To get the news of a "terminal" diagnosis can be devastating. One often remembers the questions you meant to ask only days later once the shock has started to subside. Specialist consulting times are limited and often too short to address all the uncertainties.

Staging of the cancer: TNM

The first step is do a multitude of tests to determine the gravity of the situation or staging of it. Apart from blood tests, these may include biopsies, MRI,

  • Tumour (T): exactly what type ot tumour

  • Nodes (N): are any lymphnodes involved, near the site or further away

  • Metastasis (M): has the cancer spead to other organs, like the lungs, liver or bone.

Each of the above boxes have to be checked before the specialists will decide on the best treatment opsion(s) – surgery, chemotherapy, radiation or combination therof.

This time can be frustrating and fearful with all the uncertainties. Elisabeth Kübler-Ross ( described the five stages of grief many years ago and later experienced them herself ("On Death and Dying"). You may have these all in one day in any order or over a period of time. Some people never move to accecptance and stay in denial until the end. Her described stages are:

  • Denial - This is impossible, cannot be me, lab made a mistake, nothing was wrong last time

  • Anger - How could this happen to me? Why am I punished like this!

  • Bargaining - If only I get cured/live 5 more years, then I will spend all my time/money on charities/hospices etc

  • Depression - Might as well die now, no purpose in treatment

  • Acceptance - How can I make this experience enriching to me and others? How do I live with this until I die?

Although critizised by some, still helpful to many. She merely tried to generalise certain reactions so we could associate that others also felt this way.


The first question you may have is how long do I have to live? There may be a specific prognosis for that type of cancer given the stage etc, but these are all ESTIMATES based on the evidence of medical studies all over the world. Sometimes these predictions are accurate, sometimes not. You are still an individual with individual risks and your own genetic makeup.


The second big question is why did this happen to me? We have no famliy history of cancer, I have always been living healhty etc. You may search for exposures in the past (such as radiation or asbestos), but without any direct relation or proof of causality. Most cancers can not be explained and this effort of finding out WHY can be exhausting. Think about it, but too much effort is not worth it: the situation is as it is, focus on how to deal with you in it.


At my work clinics, I often have to explain to employees what their diagnosis, procedure or prognosis means. With more specialised clinics such as breast, cardiac, chemotherapy etc. the role of the GP of explaining how things will happen has almost disappeared.


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