Fighting Cancer with Knowledge and Hope: A Guide for Patients, Families, and Health Care Providers


Anyone who is diagnosed with cancer receives a frightening blow, and in many cases the diagnosis is accompanied by a bewildering array of treatment choices. Dr. Richard C. Frank empowers patients by unlocking the mysteries of the disease and explaining in plain language the ways to confront and combat it. He explains
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Anyone who is diagnosed with cancer receives a frightening blow, and in many cases the diagnosis is accompanied by a bewildering array of treatment choices. Dr. Richard C. Frank empowers patients by unlocking the mysteries of the disease and explaining in plain language the ways to confront and combat it. He explains
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Editorial Reviews

American Medical Writers Association
Winner of the 2010 American Medical Writers Association Medical Book Awards in the Health care professionals-nonphysician category

— American Medical Writers Association Medical Book Awards in the Health care prof

Christine Horner
“Here is a resource no cancer patient should be without. Simply written and easy to understand, Fighting Cancer answers most questions a cancer patient may have and, most important, offers hope.”—Christine Horner, M.D., F.A.C.S., author Waking the Warrior Goddess: Dr. Christine Horner’s Program to Protect against and Fight Breast Cancer
Oncology Business Review
For healthcare professionals seeking to recommend a credible and current cancer resource with confidence, this guide is invaluable.—Greg Gorgas, Oncology Business Review

— Greg Gorgas

Cancer Forum
"A reference written in plain English and an affirmation of the wholistic approach to management of the patient with cancer. . . . This book gives answers to all the common questions our patients have when they are faced with meeting an oncologist for the first time."—Cancer Forum
Phyllis Osterman
“An important resource for patients, caregivers, and healthcare professionals.… [It] demonstrates the author’s astute knowledge coupled with profound compassion."—Phyllis Osterman, The Leukemia & Lymphoma Society
Diane Blum
“Dr. Frank writes in a clear and compassionate manner, presenting a well organized framework for understanding cancer and participating in care. His use of patient cases helps personalize the information and offers guidance for managing the challenges of a cancer diagnosis. Fighting Cancer with Knowledge and Hope is a book that will provide confidence and direction to people with cancer and their loved ones.”—Diane Blum, Executive Director, CancerCare
Julie K. Silver
"This is a terrific book and will be a valuable tool for readers who really want to understand the pathophysiology of cancer."—Julie K. Silver, M.D., author of What Helped Get Me Through: Cancer Survivors Share Wisdom and Hope
Elizabeth April-Fritz
“Since reading this book, I understand cancer in a completely different way. . . .it is a ‘must have’ for people who are newly diagnosed as well as people who have been living with cancer for many years. It can be used by doctors, nurses, and therapists to explain the simple and complex realities of cancer. . . .This resource is of huge value.”—Elizabeth April-Fritz, three time breast cancer survivor
Carol T. Avery
“I found this book unique. It takes complex concepts, pares them down and allows the lay reader to enter a world previously reserved for physicians, scientists, and researchers. This special privilege is offered to the lay reader, enabling one to walk away with a better understanding of cancer and all its ramifications. Adding to its uniqueness is the fact that the book accomplishes its goal without sounding ‘text-bookish’ or overly pedantic.”—Carol T. Avery, Ed.D., R.N., C., co-author of Quick Look Nursing: Obstetric and Pediatric Pathophysiology
American Medical Writers Association - American Medical Writers Association Medical Book Awards in the Health care prof
Winner of the 2010 American Medical Writers Association Medical Book Awards in the Health care professionals-nonphysician category
Oncology Business Review - Greg Gorgas
"For healthcare professionals seeking to recommend a credible and current cancer resource with confidence, this guide is invaluable."—Greg Gorgas, Oncology Business Review
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Product Details

Meet the Author

Richard C. Frank is director of cancer research at the Whittingham Cancer Center of Norwalk Hospital, medical director of Mid-Fairfield Hospice, and Clinical Assistant Attending at Weill Cornell Medical College. He has recently been appointed cancer expert for WebMD, and was named a “Top Doc” in the New York Metro area by Castle and Connelly. Dr. Frank lives in Fairfield, CT.

