The C-word

What word came to mind, seeing that title? Rude terms for female anatomy or sexual acts? Or did you know I was referring to cancer? As doctors, we’ve often tried to bury the c-word, falling back on terms like mass or tumour, trying to soften the blow, because as soon as the c-word is out there, assumptions are made: weight loss, baldness, chemotherapy, death. Sometimes patients don’t hear another word for the entire visit. Let’s take things one step at a time, I’ll say, let’s not jump right to wigs and caskets. The power of the c-word is particularly important to me currently, having received the diagnosis myself; my own rectal cancer is curable, yet I see the anxious impact of the c-word on myself and on others.
          How do we reduce the potency of a word?

          It’s fair to fear cancer. “Malignant neoplasm” is the top cause of death in Canada, since we seem to have figured out how to keep people with heart disease alive (previously the #1 cause of death). At the same time, overall life expectancy continues to rise and is now 81 for men and 83 for women in Canada. And, depending on the type of cancer and stage at diagnosis, prognosis can be extremely good. Despite the current health care crisis, we do continue to have universal coverage, so at least anyone can access treatment without going bankrupt, although many people in remote, rural and Northern areas need to travel for treatment, myself included.
          Is it helpful to consider other things that I feel would be worse? A significant spinal cord injury, sudden blindness, a major stroke, scary medical words like necrotizing fasciitis or bullous pemphigoid? Is it helpful to consider flood, war, fire, famine, torture? For me, it’s not that helpful, thankful as I am to avoid those things.
          What is it about the c-word? There are other nerve-wracking words that begin with c: corruption, criminal, crazy (anyone specific come to mind with those three?); climate change; corpse/cadaver; catastrophic. In general, those words don’t have the same emotional response as the word cancer.
          In the Harry Potter series of books, the evil wizard is called He who shall not be named, or You-know-who, to avoid giving his name power. But, as Harry Potter realizes, the name is just a word. Voldemort, he says boldly, as everyone cringes. Maybe that’s what we need to do, to take away cancer’s power too: say it all the time. Cancer. Cancer. Cancer. Not a tumour, not a mass, not a malignancy or a neoplasm: a cancer. Something that needs treatment. Something that may or may not resolve, like many other things in modern medicine. Is it possible, in this way, to gradually dilute the word, to soften its implications?
          I was thinking about other c-words, nicer ones. Comfort, caring, communication, courage.
Although it’s a bit cheesy to say it, maybe if we focus on positive c-words, while tossing off cancer any time we want, it can become benign as any other word. Cure: that’s a c-word I can live with.