GINA:
Hello, and welcome to the American Cancer Society's Cancer Survivors' Network, a service created by and for cancer survivors. In Seattle, I'm your discussion leader, Gina Tuttle. Our topic is colon cancer in men ages 50 to 65with recurrence. On the phone with us are four colon cancer survivors from across the country, men who are all between 50 and 65, and who have had recurrence. Over the next few minutes, we will discuss such issues as metastasis, ongoing metastasis, and choosing among the treatment options; making decisions about work when cancer comes back, sharing stories that help educate others to get checked routinely, the possibility that recurrence or metastasis can strike at any time, even years later, and keeping a fighting spirit all the way through the process. Let's begin. Joining us today is Ron from Courtsville, California. Ron is 59. He had colon cancer in 1998. It metastasized to his liver that same year. Ron, tell us about the treatment that you got.

RON:
We started after the resection about, oh, three months after the resection, we started 5FU. I believe it was once a month for about six months, and that seemed to beat it back quite a bit. After we did an MRI and judging with the CEA, the doctors decided it had done as much as it could, which was quite a bit. It actually had beat it back to where it was quite small in the MRI, so, we ceased treatment in August. So, it was about six months of the 5FU.

GINA:
Tell us what FU is?

RON:
5FU is, well, it's been approved for about 40 years. It's been more or less the standard colon cancer chemotherapy treatment for quite some time, like I said, for about 40 years. I would do it five days a week and then three weeks off and then do it again. And, like I say, that beat it back quite a bit. But, unfortunately, one of the things that happens with 5FU is sometimes it will come right back, and that's what it did with me. I won't say right back, but the tumor started building again. We did an MRI in late 1998, and, indeed, the tumor had started growing again, in my liver.

GINA:
So you went through a fairly standard treatment, then.

RON:
Yes, a very standard treatment. The regimen was some 5 FU, 5 days in a row, then knock it off for three weeks and then do it again. We did this for six months.

GINA:
And then you had the problem recur, and so what are you doing right now. What situation are you in?

RON:
There's a chemotherapy called CPT11. It's fairly new. It's been approved only in the last, under a year, I think, and it's a little bit different. It has totally, I won't say different side effects, but the side effects are a little more severe than they were with 5FU. But the CPT11 again does seem to be working. We've done a MRI and the MRI again has the tumors being reduced in size. The CEA is down, so again we're seeing a good pattern of the treatment and the reaction to the treatment is very positive.

GINA:
And the CEA, what is that?

RON:
CEA stands for carcinoembryonic antigens. It's a blood test that measures the antigens produced by the tumors. It's used often to judge what's happening with the tumor. It's not used for diagnosis, which kind of surprises me, but the doctors refuse to use it for diagnosis. They say it's not reliable, but they will use it as an indicator of activity or reduced activity, and my CEA is now down from what it originally was.

GINA:
Now, I understand you're getting this chemotherapy and that you kind of alternate between an okay week and a not so good week. What kind of a week are you in now?

RON:
Well, in another two days I'll be doing the chemo again, so I'm in my, what, 12th day, and I'm feeling fairly good.

GINA:
What kind of side effects are you having when you're not feeling so good?

RON:
Nausea, a lot of gastrointestinal problems, and occasionally even diarrhea. Additionally, there's some foul tastes and reaction to various foods, not reactions, that's not the right word, but the taste of some of them will instantly nauseate me. So, I have to be very choosy in what I eat. I do take medication, mostly over-the-counter stuff, although there are some prescription drugs for nausea that do help.

GINA:
Ron, do you think you were adequately prepared by the medical people for what you were going to go through?

RON:
You mean for the treatment itself?

GINA:
For the treatment and the side effects.

RON:
Prepared. Certainly I was briefed that there would be a lot of side effects. But, it varies so much that it's difficult for them to really prepare you. Because some people are extremes to the point I've known people who've actually had to cease the chemotherapy because the side effects were so severe they just couldn't survive it. My case, it's really not that bad. It's not pleasant. It's an uncomfortable two weeks and I kind of get low a couple days after the treatment, and then slowly build my way back up. It's not a fun time, but I have the added plus if you will, of seeing that it is, in fact, working. I pity those people that take it and then don't necessarily get positive results right away. And at the same time, if they were those type of people who were reacting very badly to the chemo, having strong side effects, I can see where psychologically it would really wear on you.