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Read an Excerpt

Fighting Cancer with Knowledge & Hope

A Guide for Patients, Families, and Health Care Providers

Yale University Press

Copyright © 2009 Richard C. Frank
All right reserved.

ISBN: 978-0-300-15102-2

Chapter One

Understanding Cancer

When I first laid eyes on Alice, I could tell she was in trouble. "Trouble" for me, a medical oncologist, means that a patient is sick from cancer and in urgent need of treatment. But like so many patients whom I meet for the first time, Alice was not even sure she had cancer. So "trouble" also means that I faced a daunting task: I had to explain to Alice (and her family) what cancer is, why it may have arisen, what it was doing to her body, which treatments were recommended, how those treatments worked, and how she could cope when her world was crashing in on her-all this in about an hour.

Furthermore, I needed to convey this information with great empathy and sensitivity, never forgetting that although my brain may sleep, eat, and breathe cancer, the cancer "lingo" is completely foreign to a person newly diagnosed with the disease.

As I present my assessment of a cancer situation to a new patient and family, my senses enter a state of heightened awareness: I continually monitor the body language of my listeners to discern if I am making myself understood, if my words are too strong or not strong enough, or if I should stop theflow of words to allow the necessary flow of emotions. I have taken to using a marker board, like a mini-lecture, to write out the technical words and details. As with so many other oncologists, there is no need to ask me, "What would you do if I were your brother, wife, or mother?" Please understand that this is always a given.

As Alice walked into my office for a consultation, her husband and daughter were close behind. She was clearly exhausted, gasped slightly with each breath, and, after spotting the chair nearest to me, slumped into it. She exuded a soft, sincere demeanor, though she was obviously weighed down by worry.

Alice gathered herself as I introduced myself, and then she asked me in a sweet, perplexed voice, "Doctor, what's wrong with me? I am so tired I can't even climb a flight of stairs. My stomach is bloated and I hardly eat anymore. Am I dying?"

Before I met with Alice, I had reviewed her medical records. She had recently seen her internist, complaining of several months of unremitting fatigue, loss of appetite, and shortness of breath with exertion. Her doctor had ordered CT scans of her chest, abdomen, and pelvis. These showed a large tumor on one of her ovaries, many other tumors throughout her abdomen, and smaller tumors throughout her lungs. He ordered a biopsy of one of the abdominal tumors, and it revealed a diagnosis of ovarian cancer. The tumors throughout Alice's abdomen and chest indicated that she had the most advanced stage of that cancer. A blood marker of ovarian cancer, named CA-125, was many times above the normal range, consistent with this diagnosis.

When Alice walked through the office doorway, I knew immediately that all her symptoms were caused by cancer. The sheer burden of having tumors involving so much of her body was exhausting her. The disease was competing with the rest of her body for vital nutrients, and the cancer was siphoning most of these away. The tumors in her lungs were interfering with the ability of her lungs to transfer oxygen to her bloodstream for delivery throughout her body; this accounted for her shortness of breath. The many tumors in her abdomen were causing her belly to swell and taking away her appetite.

I began to talk to her. "I can see that you are suffering. Your breathing appears labored to me, and I can tell that you must be struggling just to get through the day." With this, she nodded and began to weep. But this was a cry of relief; someone had finally explained why her condition was deteriorating so fast. "I will explain exactly what is wrong with you and tell you what we need to do to get you feeling better," I said. "But I want to start off by saying that you will very likely be feeling better soon." With that, she relaxed and started to breathe more easily.

I explained what her CT scans showed and what the pathology report indicated. I told her she had ovarian cancer and that it had spread from her ovary to her abdomen and into her lungs, which classified it as stage IV. I explained how the extent of the cancer was causing all her symptoms and that if we could shrink it, she would begin to feel better.

"Do I need chemo?" she asked. "I'm afraid of that, I don't know if my body can stand it." "Yes," I replied, "we do need to use chemotherapy. But since most of your symptoms are due to the growth of the cancer, once we stop that growth with chemotherapy, you will actually feel better. There certainly will be side effects from treatment, but we will monitor you closely for them and try to prevent as many as possible." Alice did not voice further opposition to the chemotherapy. She understood that she would be fighting for her life.

