves to protect them. Manicures and pedicures should be avoided.
Can you work during treatment? Your ability to work during treatment depends on many factors, including the type of work you do, the type and stage of your cancer, the treatment protocol and its side effects. In many cases, remaining at work during
treatment is possible, but it is a personal decision dependent on how supportive and flexible your employer is. If your employer terminates your service because of what you may be going through, be sure that you bring up your case to the Department of Industrial Relations Malaysia. There is a law to protect you from unfair dismissal.
Can you exercise during treatment? Staying physically active has been shown to help cancer patients reduce side effects such as fatigue, increase muscle strength and joint flexibility, improve general conditioning and cardiovascular function, protect bones, elevate mood, relieve the feelings of depression, control weight, and many more. Therefore, ask your doctor about the types of exercise you can add into your daily routine during your next visit to the clinic or hospital.
Sexual desire and fertility during treatment Cancer treatment may make you feel unattractive or reduce your desire for sexual intimacy. Fortunately, these issues can sometimes be short-term and will go away naturally after treatment is over. Your doctor can advise you on matters related to intimacy, while a family counsellor will be able to help if you and your partner need someone to talk to and seek advice from in matters related to the pressures on your relationship caused by your cancer.
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Managing treatment-related issues
Scalp hair loss Although hair loss may be one of the distressing side effects of cancer treatment, especially among women, it is usually temporary and hair will grow back after treatment has stopped. So, don’t be upset. In the meantime, you can still stay fashionable and beautiful by: • Getting yourself a suitable wig (the stylist will be able to create the best match for you)
An inspiring true story
Behind the victory
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Face of Cancer Standing Courageously in the
Being diagnosed with cancer can be overwhelming, especially when it happens at a young age. Siti Umira Othman, who was diagnosed with rectal cancer at the age of 26, shares her journey on cancer-fighting with us.
J
Just like many other young adults, Umira was excited to start her new stage of life after completing her studies at Universiti Teknologi MARA, but her excitement turned to ashes when she was diagnosed with Stage II rectal cancer in 2013. “I started feeling unwell during my final year of study. I experienced weight loss, fatigue and there was blood in my stool. I
went to seek medical advice, and was told that I had anaemia because my haemoglobin count was very low. I felt something was really not right when other symptoms appeared. I had bowel incontinence and diarrhoea, which disrupted my daily activities for nearly 2 months,� Umira tells us. She went to consult a doctor at Hospital Kuala Lumpur. The blood test revealed that she had a high carcinoembryonic antigen (CEA) level,
“My mother passed away 10 years ago because of the same cancer. Her cancer spread rapidly because she chose traditional treatment, instead of the standard cancer therapy. My father did not want the same thing to happen again, which was why he encouraged me to proceed with the treatment proposed by the doctor,” Umira recalls.
any serious side effects from the chemotherapy. Apart from tiredness and dizziness, which will usually go off within 2 days after treatment, other side effects I encountered was numbness at the fingers, but it did not affect my ability to write or perform daily tasks,” Umira says. “I am also grateful that I am still able to take care of myself and eat as usual. I avoid eating red meat and seafood, while increasing my intake of vegetables, fruits and fruit juice.”
“The tumour was quite large. A second review by a colorectal surgeon in Hospital Kuala Lumpur did not recommend resection of the entire rectum for me, because I will need to wear a colostomy bag permanently as a result,” Umira says.
Currently, the site where the cancer started has improved, although small lesions have been detected in the lungs and on the heart. Both Umira and the cancer care team are working hand in hand to monitor her health, maintaining hope throughout the journey.
“Instead, I was referred to Hospital Selayang for resection of only the section with the tumour. Prior to the surgery, I had a temporary colostomy and I received 25 cycles of radiotherapy, five times a week for 5 weeks, to shrink the tumour.”
“The journey of fighting cancer is definitely not easy, but I know that I need to stay strong. I took the initiative to learn more about my cancer and its treatment through the internet, bearing in mind that the same treatment could still work differently in different individuals,” she says. “I am very grateful to my family, especially my father, friends and the members of my cancer care team. They were the ones who gave me motivation to continue with the treatment, besides being very helpful and supportive. I am also grateful to the support from MAKNA, an organization that has given me lots of care and encouragement. Because of them, I know now that I am not facing the battle alone.”
After the removal of the tumour, Umira was referred back to Hospital Kuala Lumpur for subsequent treatment. “I was given oral chemotherapy for six cycles in year 2014. But soon after I completed the treatment course, my cancer was found to spread to the nearby lymph node.” As surgery to remove the lymph node was not recommended due to possible risk of faecal incontinence in the longterm, she had to undergo different regimes of chemotherapy, eight cycles in year 2015, seven cycles in year 2016 and another 16 cycles until last January. “I am fortunate that I did not experience
“I am fully aware that this is going to be a tough battle for me, but I will never give up. I believe that I can win this battle and continue to lead a normal life,” she concludes with an optimistic smile.
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Behind the victory
which was highly suspicious for cancer. Her cancer was confirmed after her colonoscopy and biopsy results showed that her cancer was at Stage 2.
Messages of Hope In late 2016, CCM Pharmaceuticals invited members attending its Purple Lavender Campaign launch to leave their inspirational messages to cancer patients and survivors. Here are some of these messages.
No matter what happens now, ALWAYS REMEMBER that you are a survivor, not a victim.
Pur p Cam le Lave n paig n lau der nch
Life isn’t about waiting for the storm to pass, it’s about learning how to DANCE IN THE RAIN.
I have no doubt that you will fight cancer with the same ferocious determination that you have with other challenges in your life. I know that the great strength you have will prevail.
References: 1. American Cancer Society. Available at www.cancer.org. 2. National Comprehensive Cancer Network. Available at www.nccn.org. 3. Mayo Clinic. Cancer. Available at www.mayoclinic.org/diseases-conditions/cancer/in-depth/ cancer-diagnosis/art-20044544. 4. Cancer Research UK. Available at www.cancerresearchuk.org. 5. National Cancer Institute. Available at www.cancer.gov.
Editorial material herein is provided for information only. Readers are cautioned not to use this information as a substitute for regular professional health care and consultation. Although great care has been taken in compiling and checking the information given in this publication, the publisher, authors, advisors and agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions or inaccuracies in this publication whether arising from negligence or otherwise howsoever, or for any consequences arising there from. The inclusion or exclusion of any product does not mean that the publisher advocates or rejects its use either generally or in any particular field or fields. Advertisements are subject to editorial acceptance and have no influence on editorial content or presentation. The publisher, authors, advisors and agents do not guarantee, directly or indirectly, the quality or efficacy of any product or service described in the advertisements or other material which is commercial in nature. Copyright: Š 2017 No portion of this publication may be reproduced in any language, stored in or introduced into a retrieval system, or transmitted, resold, redistributed, in any form or by any means electronic, electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without prior written permission of the publisher. MY-CCM-091