GINA:
And how are you doing psychologically? Even with some improvement, I would think it'd be kind of a tough thing to go through.

RON:
It definitely wears on you. You feel like, gee, I'm just starting to feel normal and in another two days I'm going to start it all over again. So, I don't look forward to that, to Thursday morning at all. And, it's about a six-hour process. During that time I almost always get into extreme nausea and vomiting, so that whole process I really dread. In fact, driving by the clinic where we do it, will cause my stomach to turn and really get uptight. It's just a psychological effect, I guess.

GINA:
I understand that you've had at least one helpful thing, and that is that you've been able to not work during this process.

RON:
Correct. I'm off on disability at the moment, and that has been a tremendous help. I'm sure some people would feel just exactly the opposite. They would want the distraction of working and keeping busy and so forth. With me, it didn't work that way. There was a lot of stress and it just somehow added to the problem. Since I have been out of work, I've been able to relax more. I've been able to keep up with things, without being in a hurry and pressed and running around at night, and so forth. So, it's been a plus for me, but, like I say, that's not necessarily true of everybody.

GINA:
Has anything else helped? In terms of just dealing day-to-day with the problems of chemotherapy?

RON:
My wife has been a tremendous help, and I really mean that. Again, it's very unfortunate because I realize there are people out there who are single and are widowed or whatever and don't have that, and that's unfortunate. Volunteers, or something, would help to alleviate some of the pressures and duties and so forth, that you have to keep up on. My wife has been very good at keeping me informed of the things that I have to do without me having to spend hours on the phone making appointments and keeping track of the finances, and so forth. So that has been, I think, a big plus for me.

GINA:
Ron, we want to talk more with you coming up in just a moment. But, let me bring in one of our other cancer survivors. Joining us now is Richard from Amsterdam, New York. Richard's 65. Richard, you had colon cancer in 1997 with surgery and chemo and then another surgery and a third surgery, and now you are doing treatment as part of that Sloan Kettering study. Tell us a bit about what you've been through.

RICHARD:
It's been a rather interesting ride, I'll tell you that. My first severe symptoms began in December of 1996 and after a series of medical tests of virtually every kind under the sun, I was found to have a mass in my secum, which is the area where the colon connects to the small intestine. And, subsequent surgery revealed a rather large tumor that was cut out and I was put on the standard regimen of 5FU Leukovorin for a six-month period and my administration, I understand Ron's was weekly or bi-weekly, but my regimen was once a week and it took about three hours.

So, at the end of the six-month period I had CT scans and x-rays and a whole bunch of other tests and they found there were no apparent tumors residing in my body, so they stopped the treatments and just hoped for the best. However, that was in November, I'm sorry, October of 1997, and getting on into December and January, I began to have severe nausea and some vomiting and tightness in my intestines. And, after more tests, I was found to have two more tumors growing in my small intestines, which were metastasized from the original site. So, again it was more surgery, and after that I was put on CPT11, as Ron was, and that was, again, a six-month regimen. And, I lost quite a bit of hair and I had some nausea and a lot of weakness and tiredness, but it really wasn't terribly severe.

After six months of CPT11, that was discontinued because again there didn't appear to be any tumors in my body. And, and another month or two went by and I began to have discomfort in my right kidney, and this pressure increased. It wasn't really pain, it was an increased pressure in my right side, and after doing some CT scans and poking and prodding my urologist put a stent in my right ureter, because he found there was an obstruction on the outside of it.

After a short period of observation and questioning, I had a further surgery, exploratory. What they found at that particular time in February of 1998, I'm sorry...1999, time flies...February of 1999, I had exploratory surgery and they found that I had three tumors growing in my pelvic area. One on my rectum, one on the abdominal wall, and one wrapped around the right ureter. These surgeons were not able to remove it so they just sewed me back up again and said, "Well, we can't do anything for you." Well, as a result of that I decided to go to the big leagues and I arranged to go to Sloan Kettering down in New York City and I'm working with Dr. Nancy Kemmeny and I got into a study using a new drug, new in the United States. It's fairly standard in many European countries, Oxalaplaten, and this particular study combined Oxalaplaten with CPT11 and they felt that it had great promise to minimize tumors or remove tumors, more than the standard of 5FU and Leukovorin and CPT11 alone. I've been on this program for eight months, and I've not had a major reduction in my tumors, but there's been enough of a reduction so that the oncologist feels that I may be a subject for surgery to remove the tumors entirely. But, I just had a meeting with the surgeon and I'm scheduled for surgery on October 20, hopefully to remove the tumors, and after that I will have probably two or three months more of chemo in order to kill any micromets that might be floating around inside the abdomen. And that's the story.