"The standard recommended treatment," I continued, "is two chemotherapy drugs, called Taxol and carboplatin, which are administered intravenously every three weeks. We are also participating in a study to determine whether adding a new medication to this standard treatment improves the outcome." We discussed the short-term and long-term side effects of chemotherapy and went over the pros and cons of participating in the clinical trial. I told her that after our meeting, she would visit one of our oncology nurses, who would further explain what to expect and how to prepare for treatment.

"Why can't it just all be cut out?" Alice asked. "For most cases of ovarian cancer," I replied, "surgery actually is the first step of treatment. But in your situation, because the cancer has spread outside of the abdomen and is causing so many symptoms, we need to attack it with a treatment that will shrink the cancer wherever it is growing in your body; the disease is too extensive at this point for surgery to be effective. So we need to start with chemotherapy and reserve surgery for a later date."

I inquired about her family history and whether other family members had been affected by cancer, in particular breast and ovarian cancer. When she answered yes, we discussed the need for genetic testing, which she wanted to do at another time. We talked briefly about her family life, habits, and spirituality as I tried to get a sense of the person.

After I answered the questions Alice and her family had, I told them about the counseling services for patients and families at our center: group counseling, in which those who have traveled or are traveling a similar road can share experiences; and individual counseling, in which patients can privately express to an experienced therapist their feelings, fears, and needs as a cancer patient and survivor.

We ended our first meeting exhausted. But we also ended it as partners, hopeful that Alice's condition would improve. I knew that we had covered a tremendous amount of new and complicated information and that Alice would probably remember only a part of it. I reassured her that we would have ample time, in future meetings together, to go over what we had discussed.

My meeting with Alice and her family highlights the essential information that any patient must find out when he or she is diagnosed with cancer. The following list summarizes this information.

When First Diagnosed: What You Need to Learn

* the type of cancer

* the stage (extent) of the cancer

* whether cure is to be expected

* possible environmental or genetic influences that may have predisposed you to develop cancer

* important aspects of the cancer, called "prognostic factors" (see chapter 2), that may help determine your prognosis

* whether you have other medical problems that may affect your choice of treatment

* recommended treatments, their schedules, and their duration

* side effects from treatment (likely and less likely), both short term and long term

* what can be done to prevent or minimize those side effects, should they occur

* other treatment options, such as (1) a different but equally effective chemotherapy drug whose side effects may better meet your needs (for example, less hair loss or a reduced chance of numbness in the hands and feet, called peripheral neuropathy), and (2) a different sequence of chemotherapy, radiation, or surgery than is being proposed and the merits of the different approaches

* if a clinical trial (research study) testing new ways to treat the cancer is available and the pros and cons of participating in the study

* what the strategy might be if the first therapy does not control the cancer

* whether a second opinion is advisable (initially or at a future time)

* how the treatment costs will be covered

* a review of the medications, vitamins, and supplements you may already be taking

* where to find counseling and support groups to help you and your loved ones cope with the many emotional and life challenges posed by cancer

These essential topics are covered in later chapters. First I wish to focus on the disease itself and answer the deceptively simple question, "What is cancer?"

Alice's story provides one answer: All of the above is cancer. Cancer is all the physical and emotional upheaval that a person's body and mind must endure in response to an "invasion from within" of bizarre collections of cells that form troubling growths called tumors. From a medical point of view, cancer can be defined another way:

What is Cancer? Cancer is a disease caused by the growth and spread in our bodies of cells that do not know how to die.

The Three Essential Properties of Cancer

All cancers begin with the conversion of one cell from a normal state into a cancerous state. During this process, which in most cases takes many years, the changing cell acquires three main properties that distinguish it as a cancer cell. These three essential properties are the defining characteristics of the disease. Normal cells have none of these properties. The three properties are:

1. An unlimited capacity for growth

2. An inability to die

3. An ability to spread (from the site of origin)

To know these properties is to appreciate the very nature of cancer. They define how well a cancer grows and survives in the body, and they largely determine how curable any particular cancer is. It is extremely important to realize, however, that the power and extent of each property is different for each cancer. Some cancers grow slowly, others quickly; some have a great capacity to spread throughout the body, others a more limited ability to do so. Just as every person is unique, so is every cancer. This is why I caution patients that the information they receive about other people with cancer will probably not relate to their case.


