Coping with cancer

What is the impact of cancer on my life?

Getting diagnosed with cancer has a great impact on your life and the lives of your loved ones. It can cause feelings of anxiety, uncertainty, fear, or even depression.

Undergoing treatment for cancer is intense and will affect your work and social life. To find support, approach your doctor or nurse at the hospital, or your family doctor. They will be able to give you contact information about patient organizations or others who can help you with psychological support, or practical matters such as financial advice.

You may worry about your prognosis, the impact of treatment on your work, social life or financial situation. Most people who have been diagnosed with cancer will probably have these worries. You can ask the doctor about psychological support if you feel you need someone to talk to. A patient organisation can also offer support.

During treatment, you will be away from your work. Talk to your boss about the best way for you to get back to work. Perhaps you could work part-time, or in a different function.

Discuss with your healthcare team the possible financial consequences of your treatment. They might be able to direct you to people or places where you can get advice about your economic situation or even financial help.

Lifestyle advice

It is important to maintain a healthy lifestyle during treatment. Try to get physical exercise regularly. Find an activity that you enjoy doing. If you have doubts about what you can do, ask your doctor to refer you to a physiotherapist.

Try to eat a balanced diet with a mix of vegetables, fruit and dairy. Also include starchy food like bread and potatoes, rice or pasta, and protein-rich food like meat, fish, eggs, or legumes. Try to eat less sugar, salt, and fatty food. If you have any questions, ask your doctor to refer you to a dietician.

Cancer treatment and sexuality

Cancer treatment can affect your sexuality. You may experience erectile dysfunction after radical prostatectomy. Hormonal therapy can lower your sex drive (libido). Feelings of depression and fatigue can also have a negative effect on your sexual life. It is important that you talk to your partner about your feelings. There are many ways in which you can be intimate. If it is difficult to be sexually active, be near each other, touch each other, give and take hugs, and just sit or lay down close to each other.

Psychological support

A cancer diagnosis can make you look at life in a different way and you may realize you now have different priorities. This will affect your work or relationships and can make you feel disoriented and uncertain. Changes in your daily life as a result of the disease or the treatment can lead to isolation.

Talk to family, friends, or your spiritual advisor about your feelings and wishes. If you do not feel comfortable addressing these issues with those close to you, you can ask your health care team for a referral to a psychologist. The psychologist can give you the tools to deal with these feelings.

Support for partners

A cancer diagnosis can put pressure on your relationship. Often talking to each other becomes more difficult because of the time and energy spent on treatment. You could decide to discuss any difficulties with a therapist.

You may experience a similar degree of stress, anger, and depression as your partner. You could feel exhausted, both physically and emotionally. This can be a result of the responsibilities of caring for your partner, and taking on extra tasks around the house.

Be sure to make time for yourself and think about your own needs and wishes.

Your partner’s cancer treatment can affect your sex life. Try to talk to your partner about your feelings. There are many ways in which you can be intimate. Be near each other, touch each other, give and take hugs, and just sit or lay down close to each other.

It is normal to worry about being left alone.

If you feel you need somebody to talk to, approach your family doctor or your spiritual advisor. Patient organisations also offer support for partners. They can also help you find people or organizations that can help you with practical things like legal and financial issues.

Support for family and friends

A cancer diagnosis not only affects the patient, but also the people around them. As a loved one, you can offer support in many different ways. Sometimes you can help with practical things like laundry, gardening, or grocery shopping.

It may also be helpful to go to the doctor together. You could offer to drive to the visit or help formulate questions to ask during consultation. Being there for the consult can also be good. You may remember different things or focus on other details, which you can later discuss together. You could also ask the doctor how the treatment may impact your lives in terms of caregiving and psychological effects.

The diagnosis and treatment can be very emotional for everybody involved. Cancer treatment is intense and your life may change suddenly. Questions about prognosis, effects of the treatment, and death will come up. As a friend or loved one, you can be there and listen. You don’t need to have the answers.

If you feel you need somebody to talk to, approach your family doctor or the medical team to get support. Patient organisations also offer support for family members or friends of people who have been diagnosed with cancer.