GINA:
Richard, that's pretty remarkable, going from being told, "There's nothing more we can do," to have some hope like this.

RICHARD:
That was a pretty down period for me, Gina.

GINA:
How did you get through it?

RICHARD:
Well, I developed a great deal of spiritual and emotional strength ever since this started. You either sink or swim. You have to go with the flow and be strong, and be assertive and take your own treatment into your own hands, or you can just curl up and die. And I choose not to curl up and die. And, I wanted the best treatment and I sought the best treatment and I got some of the best doctors in the nation, and they've been very helpful and useful and I have a positive feeling about what's going to happen in the future.

GINA:
You are a founder and board member of the Colon Cancer Alliance, so I suspect you are useful to a lot of other people in helping them find how to get the best treatment and how to find a great doctor like yours, and possible treatments. Where do they start?

RICHARD:
The CCA? It started last year. Actually started in January of this year, and we have a rather interesting story. In September of 1998 there was a march against cancer in Washington DC in the mall area between the Washington Monument and the Lincoln Memorial. I was a member, I still am a member of an online list serve sponsored by ACOR and there are about 600 people on this particular list and we would support each other and give medical information and emotional support, and a lot of friendships developed online. And, so we decided that a few of our people on the list would go to Washington and join in the march. And they all did it themselves out of their own pockets, and I believe about 15 people from across the country all traveled to Washington and they met and they joined in the march against cancer. But, what they found was that virtually every major cancer was represented, breast cancer, ovarian cancer, prostate cancer, everyone had tents and banners and handouts and flags and little ribbons and all the other paraphernalia to foster their organization. But, it was absolutely amazing that colon cancer, which is the second major killer of people in the United States, did not have any representation, whatsoever.

So, as a result, when we came back we began talking about forming a national organization to advocate and support colon cancer patients and survivors and caregivers. So, in February of 1998, we had our first face-to-face get-together in Washington, and we set up the foundation for the Colon Cancer Alliance, and we hired an attorney, and we hired some staff people to help us out and get started. But, primarily we are, at the present time, an all-volunteer organization, and we are in the process of by building a nation-wide advocacy group and we are extremely successful, as far as we've gone so far.

Additionally, The Colon Cancer Alliance has a web page which is tied into a large number of colon cancer linkages, and it would be for anyone who has a computer. They should just go to their homepage and on the address line, type in "ccalliance.org" and it would get to our Web site. And, they will find everything they need to know about colon cancer and emotional support. They'll find chat rooms, they'll find buddy groups and they'll find everything they need to help them work their way through this disease.

GINA:
"ccalliance.org," and Richard, will they find some suggestions on how to do what you did, which is to go ahead and find some research, find a doctor who is willing to try something different? Will they find advice about how to do that?

RICHARD:
Yes, we do have a listing of doctors. We have a medical advisory board. Right now, we have fifteen of the top colon cancer experts in the country who have joined our medical advisory board and they are available to answer questions. We also have several other experts who are available through e-mail to answer any questions you may have. One thing I would suggest is that anyone who finds that they have colon cancer or are a caregiver or a survivor, who wants to get some excellent information and support should go to ACOR.org. This will bring them to the ACOR homepage, and that is the Association of Cancer Online Resources.

GINA:
Association of Cancer Online Resources. Richard, thank you very much. Hang on, we want to talk with you some more.

GINA:
Right now, I would like to bring into our discussion, also, Keith, from Vadnais Heights, Minnesota. Keith, thanks for joining us. Keith is 64. You had colon cancer in 1969, a recurrence in 1994, prostate cancer in 1998, and while there is a lot of information out there, researchers know a lot, doctors know a lot, there are still a lot of people who don't get diagnosed quickly enough. What's your experience been and what do you suggest?

KEITH:
Well, first of all, the prostate cancer was in 1996.

GINA:
Okay, sorry.

KEITH:
The two colon cancers were unrelated. They were 25 years apart and I was just very fortunate for early detection, and I was very fortunate for early detection on the prostate cancer.