The growth of cancer is very much on the minds of all those affected by this disease: patients, physicians, and researchers.

When a cancer patient wonders how long it has been from the time his or her cancer first started to when it was diagnosed, he or she is asking about the growth rate of the cancer. Another way to phrase this question is: "How fast is the cancer growing?" When a patient asks if the cancer is in "remission," he or she is really asking if the cancer has stopped growing and, more to the point, started to shrink. On the other hand, if the patient is told that the cancer has "relapsed," then it means the cancer is growing again.

The Meaning of Remission. There are two main types of remission: partial or complete. In a partial remission, the cancer shrinks in size by at least 30 percent; in a complete remission, the cancer becomes undetectable. In the past, cancer doctors and researchers believed that only treatments that achieved remission could benefit patients. However, some newer cancer treatments, called targeted therapies (discussed in chapters 6 and 7), not only improve quality of life but prolong life merely by "freezing" or stabilizing the growth of cancer (without necessarily shrinking tumors); this has led to a new mindset about the goals of therapy. Especially for cancers that are not considered curable, prolonged stabilization of the cancer can be as worthy a goal as obtaining remission.

Oncologists (physicians with advanced training and certification in the medical care of people with cancer) have the same concerns as patients, but with a focus on how the health of their patients is or will be affected by cancer growth. For each patient, oncologists weigh several factors to assess and anticipate the growth potential of a cancer. These include: (1) examining the pathology report, which can indicate the aggressiveness of the cancer and its potential to return after treatment; (2) determining how rapidly any symptoms caused by the disease have developed; and (3) assessing the extent of the cancer as determined by imaging tests (CT scans, MRIs, bone scans, and PET scans) and blood tests.

Some types of cancer generate a protein, called a "tumor marker," that is released into the bloodstream and can be measured through a simple blood test. Although very elevated tumor marker levels often indicate an aggressive cancer, these tests are conducted primarily to track the progress of treatment (as a cancer is successfully treated, its tumor marker will fall). The main tumor markers are:

Major cancer tumor markers (blood tests)

Tumor marker Cancer

AFP, HCG testicular, liver (AFP only) CEA colorectal CA 15-3, CA 27-29 breast CA 19-9 pancreatic, biliary tract CA-125 ovarian PSA prostate M-protein; free light chains multiple myeloma LDH lymphoma Beta-2 microglobulin myeloma, lymphoma

Oncologists process all this information to determine if a cancer is fast or slow growing and if it has a high or low potential to spread to other organs. Oncologists must see the full cancer landscape for each patient, that which the affected person could not possibly see. Following these assessments, the oncologist makes recommendations as to whether treatment should be started urgently (the same day) or in the near term (in a few days or weeks), or whether treatment can be deferred based on the future behavior of the cancer (that is, no treatment is necessary at present). For example, a person who experiences sudden back pain and is found to have a rapidly growing tumor that is pressing on the spinal cord requires urgent treatment to alleviate pain and prevent paralysis. In contrast, a seventy-five-year-old man with a slow-growing prostate cancer that is not causing any symptoms may never need the cancer treated. All of these clinical lines of thought revolve around the growth properties of the cancer in question. For each patient, the growth assessment of the cancer is best understood through discussions with the oncologist.

Cancer researchers are also focused on growth as they work to discover new and better ways of treating cancer. Scientists study the molecules inside cancer cells that stimulate them to multiply and grow. By understanding how these important molecules work, researchers can develop drugs that will block them from functioning. The hope is that interfering with these critical targets will cause the cancer cells to die. These growth targets and the drugs designed to block them are discussed later.

We've established that growth is central to thinking about cancer. But what does it mean for cancer to grow, and to grow in an unlimited way? What actually is growing? The answer is the number of cancer cells. All cancers start with one cell, and that cell multiplies to form the tumors that are ultimately detected. One cell becomes two cells. These two cells then duplicate themselves to become four cells, which multiply to eight cells, and so on, until there is an entire population of cells (fig. 1).