Preparing for a consultation

Preparing for a consultation can be very useful. It will help you and your doctor better address your questions and concerns. It can also help you prepare for treatment and the possible side effects. Here are some things you can try:

  • Write down the questions you would like to ask the doctor. This will help you remember things that you want to ask. Writing down questions can also help you organize your thoughts
  • If you can, take someone with you to the visit. It is good to have someone to discuss what the doctor said and you probably remember different things
  • Ask for information about your specific type of cancer
  • If the doctor uses words you do not understand, ask for an explanation
  • Tell your doctor what medicine you take and if you take any alternative medicine. Some of these medicines can affect the treatment

After the consultation you can:

  • Search the Internet or go to the library for more information about your type of cancer. Be aware that not all the information you see online is of good quality. Your doctor or health care team can point you to reliable websites
  • Contact a patient organisation, they can offer support and information
  • Discuss with your health care team the possible financial consequences of your treatment. They might be able to direct you to people or places where you can get advice about your economic situation or even financial help
  • If you want, you should ask for a second opinion from another specialist

Cancer treatments and side-effects

About side effects

The side effects you might have vary from person to person and depend on the cancer drugs you are having.

Different drugs have different side effects

Not all cancer drugs cause hair loss or sickness for example. And the side effects of each drug vary for different people.

You might get only very mild side effects. You might get one or a few side effects of a particular drug. It is not possible to say beforehand whether you will have a particular side effect, when the effect will start or stop, or how bad it will be for you.

Side effects depend on many factors including:

  • which drugs you are having
  • how long you have been taking the drug
  • your general health
  • the dose (amount of drug)
  • the way you have the drug (for example, as a tablet or injection)
  • other drugs or cancer treatments that you are having

Ask your doctor, nurse or pharmacist to write down the names of your drugs so that you can look each one up.

Side-effects of chemotherapy

Side effects

There are more than 100 different chemotherapy drugs. This page tells you about the side effects that they may cause. But different drugs cause different side effects. Your doctor or nurse will tell you about specific side effects of your own treatment.

It’s important to remember that you probably won’t get every side effect listed. For some people the effects are mild. Sometimes the side effects of chemo can be unpleasant, but it can help to remember that:

  • most side effects are short-term
  • they will begin to go once the treatment has finished
  • you can have medicines to reduce most side effects

Let your nurse or doctor know if you have side effects that are troubling you.

Find side effects of specific drugs

Tiredness and weakness

Chemotherapy can make you feel very tired. The tiredness can increase as you go through your treatment and could last for quite a few months after the treatment ends. This is called fatigue.

You might also feel weak and as though you have no energy. This is called lethargy and can be part of fatigue.

A drop in the number of platelets

You might notice you:

  • bruise more easily
  • have nosebleeds
  • have bleeding gums when you brush your teeth

This is due to a drop in the number of platelets that help clot your blood.

If your platelets get very low you may have lots of tiny red spots or bruises on your arms or legs called petechiae.

Tell your doctor or nurse straight away if you have petechiae.

You will have a platelet transfusion if your platelet count is very low. It is a drip of a clear fluid containing platelets. It takes about 15 to 30 minutes. The new platelets start to work right away.

An increased risk of getting an infection

Chemotherapy drugs often stop the bone marrow from making enough white blood cells. White blood cells are part of your defence against infection.

When your white blood cells are low, bacteria can quickly increase in the blood. You might not have enough white blood cells to fight the bacteria. So a minor infection can become life threatening within hours.

Signs of infection

It’s important to tell your hospital treatment team urgently if you have any signs of infection such as:

  • an increase in your temperature to 38 degrees Celsius or higher
  • feeling cold and shivery
  • headaches
  • aching muscles
  • a cough
  • a sore throat
  • pain passing urine
  • a lower than normal temperature

Contact your cancer centre immediately. Some infections can be life-threatening if you don’t have treatment quickly.

You might need antibiotics by injection or through a drip to control the infection. Tablets might not be enough.

Neither you or your doctor can tell whose fever could develop into a severe illness. So all possible infections must be treated urgently.

Your doctor won’t think you are making a fuss about something minor. It is better to be on the safe side.

Hearing

Some chemotherapy drugs can affect your hearing. This usually gets better when treatment finishes, but your doctor may reduce the dose of your treatment or change your treatment.

Tell your doctor or nurse if you have any changes to your hearing.