GINA:
And, that was because you went in for your exam?

KEITH:
Yes. In all cases. Somebody mentioned about 5FU and in 1969 my oldest sister was in the final stages of cancer and I decided I'd get a physical and about ten weeks before she died, I was diagnosed with colon cancer. But, when you mentioned 5FU, my sister was one of the first people in the United States to be on clinical trial Phase I with 5FU. And, she started that in 1966, so she always said that if she could help anybody else, she was more than happy. I know in some cases it's helped and in some it hasn't but it's a very widely used chemo. And, I'm real pleased to say that she was a forerunner on that and then, ironically, one year ago this Friday, September 24th, we lost a 34-year-old daughter to cancer, and she survived three years and three months with non-functioning islet cells, which come out of the pancreas. It's not quite the same as pancreatic cancer, but she had chemo for 27 consecutive months, and one of the chemos that she used to sustain her life and help her see her daughter become three and one-half years old, was 5FU.

GINA:
A whole family history right in there.

KEITH:
And, I would say that I have picked up, through an ACS meeting, I sat across the table from a doctor in Milwaukee who knows a doctor at Creighton University in Omaha, Nebraska, by the name of Dr. Lynch. And that upper right inside colon that one of the individuals mentioned, is pretty much a hereditary type. And, they are doing research on my family and they are going to do a gene mutation on me, because my mother had colon cancer, I lost a sister to colon cancer, and I have had colon cancer.

GINA:
So, like your sister, you are helping with the research.

KEITH:
Well, whatever we can do.

GINA:
This is the "Lynch Syndrome" you're talking about.

KEITH:
That's right. There's a doctor in Omaha at Creighton who developed that and diagnosed it from a family genetic standpoint. And, anybody with children should find out if they fall into that because it certainly can help on the awareness of getting colonoscopies on a more consistent basis or any checks you need for determining colon cancer.

GINA:
I've got a couple of questions about doctors. First, how did you hook up with Dr. Lynch and the research on this?

KEITH:
I just met this doctor from Milwaukee and he told me about Lynch in Omaha. Because he teaches medicine at the University of Wisconsin Milwaukee medical school, and he brings Lynch up every two years to speak to his students.

GINA:
You've dealt with a lot of doctors over the years. I'm wondering what recommendations you might have on how a person can be an effective advocate for themselves.

KEITH:
Well, I think that the one individual that talked in terms of going to Sloan Kettering and moving to the next level, you know, you have to be your own advocate. I think you need somebody else in the room with you and you need to be taking notes, and don't let a doctor, he or she, put a hand on the doorknob to leave until you're through. You're the customer, and you ask all the questions and make sure you get them answered in a layperson's language so you can comprehend what they're saying. That's one of the first things.

GINA:
That's not as easy as it sounds, is it? To make a doctor stay there long enough to answer your questions?

KEITH:
Well, I think if you're asking intellectual questions and you know, instead of just wandering around and being foolish, they'll listen and they'll stay. I think doctors are continually improving on their bedside manners.

GINA:
And, patients are more knowledgeable. Perhaps, maybe write down your questions ahead of time?

KEITH:
Well, yes, but one triggers another and you just have to keep writing messages down and, you know, whatever goes through your mind, write it down. And, then ask the next question. And, ask the hard questions, too. If I do this, what are the consequences? If I do that, or if I let it go, and things of that nature. But, being proactive, and I've just been very lucky to get to doctors on time.

GINA:
Keith, thank you for your story.

GINA:
Hold on, we want to talk with you some more. We have one more cancer survivor to bring into this discussion, and that is Dick from Bellevue, Washington. Dick had colon cancer in 1973, and Dick, like Keith, you had a recurrence quite a few years later. That was 1995?

DICK:
That's right. I was cancer-free for 22 years, Gina.

GINA:
So, was it a big surprise?

DICK:
Oh, very much so. Yes, very much so. Listening to your other guests today, I would have to preface anything I say by commenting that I probably am the luckiest of all, because my treatments have been fairly simple and straightforward compared to most other colon cancer stories that I have heard, really, amounting to nothing but surgery in both cases.

GINA:
And, I think that's worth emphasizing. A lot of people get the diagnosis of colon cancer and fear the absolute worst immediately.

