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LEARNING ABOUT CANCER
WHAT IS MY ROLE AS A CARER?
CARERS AND THE MEDICAL TEAM
CARING FOR THE PATIENT
WHEN THE PATIENT’S HEALTH FAILS
PALLIATIVE AND ADVANCED CANCER CARE
DEALING WITH PRACTICAL & PERSONAL AFFAIRS
PRACTICAL TIPS
STORIES OF HOPE
LIST OF HOSPITALS IN MALAYSIA
SUPPORT GROUPS

 
 CARERS AND THE MEDICAL TEAM

  As a carer, your efforts must complement that of your loved one’s medical team. Support the medical team by following all their instructions. If you have doubts, ask for further clarification.

At times, some carers feel that because they are not medically trained, their efforts are not as helpful as the medical team. Do not feel this way.

Carers help to ensure that the treatment is effective. Your role is important in the recovery, well being and comfort of your dear one.

Opening up the communication passageway no matter how hard it can become, allows both the caregiver and the loved one to process the situation and reach an understanding. This in return will compliment the medical team’s effort in prescribing the treatments.

LEARNING ABOUT TESTS & TREATMENTS

The more you know about the tests, treatments and medication prescribed, the better you can care for your loved one.

You will understand why certain drugs have been prescribed instead of the others. Or why only certain tests have been done and not the others.

Ask the medical team to repeat and explain in simpler terms if required. Even if they have explained to you earlier, they would understand that you and your loved one may have been in shock when receiving the information.

You can also refer to authoritative books and the Internet but make sure you visit only reputable medical sources.

Tests for Cancer
Medical tests are carried out to confirm if a person has cancer. There are various tests to identify different cancers.

Before any tests are conducted, the doctor will enquire the patient on their ailments, family history and lifestyle. He will also look at the patient’s symptoms and complaints.

Based on this information, the doctor will recommend certain tests to diagnose what cancer the patient could have. Tests are never done unnecessarily.

The doctor also may run more tests to confirm the result or to identify other types of cancer. Following are some of the tests you can expect:

Blood Tests
  • Full blood count
    Conducted to examine the number of red, white and platelet cells in the blood. The level of red blood cells will show if the patient is anaemic. White would point to the person’s immunity level – if they are fighting an infection. Platelets are checked as they

  • Electrolytes (electrolyte estimation)
    Used to see if there is an imbalance of salts in the blood, particularly sodium and potassium. An imbalance indicates that the patient is unwell.

  • Urea & Creatinine
    Urea and creatinine levels are measured to check kidney function.

  • Liver Function Tests
    The level of protein and certain enzymes are measured to see if the liver is working correctly and efficiently.

  • Special Blood Tests
    Performed when certain specific cancers are suspected such as ovarian and testicular cancer. These tests are also done to measure how well a cancer patient is responding to treatment.
Biopsy
A biopsy may be done either to support blood tests or as an independent test.

Biopsy means removing tissue from the living body for diagnostic purposes.

During a biopsy, the entire lump (tumour) may be removed or just a part of it. It may be done during the patient‘s first visit to the doctor or during subsequent visits. This is done via a minor surgical operation. The lump is then examined.

Both the timing and size of the lump to be removed will depend on the patient’s condition and the location of the lump within the body.

Fibreoptic Endoscopy
Very simply, this test uses a micro camera attached to fibreoptic cables which can be inserted into hollow cavities in the body (the throat, nose, rectum, etc).

It allows the doctor to see inside the patient’s body without having to perform surgery. The fibreoptic cables can be controlled from the outside for a more detailed view of the patient’s organs and tissues as well as extract a tissue sample for biopsy.

The process is slightly invasive, but not painful. Patients are normally sedated or under anaesthetic during the procedure to reduce discomfort. This technique has several variations:
  • Bronchoscopy
    To examine the airways leading to and directly from the lungs. The tube is inserted through the nose.