Breathlessness and looking pale

Chemotherapy makes the level of red blood cells fall (anaemia). Red blood cells contain haemoglobin, which carries oxygen around the body. When the level of red blood cells is low you have less oxygen going to your cells. This can make you breathless and look pale. Tell your doctor or nurse if you feel breathless.

You have regular blood tests to check your red blood cell levels. You might need a blood transfusion if the level is very low. After a transfusion, you will be less breathless and less pale.

You can also feel tired and depressed when your blood count is low and feel better once it is back to normal. The levels can rise and fall during your treatment. So it can feel like you are on an emotional and physical roller coaster.

Eating and drinking

Many chemotherapy drugs can make you feel sick or be sick. But anti sickness medicines can usually control this well.

Some drugs can make the lining of your mouth very sore or cause small mouth ulcers.

Some can also change your sense of taste for a while.

Some chemotherapy drugs might irritate the lining of your bowel and cause diarrhoea. This usually happens in the first few days after treatment. It can be well controlled with medicines.

Some chemotherapy drugs and some of the medicines to control sickness can cause constipation.

Kidneys, liver, heart and lungs

Some chemotherapy drugs can cause changes in the way your kidneys, liver, heart or lungs work. The changes are usually temporary and go back to normal when your treatment ends.

But for some people, the changes may be permanent. Your doctor can tell you if your drugs are likely to cause any changes.

Some chemotherapy drugs can increase your risk of developing blood clots. Contact your hospital immediately if you become breathless or have swelling in your leg.

Chemotherapy can affect your appetite. Don’t worry too much if you really don’t feel like eating for a few days after treatment. You can make up for lost calories later. However, it is important to drink.

Your doctor or nurse can answer any questions about what you should or shouldn’t eat. And if you have a problem with diet, digestion or weight loss, talk to your doctor, cancer nurse or dietician.

Side-effects of immunotherapy

What are the side effects of immunotherapy?

Immunotherapy can cause mild, moderate and even severe side effects. The most common include fatigue and flu-like symptoms, such as fever and chills, headaches, and pain in the muscles and joints.

Nearly everyone undergoing immunotherapy has these side effects at first. It usually gets better as your course of treatment continues. These symptoms appear 2 to 4 hours after your injection and last for about 12 hours. Paracetamol can help to relieve these symptoms.

Immunotherapy can also cause a temporary drop in the number of red or white blood cells, or blood platelets. A drop in white blood cells can increase the risk of infection. Lower levels of red blood cells can lead to tiredness and feeling out of breath. You could need a blood transfusion if the levels become too low. A drop in blood platelets can cause nosebleeds, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms and legs, known as petechia. Itchy, dry skin, or rashes could also occur.

You should contact your health care team if you have any of these side effects. Your doctor will check your blood counts regularly.

Other symptoms include nausea and vomiting, diarrhoea, loss of appetite, and changes in taste or a metallic taste in your mouth. You could also experience a sore throat and pain when swallowing. Because these symptoms may lead to dehydration, weight loss, or malnutrition, be sure to let your doctor or nurse know if they do not go away.

During the course of treatment you may feel depressed, anxious, or have trouble sleeping. These feelings can be a side effect of immunotherapy, but they may also be a response to your diagnosis. You can ask your medical team about psychological support if you feel you need to have someone to talk to.

Side-effects of cancer drugs

The side effects you might have vary from person to person and depend on the cancer drugs you are taking.

Side effects can happen as a direct result of medical treatment. All drugs used to treat cancer cause side effects. It can be easy to confuse drug side effects with symptoms of the cancer.

Symptoms happen as a direct result of your cancer and are not due to your treatment. Treatment aims to shrink your cancer and make your symptoms better, but can cause side effects.

Different drugs have different side effects
Not all drugs cause hair loss or sickness. And the side effects of each drug vary for different people.

You might get only very mild side effects. You might get 1, 2 or a few side effects of a particular drug. It is not possible to say beforehand whether you will have a particular side effect, when the effect will start or stop, or how bad it will be for you.

Side effects depend on many factors including:

  • which drugs you are having
  • how long you have been taking the drug
  • your general health
  • the dose (amount of drug)
  • the way you have the drug (for example, as a tablet or injection)
  • other drugs or cancer treatments that you are having

Ask your doctor or nurse to write down the names of your drugs so that you can look each one up.