DICK:
Well, many times colon cancer will present without symptoms, and that's the frightening part, when you don't have an opportunity to discover the disease until it has reached an advanced stage. It can be alarming and can present different odds to treatment approaches. But, I was very fortunate the first time around, though I was only 34-years-old when I was diagnosed. I was way outside the normal statistical envelope, but I've got a history of colon cancer, both with my mother and father. And, I also had symptoms the first time around. Add to that a very alert physician, who just wasn't about to give up until he had determined the source of this pain. And, and this was really prior to the development of the colonoscope. So, we found my tumor with an old barium enema, but we found it nonetheless, and it was able to be treated with surgery alone.

GINA:
Dick, you've had the recurrence many years later. How do you feel now about the possibility there could be another recurrence?

DICK:
Well, evidently, the kind of tumors that have affected me. My medical team, the second time around, found a tumor again this time with no symptoms at all. But, after my first bout, I became a great deal more vigilant about regular checkups. And, I was in having a regularly scheduled colonoscopy, experienced no symptoms at all when the second tumor was found. As a result, we found it quite early and the treatment was again pretty straightforward, but we opted for a fairly aggressive surgery the second time around, because I seemed to have the kind of tumor that grows in the mucosa of the colon. So, we eliminated that area, and my outlook now and my prognosis is really quite good. And, since my last surgery, which was December of 1995, I have been very very healthy and functioning normally and doing very well with a good positive outlook.

GINA:
Functioning normally and pretty completely normally.

DICK:
Yes. I was able to avoid the ostomy procedure, so I'm fully functional in terms of bowel activity and very comfortable.

GINA:
That's terrific. I'm wondering if you changed your diet or exercise or anything after either the first or second bouts of cancer.

DICK:
Well, I did after both, really. I tried to use both those experiences as wakeup calls and just reminders that probably no one like ourselves has the level of responsibility that we should appropriately have for our own health. So I tend to be very watchful about the kinds of food I eat, and I try to exercise a little more regularly. You know, back in the seventies, I was using tobacco. I don't anymore and haven't for more than 20 years, so, yes, you do make some changes.

GINA:
And, in a way that's pretty good because it helps you feel better overall regardless of the cancer.

DICK:
Absolutely. And I think that beyond that, as the head of a household, it helps me to set an example for others in the household, not only about health and dietary habits but also health monitoring, and getting regular checkups and being more conscious of the personal health responsibility that really should rest on each individual's shoulders.

GINA:
Dick, thank you. We'd like you to stay on the line and we'd like to bring everybody into this discussion right now. It looks like we have in this group no ostomies at all, and in fact, I understand that's becoming fairly normal. Richard, maybe because of your work with the Colon Cancer Alliance, you could address that.

RICHARD:
It's very interesting that surgical techniques have improved so much that they are now able to take other portions of the intestines and form a new rectum, which over a period of time will function almost normally. It's called a "j-pouch" and essentially what they do is make a pouch out of muscle and tissue near the rectum. And, it is a j-shaped piece of flesh and tissue and it does replace the rectum and works quite well. But, again, one of the major problems that a lot of people have is the fear of having a colostomy, but again, the likelihood of it ever happening to many cancer patients is very, very slim.

GINA:
That's encouraging.

GINA:
You know we just had Dick tell us about being the head of the family, and dealing with cancer, and in a lot of families, women tend to take the leadership role in health issues, and I'm wondering what it's like to be a husband and a father and deal with cancer and how it affects your relationships. Ron, maybe you'd like to talk about that?

RON:
Well, again, my children are grown and on their own, and, certainly they are concerned, but they don't see the day-to-day effects as much. They're somewhat distant, so they don't see the reactions to the chemo and the side effects and so forth. They're very curious and one of the questions that I field quite often is, "How are you doing? What effect is the cancer having?" And I don't know about the other gentlemen and I'd be curious as to their answer, but even doctors ask me that same thing. How are you feeling? And, the truth of the matter is I have absolutely no effect of the cancer itself, other than the side effects of the chemo. And I asked the doctor, "What am I supposed to feel?" You know, "Tell me what I should be anticipating?" And, I got some rather vague answers, to be honest with you. Back to the original question, my wife again is fielding most of the questions and doing most of the little administrative things, relieving me a great deal to where I can simply deal with the side effects. I have no effects from the cancer itself. Even though my tumors are, I'm stage IV, the tumors are in my liver, they are having no ill effects at present.