  • Oesophagoscopy / gastroscopy / duodenoscopy
    To examine the gastro-intestinal tract (stomach). The tube is inserted through the mouth into the stomach.

  • Colonoscopy
    To examine the intestinal tract with the tube inserted through the anus.

  • Cystoscopy
    To examine the bladder (urethra) with the tube inserted via the bladder itself
X-rays
X-rays help doctors ‘see’ the tumour in the body, particular those in the stomach (digestive tract) and the breast. You may hear the doctor mention tests such as Barium meal, Barium enema and mammogram (for breasts). These are all X-ray based tests.

Scans
Similar to X-rays but scans can give a better picture of the size, position and shape of lumps in the body. Scans commonly use either CT scans or MRI scans.

Both require the patient to lie still as they capture images or data of the patient’s body which is displayed on a computer. The process is painless.

There is also the ultrasound (ultrasonic) scan. Normally used in pregnancy, it can also be used to examine organs. It is noninvasive, harmless and inexpensive.

Treatments for Cancer
Once the doctor diagnoses that a patient has cancer, a treatment plan is prescribed. Following are some of the treatments that your loved one may undergo with regard to their cancer.

Surgery
Surgery is used when the tumour is limited to one area and there is a good chance that the entire tumour can be removed completely. If the operation is done early enough, it can be highly successful in removing tumours and greatly reduce the chance of it recurring.

The initial reaction from many patients is to opt for surgery simply because in their panic or fear, they want to remove the ‘sickness’ from their body as quickly as possible. But if the cancer has spread too far, the tumour is too advanced or the patient is too weak, other methods may be recommended.

You may need to counsel your loved one on their condition and why surgery is not suitable for them.
On the other hand, he/she may be scared of facing surgery. If so, you can assure them that the procedure is safe and necessary for their health.


Tips for surgery:
  • Arrive on time for all appointments (normally a day before the procedure)
  • Before surgery the patient may undergo blood, urine and general health tests.
  • A consent form will need to be signed either by you or your loved one before surgery.
  • Ensure that no food or drink is consumed several hours before surgery.
  • Based on doctor’s instructions, prepare your home so that your loved one will be comfortable upon discharge from hospital.
  • Ensure your patient gets enough rest as per doctor’s orders and attends all post-surgery appointments.
  • Constantly check the wound to see if it is healing well.
Radiotherapy
Radiotherapy uses small quantities of radiation to ‘attack’ the tumours and eliminate them. Like surgery, it targets a particular area where the tumour is located.

Radiotherapy can be used independently or in combination with surgery and chemotherapy. Radiotherapy first ‘shrinks’ the tumour so that a less invasive surgery can be done. Or it can be done as a follow-up to surgery just in case some cancer cells remain.

Today, modern technology has made radiotherapy more accurate – attacking the cancerous cells with minimum damage to healthy tissue. Damaged healthy tissue will grow back.

Watch out for these post radiotherapy side effects:
  • General tiredness
    Solution: Get your loved one to rest more after radiotherapy

  • Redness of the skin (similar to sunburn)
    Solution: Use talcum powder and body lotions as recommended by the doctor.

  • Hair loss (if radiotherapy is aimed at the scalp, armpits and pubic area).
    Solution: Hair will grow after treatment stops.

  • A sore or dry mouth (if radiotherapy is applied to the head or neck)
    Solution: Pay special attention to dental hygiene, avoid spicy food and alcohol.

  • Diarrhoea, nausea and vomiting
    Solution: Have ready anti-diarrhoea and anti-nausea medication. Drinks with hydrating salts are also useful.

  • Cystitis (temporary burning sensation when urinating)
    Solution: Consult your doctor for medication if none is prescribed
Chemotherapy
In chemotherapy, most drugs are intravenously fed into the patient, which then goes into their body and attacks the cancerous cells.

This treatment is used when the cancer has spread throughout the body or has a good chance of spreading through the body. It is used to combat many cancers such as leukaemia, lymphomas, childhood and adult cancers.