Side-effects of hormone therapy in men

Many men find that the side-effects are often worse at the start of treatment. They usually settle down after a few weeks or months.

Tiredness

You may feel more tired when you are taking hormone therapy.

Problems getting an erection (impotence)

Hormone therapy lowers the amount of testosterone in the body and this affects your ability to have and maintain an erection. This may get better within 3 to 12 months after the treatment ends.

For some men, erection problems are permanent. It depends on the drug you are having and how long you have been taking it.

Your doctor or clinical nurse specialist will be able to offer you advice.

Hot flushes and sweating

Hot flushes and sweating can be troublesome. They may last for 2 to 30 minutes and you may have a few a month or more often. They are the same as the hot flushes women have when going through menopause.

Lowered testosterone levels cause hot flushes. They are most likely to happen when taking luteinising hormone blockers, because these drugs cut testosterone production off altogether.

Getting overheated, drinking tea or coffee, and smoking can all make flushes worse.

They may gradually get better as you get used to the treatment. But, in some men the flushes keep on happening as long as you take the drug.

Talk to your doctor or clinical nurse specialist if you have problems coping with hot flushes and sweating. There are treatments that may help.

Breast tenderness

Breast tenderness is a particular problem with high dose bicalutamide (Casodex). The breast tissue can become painful and swollen.

Taking the drug tamoxifen can help to reduce breast tenderness in about 6 out of 10 men taking bicalutamide. Or, sometimes it can help to have a small dose of radiotherapy to the breasts before your hormone treatment starts.

Pain from tumour flare

Pain caused by a secondary prostate cancer can temporarily worsen when you start hormone treatment. This is called tumour flare.

Your doctor should always prescribe another hormone therapy when you start leuprorelin (Prostap) or goserelin (Zoladex) injections. This other hormone therapy helps to prevent tumour flare from causing bone pain. If the pain carries on, your doctor can prescribe drugs called bisphosphonates to treat it.

Weight gain

You might put on weight. You should be able to control this with diet and exercise. But it is often a struggle to keep weight down when you are having hormone treatment. Ask to see a dietician for advice about managing your weight.

Memory problems

Some men and women feel that their memory gets worse when they have been having hormone treatment for a while. Your memory may not improve while you are taking the hormone treatment. But there are ways to make life easier, such as making lists so you don’t forget things.

It is natural to feel cheated and upset if you have this particular side effect. Talk to your doctor or specialist nurse if you feel this is having a significant effect on your life.

Mood swings and depression

Some men and women have mood swings and even depression while having treatment such as Zoladex (goserelin). Talking with someone close to you may help. If you don’t feel comfortable sharing your feelings with people you know, seeing a counsellor may help.

Bone changes

Men taking hormone therapy for prostate cancer are at risk of bone thinning (osteoporosis). There is evidence that the risk of problems such as bone fractures is slightly higher for men having long term treatment to block testosterone (for example, Zoladex). Your doctor may suggest taking vitamin D and calcium to help lower your risk of problems from osteoporosis.

Other advice is to:

  • stop smoking
  • reduce the amount of alcohol you drink
  • take regular weight bearing exercise, such as walking

Risk of earlier heart attack

There is some evidence that if you are over 65, and at risk of dying from a heart attack, this is more likely to happen sooner if you have been taking hormone therapy for 6 months.

This may be because some of the side effects of hormone therapy, such as weight gain, can make heart disease worse.

Remember that the side effects we have listed above are general ones. Tell your doctor or nurse if you have any side effects. They may be able to help reduce them.

Side-effects of hormone therapy in women

Tiredness

You may feel more tired when you are taking hormone therapy.

Digestive system problems

Hormone therapy can cause a few problems with your digestive system.

You may feel sick. This is usually mild and settles down after a few days or weeks. Your doctor can prescribe anti-sickness tablets, which should help.

You might have constipation or diarrhoea. This is usually mild and can be controlled with diet or drugs. But as with any diarrhoea, if it is severe or lasts for more than 2 or 3 days, you need to tell your doctor or nurse.

You may lose your appetite a little. Or you may have an increased appetite, which can lead to weight gain.

Menopausal symptoms

You may start your menopause when you begin hormone therapy. This could be temporary or permanent.

Your periods will stop if you are taking a luteinising hormone (LH) blocker. Your periods may stop or become lighter if you are taking tamoxifen.