It is generally thought that one billion cancer cells need to have formed before a cancer can be detected. This is the number of cells present in a one-centimeter tumor (nearly a third of an inch). The ability to detect cancer when far fewer cells are present is a high priority of cancer research.

While the growth of cancer cells is certainly a bad thing, the growth of healthy cells is of course, necessary for our bodies to function properly. The difference between normal cell growth and cancer cell growth is that normal growth is always precisely timed and controlled. For example, when a human fetus is developing, cell growth is explosive because one fertilized egg must give rise to the trillions of cells that ultimately compose a body. Yet the process of making the heart, brain, or any other organ is tightly regulated: cells stop growing once the correct organ pattern is laid down. In fact, when an organ reaches maturity, most of its cells lose the capacity to multiply. This is why our heart cannot replace damaged cardiac muscle after a heart attack and why our bodies cannot heal a spinal cord injury by making new nerve tissue.

Mature adult organs have a limited capacity to regenerate, with the exception of the liver, the inner lining of the intestines, and the bone marrow. Fetal tissue, on the other hand, has the full capacity to form new cells, which is why fetal stem cells (the cells with the greatest regenerative capacity) are being studied as a way to help victims of numerous illnesses and injuries, such as Parkinson's disease and spinal cord damage. The hope is that if fetal stem cells are implanted in an environment of nerves, for example, they will sprout new nerve cells to replace the damaged ones.


Excerpted from Fighting Cancer with Knowledge & Hope by RICHARD C. FRANK Copyright © 2009 by Richard C. Frank. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

Foreword Edmundo Bendezu ix

Preface xiii

Acknowledgments xvii

Part I Exposing Cancer

1 Understanding Cancer 3

When First Diagnosed: What You Need to Learn

The Three Essential Properties of Cancer

Understanding How Cancer Spreads

2 Diagnosis, Staging, Curability 23

Making a Diagnosis of Cancer

Determining the Extent or Stage of Cancer

Estimating Curability

3 Understanding Specific Cancers 54


Blood and Lymph Cancers


Brain Tumors

4 Why Cancer Develops 85

Cancer and the Blueprint for Life

Family Cancers

Cancer and the Environment

Why Do Only Some People Get Cancer?

Part II Attacking Cancer

5 How Cancer Grows: The Basis of Cancer Treatments 117

Cancer Develops over Decades

Cancer Grows by Organized Chaos

Cancer Can Grow Unpredictably

Cancer Is Survival of the Fittest

The Devil Is in the Details

6 Cancer Treatments Revolve around Metastasis 129

After Surgery: "Why Do I Need Chemo If I'm Cancer Free?"

Eye on the Prize: Complete Cancer Eradication

When Surgery Is Not the First Step

Metastatic Disease: Cure versus Control

How a Treatment Strategy Is Chosen

Cancer in the Older Individual

The Role of Surgery in Metastatic Cancer

The Role of Radiation Therapy in Metastatic Cancer

7 Cancer Treatments at Work 159

A New Era of Hope

Targeting the Lifelines of Cancer


Targeted Therapies

Hormone Therapies

Radiation Therapy

Why Do Cancer Treatments Sometimes Fail?

8 Get Prepared to Survive 191

Survivorship and the Power of People

Survival Is Spelled LMNOP

Final Thoughts

Appendix 1 Types of Cancer Medicine 205

Appendix 2 For More Information 209


References 219

Index 236

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  • Posted July 9, 2009

    A Great Book on Cancer!

    I thought this book was amazing. It was so easy to understand. It was so interesting as far as the different case histories. Usually you would think a book on cancer would scare you, but this book was so comforting. The doctor who wrote it has a very special way that makes you feel that you will be okay. This is a book for people that have cancer or for anyone that wonders what they would do if they had cancer. I highly recommend this book. Annie from Brooklyn, New York

    1 out of 1 people found this review helpful.