GINA:
Richard, how about you and your marriage?

RICHARD:
Well, actually, mine's a rather interesting situation. My wife works for a group of doctors and we have half-dozen doctors who are relatively close friends, including my surgeon, my primary physician, and my oncologist. And, prior to getting colon cancer, I never heard of such a thing. It just never even came into my sphere of being. And, once I began to seek out information, I was amazed at how much I began to learn from these friends and associates.

So, essentially the question can be answered in two ways. Number one, the wife is a tremendous asset to me. She is a fantastic caregiver, she is very knowledgeable and she works diligently to make sure that all my appointments are made, my blood tests are done on time and they get to the right people. And, she makes sure that I have the right kind of food and she pushes me to exercise. So, she is an excellent caregiver. I have no fault with her at all. In fact, I'm so happy and proud that I have her to share this difficulty with me. Emotionally, she is as tight as a super wound rubber band. For her, it is a very difficult role to play because she is fully aware of what can happen with cancer, and she does not want that to happen to me. So, her emotional state is usually one of depression and anxiety and but she copes very, very well because she realizes that she has to be essentially up for me, because she doesn't want me to suffer the same anxieties and stresses.

My feeling is that I've had a wonderful life, and if the good Lord wants to take me, well I'm ready to go, but I'm not going to rush it. I have too much living left to do. And, as far as my children are concerned, I have four children, two boys and two girls and they all live relatively close and again, their emotional reaction has been extremely positive. They are very supportive and they're very helpful. They try to help their mother as much as they can, and they are demonstrating their love and affection for me far more than they ever did prior to my getting colorectal cancer.

GINA:
Dick, I understand that your wife has been helpful to other wives whose husbands have cancer. Is that right?

DICK:
Well, she, I think, followed my lead, Gina, in one way, and that is that after my first experience with cancer, I became pretty active as a volunteer with the American Cancer Society. My wife then, about a dozen years ago, even before my second bout with cancer, decided that she would involve herself in some anticancer activities, and here in Seattle there is a wonderful cancer research center called Fred Hutchinson. And, and she joined a guild there, a group of women who raise funds and participate in activities that are supportive of that research center, and stayed with the guild for a number of years, rose through the presidency that she occupied for a couple of years. And, so, she not only understands my activism with the America Cancer Society but has created a path of her own to do what she can to help the effort, the battle against cancer.

GINA:
Dick, I'd like to ask you kind of a personal question. Here you're a well-known TV personality, locally, and you made the decision to help other people by talking about your experience. I'm sure that you've saved a lot of lives over the years. But, because of your activism, and because of the way people recognize you, do you sometimes feel that cancer takes up too much of your life?

DICK:
No, I don't feel that way. My experience with cancer, fortunately, and I do count myself as a very lucky person in this regard. I have had excellent care. I have benefited on both occasions. I have benefited from early detection, and so, while I did have some invasive surgery, my actual dealing actively with my own cancer issues was relatively short-lived each time. My volunteerism now is something that I do in addition to a very active career in marketing and public relations that I'm still pursuing. So, I think I keep it in balance, but I also have a very strong feeling that it is something I will do for the rest of my life.

GINA:
I think there was a case of you addressing the issue from a hospital room at one point. Is that right?

DICK:
Well, that's true, I had been invited to, because I do a lot of master-of-ceremonies work for ACS and they had a national meeting in Denver that I was scheduled to attend. I was to fly out of Seattle on a Thursday morning, and on Wednesday, I wound up in the hospital with an intestinal blockage. A good fiend of mine, who is a colorectal surgeon in Tacoma, was aware of my situation and called me here in Seattle at the Virginia Mason Medical Center. He got hold of me in my hospital room and asked me if I felt up to talking to the group there in Denver over a telephone hookup. And, so, I did. And, it was very rewarding. I actually felt pretty good about it and told him, "You know, I apologize for not being there." I said, "I just hit a little bump in the road and I'd be back with them next year."

GINA:
That's great.

GINA:
It's almost time to wrap this up, but before we go, I'd like to ask each of you what kind of advice you might give to a man who is in your situation, somebody over 50 dealing with a recurrence of cancer, and Keith, let's start with you. What's your advice?