You might also get other menopausal symptoms, even if you’ve already had your menopause. For example, you may have vaginal dryness, hot flushes, sweating and a lowered sex drive.

Tell your doctor or nurse if you are having any problems coping with the sweating. There is treatment available that may help.

Hair thinning

Some hormone therapies can cause hair thinning. This is usually not noticeable by other people. But if you are worried about hair thinning and would like tips on ways to cover your hair, you can learn more about hair thinning and cancer drugs.

Find out more about coping with hair loss or thinning from cancer drugs

Muscle and bone changes

You might develop pains in your joints. This often settles down after a few weeks. You can take a mild painkiller to help control aches and pains.

Some hormone therapies such as aromatase inhibitors can cause thinning of your bones. Tamoxifen can cause bone thinning in premenopausal women. Tamoxifen doesn’t cause bone thinning in postmenopausal women, and it can help to maintain the strength of your bones.

Weight bearing exercise can help to build up the bones and protect them. This means any exercise where you are carrying your own weight, such as walking, running, cycling or exercise in the gym.

Swimming is not weight bearing exercise. So although it is good for you in other ways, it won’t help with bone thinning. Check with your doctor before starting any new type of exercise, especially if you have not exercised for a while.

Bone thinning can lead to osteoporosis and bone fractures if it continues for a few years. So your doctor may treat you with a drug (a bisphosphonate) to strengthen your bones.

Weight gain

You might put on weight. You should be able to control this with diet and exercise. But it is often a struggle to keep weight down when you are having hormone treatment. Ask to see a dietician for advice about managing your weight.

Headaches

Let your doctor or nurse know if you have headaches. They can prescribe a mild painkiller such as paracetamol for you.

Memory problems

Some men and women feel that their memory gets worse when they have been having hormone treatment for a while. Your memory may not improve while you are taking the hormone treatment. But there are ways to make life easier, such as making lists so you don’t forget things.

It is natural to feel cheated and upset if you have this particular side-effect. Talk to your doctor or specialist nurse if you feel this is having a significant effect on your life.

Mood swings and depression

Some men and women have mood swings and even depression while having treatment such as Zoladex (goserelin). Talking with someone close to you may help. If you don’t feel comfortable sharing your feelings with people you know, seeing a counsellor may help.

Blood clots

Your risk of blood clots (thrombosis) can slightly increase when you take tamoxifen. Tell your doctor if you or a close relative have had a blood clot in the past.

Let them know if you have pain, redness or swelling in your legs. Also tell them if you have sudden breathlessness, chest pain, or if you cough up blood.

Remember that the side effects we have listed above are general ones. Tell your doctor or nurse if you have any side effects. They may be able to help reduce them.

Side-effects of radiotherapy

Side-effects during treatment

Radiotherapy affects people in different ways, so it’s difficult to predict exactly how you will react. Some people have only mild side-effects but for others the side effects are more severe. Some of the main side effects are explained below.

Tiredness and weakness

Most people feel tired while they are having radiotherapy, particularly if they are having treatment over several weeks. This is because the body is repairing the damage to healthy cells. Or tiredness can be due to low levels of red blood cells (anaemia).

You might also feel weak and as though you don’t have the energy to do your normal daily activities. This may last for a few weeks after the treatment ends. Rest if you need to and try to exercise a little when you can. This can help to reduce the tiredness.

Sore skin

Some people get sore skin in the area being treated. The skin may look reddened or darker than usual. It may also get dry and itchy. The skin may break or small blisters can start to form in the area. The staff in the radiotherapy department can advise you on the best way of coping with this.

Loss of hair in the treatment area

Radiotherapy makes the hair fall out in the treatment area. Hair in other parts of the body is not affected. The hair should begin to grow back again a few weeks after the treatment ends.

Other side effects

Other side-effects that you may have, depend on the area of the body being treated. Tell your doctor, nurse or radiographer about any side-effects. They can help you find ways of reducing the effects and coping with them. They can give you leaflets which describe the side effects.

Possible long-term side-effects

For many people the side effects of radiotherapy wear off within a few weeks of the treatment ending, and they can go back to a normal life. But for some people radiotherapy can cause long-term side-effects.

The possibility of long-term side-effects depends on the type of cancer and its size and position. It might also depend on how close the cancer is to nerves or other important organs or tissues.