Unfortunately, the drugs used (cytotoxic drugs) also attack normal cells. But with better drugs, the effect on healthy cells has been reduced while maintaining or increasing the damage on cancer cells. A complete chemotherapy course can take from one to several days repeated over 1-4 weeks.

Most patients are unable to continue with their daily lives during chemotherapy. Your physical and emotional support is important in helping them complete the course and reduce the side effects.

The side effects are similar to radiotherapy with some additions:
  • Bone marrow damage
  • Fertility reduction
  • Pins and needles, numbness or pain in hands or feet (temporary)
Things to know about chemotherapy:
  • For each visit, the cancer patient will undergo a pre-therapy check for possible side effects. Make sure you are aware of this so you can be better prepared. A blood test will also be done.
  • During the treatment, make sure your loved one avoids public places. Chemotherapy can cause a weakened immune system which makes them susceptible to infections.
  • Avoid many people visiting your friend or relative during chemotherapy.
  • If your loved one has a raised temperature or a sore throat, he/she could be ill.
Targeted Therapy
Targeted cancer therapy uses drugs to destroy cancer cells or block them from spreading. At the same time, the drugs are designed to not damage healthy cells.

The drugs work by blocking specific enzymes and proteins that make the cancer cells grow. This is possible as the drugs can identify specific markers found only in cancer cells. The cancer cells are killed while healthy cells are left untouched. This reduces the impact of side effects on the patient.

Many targeted cancer therapies are being tested and some have been approved for use.

Consult your doctor on whether your loved one can also receive targeted therapy if it is available.

Hormone Treatment
Hormone treatment involves controlling levels of certain hormones in the body to suppress the growth of cancer cells.

It is used mainly to treat cancers of the breast, uterus, ovaries and the prostate gland.

The type of hormone treatment recommended would depend on the type or cancer and whether it would respond well to this kind of treatment.

Clinical Trials
Clinical trials are research studies that involve people. They are the final step in a long process that begins with research in a lab and animal testing. Many treatments used today are the result of past clinical trials which have proven the benefit of these treatments.

In cancer research, clinical trials are designed to answer questions about new ways to:
  • Treat cancer
  • Find and diagnose cancer
  • Prevent cancer
  • Manage symptoms of cancer or its treatment
Clinical trials may be an option for you and your loved one. Choosing to join a clinical trial is something only your loved one, you, and your doctors and nurses can decide together.

You may want to discuss the benefits and drawbacks with your loved one and the doctor. Clinical trials offer high-quality cancer care. However, these new treatments may have side effects that doctors do not expect or that are worse than those of standard treatment.

By looking at the pros and cons of clinical trials and other treatment choices, allow your loved one to play an active role in a decision that affects your life together.

Complementary & Alternative Therapy
You may possibly consider certain complementary treatments to be used with conventional medicine. Acupuncture and reflexology may be helpful in relieving pain and providing comfort. Aromatherapy could have soothing effects for the senses.

Alternative therapy (treatment that replaces conventional medicine) is not recommended. Many of these are not part of conventional medicine because they have not been scientifically tested or proven and may produce no results at expensive cost.
By relying solely on these methods, your loved one’s cancer may reach a more advanced stage, which is harder to treat.

While it is your friend or relative’s decision (and your choice as well) to consult bomoh, sinsehs and other traditional practitioners, consider carefully before doing so.

Ensure that any treatment you opt for has a proven track record of being effective:
  • Ask your loved one’s medical team before proceeding.

  • Be careful about what pamphlets and other material say. Verify the information with the medical team.

  • Consult the medical team to ensure that the therapy does not cause complications with prescribed treatment, especially if they are consuming any traditional medicines.

  • Encourage your loved one to continue with his /her doctors’ prescribed treatment.
 

 
A Community Service Project by: Malaysian Oncological Society and Pfizer Malaysia - (latest update: 24-02-2011)