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  • Posted July 9, 2009


    Dr. Richard C. Frank is truly a remarkable doctor whose work in the field of cancer is incredible. As he shared, his knowledge and experiences with his patients, I was so moved. From diagnosis to treatment, Dr. Frank never gave up hope continually working toward a cure. The medical terminology that can be complicated and overwhelming was carefully explained. It's a gift. May God bless you.

    1 out of 1 people found this review helpful.

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  • Posted September 7, 2009

    Excellent book for cancer patients and their families

    I can't say enough positive things about this book. It is very user friendly and provides a sense of hope at a time when most readers are
    going through an extremely difficult and stressful time. Richard Frank speaks from experience and the case examples are really helpful in making
    the information relevant. I read many books about cancer but this is one
    of the best I have read. Highly recommended.

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  • Posted August 7, 2009

    more from this reviewer

    A down to earth, easy to understand explanation of cancer

    This book is amazing. I wanted to find out everything I possibly could about cancer as a result of a relative who was diagnosed with cancer. This book goes into great detail explaining all aspects of cancer in a straight forward and easy to understand manner. It has alleviated many of my fears and given all of us hope about a positive outcome. Furthermore, the book provides moral help for the family in coping with the disease. The examples Dr. Frank provides throughout the book makes the material easier to read and provides real life experiences that are very much relevant. I will definitely recommend this book to any of my friends or acquaintances that have to confront cancer either as a patient or as a close family relative. Kudos to Dr. Frank for this wonderful piece of work.

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  • Posted July 9, 2009

    more from this reviewer

    The Best Book on Cancer written by a Brilliant Compassionate Physician

    5.0 out of 5 stars An amazing book on cancer written by a great doctor June 15, 2009
    By Ruth Hayon (Rockaway Beach, New York 11694) - See all my reviews

    The first thing that struck me about the book is the warmth that comes through from the author. Here is a quote to illustrate this from Richard Frank's Fighting Cancer with Knowledge and Hope. "There is no need to ask me, `what would you do if I were your brother, wife or mother'? Please understand this is always a given." I know many people affected by cancer. The book is an eye opener and answers any question ever asked about cancer. I feel like I know Dr. Frank and his patients from the way he writes. I now understand cancer. I think this is an incredible book and should be in Oprah's book club. I loved this book and I am recommending it to all my friends. Thank you. From Ruth Hayon, Queens, New York

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  • Anonymous

    Posted July 5, 2009

    Fighting Cancer with Knowledge and Hope is a remarkable book

    I have helped many friends through cancer and all needed a book like this. It is wonderful and hopeful and realistic. For one doctor to have so much knowledge and to communicate it with such compassion and insight is truly remarkable. There is so much to be learned from this book and it is so easy to learn from. Every person diagnosed with cancer must have this very special book.

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  • Anonymous

    Posted July 5, 2009

    Got Cancer?

    I actually read this book twice. The first time was for my own benefit, but the second time was to help a friend. Unlike any other cancer book out there, this does not focus on one particular cancer, but reads more like short stories mixed with the feeling like you are having an actual discussion with the doctor which makes the diagnosis of cancer seem less scary and overwhelming.

    The book is written in 2 parts which was helpful in finding out the basics on cancer, how people may get cancer, how certain cancers are treated and why two people with the same type of cancer may be treated with different types of chemotherapy. Most importantly is guides you on what you can do to help yourself be your own advocate.

    Overall, this book is THE reference book for anyone with cancer or who may know someone who has been diagnosed with cancer.

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  • Posted June 20, 2009

    excellent book

    Dr. Richard Frank has done an excellent job of imparting the knowledge every cancer patient should have. This book is beautifully written with case histories illustrating examples of successful treatment. It explains what cancer is, why and how it starts, the effects of the environment, DNA, and nutrition on its genesis. The various treatments -chemotherapy, targeted therapy, hormonal therapy, and radiation are explained. How and why each treatment works or doesn't work are discussed as well as problems a patient may have during treatment and later as a cancer survivor. It is a "must read" for all cancer patients, their loved ones, and care givers. Dr. Frank, as Head of Cancer Research at Norwalk Hospital, brings a wealth of information and understanding to this work.

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    Posted July 9, 2009

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