It is important to ask your doctor, specialist nurse or radiographer about the possibility of long-term side effects. Depending on the position of the cancer the possible long-term effects might include:

  • a change in skin colour in the treatment area
  • a dry mouth
  • breathing problems
  • loss of ability to become pregnant or father a child (infertility)
  • low sex drive
  • erection problems (impotence)
  • long-term soreness and pain
  • bowel changes
  • bladder inflammation

Sex and fertility

Chemotherapy might affect your sex life. You could feel tired and lose interest in sex. Some chemotherapy drugs can affect fertility. If you’re hoping to have a child, discuss it with your doctor before you start treatment. There might be steps that you and your doctor can take to help keep your fertility.

Feeling and being sick

Sickness caused by chemotherapy can start within a couple of hours of starting your treatment and only last a day or so. Or it can come on more than 24 hours after the start of treatment. This is called delayed onset nausea and vomiting and usually lasts about a week.

Sometimes sickness doesn’t start until you have had your first few cycles of chemotherapy. It all depends on the chemotherapy drugs you have and how you react to them. This can vary from person to person.

If you are being sick with chemotherapy, do tell your doctor or chemotherapy nurse. There are lots of different anti sickness medicines and some work better for some people than others.

Hair, skin and nails

Some chemotherapy drugs make some of your hair fall out, so that your hair is thinner. Other chemotherapy drugs make all the hair on your head and body fall out, including eyebrows and eyelashes.

Losing your hair can be distressing. But it’s temporary and the hair starts to grow back a few weeks after treatment ends.

Some chemotherapy drugs can make your skin dry and sensitive. Some may cause rashes. You may find that your skin is more likely to burn in the sun or react to chemicals. So be careful when you’re in the sun, and wear at least factor 15 sun protection.

If you have dry skin, avoid swimming while you are having treatment. Some people find that their nails also change and become dry, ridged or brittle or have white lines on them.

Late side-effects

Most chemotherapy side-effects are temporary and disappear once your treatment is over.
But for some people, chemotherapy can cause long-term changes in the body. Some of these changes may happen months or many years after the treatment has finished.

Late side-effects can include early menopause, infertility, changes to feeling in your hands and feet (peripheral neuropathy) and heart and lung problems. Your doctor and chemo nurse can talk to you about the risk of late side-effects with the drugs you’re having.

Palliative care

Sometimes recovery from cancer is not possible. When treatment is no longer successful you may be offered palliative care to make you more comfortable.

Palliative care is a concept of care with the goal to optimise your quality of life if you cannot recover from your illness. During palliative care you and your loved ones are supported by a multidisciplinary team. Together, you address physical, psychological, social, and spiritual questions. Palliative care includes controlling your symptoms and medical treatment for pain management.

The palliative care team can provide care in the hospital or at your home. Another option is hospice care. A hospice is an institution which provides care during the final phase of your life.

Talk to the palliative care team and your family about your feelings and your wishes. It is important to discuss:

  • Your symptoms and how much bother they cause
  • The possibility of getting help with cleaning, washing, or cooking if you need it
  • Financial matters
  • Legal issues such as your will
  • If there is something you want to do or somewhere you would like to go. The palliative care team can help you with practical things such as a wheelchair, if you need it
  • Where you want to spend the final phase of your life: at home or in a hospice. If you want to be at home, the palliative care team will look into whether this is possible
  • If you would like to talk to somebody who can give you support, such as a psychologist or a spiritual advisor

Palliative Care – The role of family, friends, and partner

As a loved one or a close friend, you play an important role in palliative care. You can help with practical things such as cleaning, washing, or cooking. You may also support the palliative care team in caring for your partner, family member, or friend. Ask the palliative care team about the possibility of getting professional home care if you feel you need it.

If you feel you need somebody to talk to, approach the palliative care team, your family doctor, or your spiritual advisor. The palliative care team can also point you to people who can help you deal with your feelings.

Patient organisations also offer support for partners, family members, or friends.

How to find a patient organisation nearby

Patient organisations can be very helpful. To find one close to you, ask your family doctor, nurse, or doctor at the hospital. You can also search the Internet for a patient group.

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© Cancer Research UK [2002] All right reserved. Information taken 23/02/2018.