KEITH:
Well, again, I just think you have to be proactive and get the best available information and try to respond with that. We live near the Mayo Clinic, 70 to 80 miles away. Now, I've never needed to go there, because the fact the doctors I've had have been so on top of things, and like Dick in Bellevue, both of my surgeries have been not followed with any chemo or radiation because they were able to cut in and take care of the thing right away. But, then you've got to get the facts and then deal with the issue. I would like to share that because of the loss of our daughter, I've been on both sides of the ledger, being the person laying there getting the surgery, getting the treatment, and I never had any idea what my family was going through, until our daughter was diagnosed. And I think that one of the things is, you've got to talk to one another. If another man gets diagnosed with cancer, is how difficult it is for the spouse and the caregiver, the kids and everybody in the family. It's a very difficult journey for them, and I don't know how you reach out to show your strength, but you've got to understand that they're going through as much trauma as you are as a patient.

GINA:
Let me follow up on that briefly, Keith. It's not a case of suggesting that everybody just sort of button up and keep a stiff upper lip. That it would help more to talk, is that right?

KEITH:
Absolutely. Our family was close before my diagnosis 30 years ago when I was 34 years old, and each journey we've become closer and of course. This last blow, losing a daughter, was so crushing, but our family is close. And, we communicated and we all, we never left anything on the table. We always kept the words out and said how we felt about each other.

GINA:
Ron, you have had more than surgery. You were undergoing chemotherapy. You talked about a good week followed by a not-so-good week. What kind of advice would you have for somebody who's going through this?

RON:
Well, I think what's been reflected by the other gentlemen, I would also add to and that's openness is very important for everyone, as the gentleman before me just said. Keep everything open and on the table, but the other thing is a positive attitude. I think attitude makes a big difference along with maintaining the rest of your health. It can be awfully easy to focus on just the treatment and just the cancer itself and tend to forget the holistic approach and keeping healthy on a day-to-day basis. A little bit of exercise, watching diets, so forth. Sometimes, doctors will tend to somehow overlook certain things. My oncologist is very happy when I gain weight, but my general practitioner is not. So, you kind of have to balance these things and watch. Like I say, an oncologist is looking for something other than a rapid weight loss, of course. You don't want to do that, but you have to sort of keep track of things yourself and maintain your entire health.

GINA:
Richard, from Amsterdam, New York, what kind of advice would you leave with somebody in your position?

RICHARD:
I'd have to echo everything that the other gentlemen have said, Gina. Number one, you have to maintain a positive attitude. If you're going to have colon cancer, now is the best time to have it. There are so many new treatments coming down the pike. The likelihood of long-term survival is much, much better now than it ever has been in the past, but you also have to make sure that you do take charge of your own treatment. You have to be very positive. You have to be proactive and you have to learn as much as you can about it and make sure that your doctor knows that you know a great deal about it and ask the right questions and even tell him that you want to seek out certain treatments if he doesn't bring them up himself. Essentially, a positive attitude and a proactive relationship with your physicians is the best thing you can do for yourself.

GINA:
Good advice and maybe following up on what Ron said, not only talk to your physicians, but have them talk to each other. Dick, tell us some final thoughts on what you would tell somebody who's in your situation.

DICK:
Well, this is a tough group to follow, Gina. There are some pretty eloquent gentlemen here that have been part of the program. I'm not sure that I can add much, except to emphasize, reemphasize what they have said. Vigilance has certainly always been my watchword, you know. Know what's going on with your own body, with your own health. I was really pleased to hear one of our guests remind us all to remember our spouses and families and what they go through, and to be sensitive to their feelings. I know, in one case, I found out after the fact, that as much as my wife had seemed like a rock through the experience, in actuality, it scared her to death, and we didn't talk about the level of her emotional involvement until later. So, that's an excellent point. And, then I guess the only thing that I might add is that I've always felt, too, that an informed patient is a better patient. And there's lots of great information available for the asking, from organizations like the American Cancer Society and certain sites now available to most of us on the Internet. So, go out there and keep yourself informed, and I think you'll probably end up doing a better job of caring for yourself.

GINA:
And, with that, we're going to have to end this very rewarding discussion. I thank each of you. You've shared your personal experiences and I know it's been a help to a lot of other people. For the American Cancer Society's Cancer Survivors' Network, and from our HealthTalk Interactive Studio in Seattle, I'm Gina Tuttle.