Cancer: Where Knowledge Does Not Resolve Uncertainty

I am routinely questioned about my metastasis by anxious survivors who want to know what went wrong. They want to know my cancer type, stage, and grade. I know they are doing mental calculations to know how I am different from them. They are looking for reassurance that this won’t happen to them. Everyone who has had cancer is curious about why someone’s cancer metastasized. Will they be next? The fear is understandable.

I have no answers, no reassurance to give. Everyone is different. I have always lived a healthy lifestyle. I eat right and exercise. I was never overweight. I have never smoked tobacco, never drank alcohol, and never experimented with any drugs. Once I got cancer, I followed my oncologists’ recommendation without wavering. Yet, cancer came back.

Honestly, it’s just bad luck. Science still is not quite where they can tell who will have metastasis and who won’t. Of course, the higher the stage, the risk increases. We know something, but not everything.

Sadly, living with uncertainty is a big part of dealing with cancer, and knowing the initial stage and grade of my disease won’t change that.

[Commentary by Dheeraj Raina: This is a version of a Facebook post by Uzma dated March 31, 2017. I have edited it for grammar and clarity. To read my approach to her unpublished work, read this.]

Featured Photo by Santiago Lacarta on Unsplash

Cut-resistant Gloves And Cancer

Some years ago, I saw an advertisement for “NoCry” cut-resistant gloves. The picture in the ad showed two hands wearing the gloves and a large kitchen knife being pulled across one palm (see bottom of page). At that time, I thought, “No one pulls a kitchen knife across one’s palm like that!” I wondered who would genuinely need these gloves. They will never pay for themselves except for people who accidentally cut themselves all the time. Then, two years ago, I bought them.

Over the course of her multiple chemotherapy regimens, especially since her cancer returned in 2016, Uzma developed nerve damage known as chemotherapy-induced peripheral neuropathy (CIPN). CIPN is a common side-effect of many cancer medications. One scientific study found that almost 70% of cancer patients have CIPN one month after chemotherapy ends. For many, the symptoms subside with time since treatment, but the same study found that almost one-third of cancer patients still have CIPN six months out of treatment.

There isn’t one particular explanation for CIPN. Science tells us that there many roads to this kind of nerve-damage with cancer treatment. Some mechanisms are more relevant to some drugs, while others play a role in CIPN caused by other medications. We know that smoking, pre-existing neuropathy (from diseases such as diabetes), and impaired kidney function increase the risk of CIPN. In most cases, large nerve fibers suffer damage, leading to a “glove and stocking” pattern of symptoms. That is, the symptoms are most significant in the areas of the body that gloves and stockings would cover.

These symptoms commonly include varying degrees of burning pain, numbness, tingling, itching, and other unusual sensations. They may also include weakness, and when involving the feet, problems with balance. Changes in heart rate, diarrhea, or bowel movement patterns can occur in case of damage to nerves for automatic functions.

By the final several months of Uzma’s life, she had constant burning pain, tingling, and numbness in the glove and stocking pattern. By mid-2018, the problems with dulled sensation had become strong enough that she stopped driving.  She felt she couldn’t be sure about applying the right amount of pressure on the gas or brake pedals. By then, problems with weakness and balance also became significant enough that she had a couple of falls on the street. From that point on, she needed assistance when walking, especially outside the home. Eventually, in the house too.

By the time Uzma left us, we were renting a stairlift and owned all sorts of equipment including, suction bathroom handrails, a shower stool, a toilet seat riser, toilet seat handrails, a cane, a rollator, and a wheelchair. The goal was to help her maintain as much independence as possible.

The first tool we purchased, way back in 2017, to help with CIPN-related disability was a pair of cut-resistant gloves. You see, long before, burning pain, weakness, and problems with balance, Uzma had started to have numbness in her fingertips. It made her frustrated at needing help with one of the things she loved to do — cook. The numbness caused her to feel afraid to use knives. Though she would ask me for help, she hated that she couldn’t just start food prep whenever she wanted to and had to rely on someone to help. The cut-resistant gloves fixed that problem and gave her confidence back. She could ask for help if she wanted, but she didn’t have to ask for help.

I was reminded of this while reading this piece in the online magazine Vox:


As the article rightly points out the utility of a banana-slicer, “Imagine being unable to slice a banana over your morning cereal because your hands are paralyzed or joint contractures make it hard to grip both the banana and the knife.” It then makes us think about the kinds of impairments that for which ‘useless’ tools such as a sock-slider and yolk separator might be helpful.

I admit that commercials for these products are sometimes too funny. They often show people making exaggerated movements while doing things like separating egg yolks or putting on socks. The exaggerated movements lead to spoiled eggs or falls. Then they present the relevant product as the solution. Maybe those people in the commercials can’t do things the usual way. Perhaps they have a disability that is not evident to the casual observer. I think the ads may have to be that way. While the product may have been developed for a niche group of people, limiting one’s sales to that niche will never get the profits that a broad market will.

It’s easy for us to think walkers and canes help with disabilities because the impairments for which they help are usually evident to us. Let’s pause once in a while and think about the products that help with not-so-obvious difficulties.

And let’s give a thought to cancer patients suffering from nerve-related pain, numbness, and weakness. Let’s ask our loved ones with cancer about it as often they won’t complain about this. They think this is the least of their problems. Even if that were true, neuropathy is a problem with real consequences and risks for them.


Does Modern Life Cause Cancer?

Every day we hear of a friend, or a friend of a friend, or some celebrity getting cancer. We are positive that we didn’t hear about so many people getting cancer 25 years ago when we were young. Surely there must be something wrong with modern life that this disease afflicts so many of us today. Those looking to blame modernity for this usually find the culprits in pollution, plastics, and processed food. And chemicals. And don’t forget kale, or rather too little of it.

I vaguely remember a textbook of pathology that I last read in medical school saying, and I paraphrase — “the biggest risk factor for death is life.” The more years we are alive, the more likely we are to die. Life expectancy at age 75 is much lower than life expectancy at age 10. Accidents and injuries tend to get us young. But most other causes of death are likely to get the older among us. What is true of most causes of death is true of cancer too.

Highlighting the relationship between age and death is not just me being cute. It’s essential in the context of cancer. American Cancer Society tells us that 87% of all cancer cases occur in individuals 50 years or older. Why? Each day that we are alive, our DNA has a small chance of mutating. Some of those mutations cause cancer. The risk may be minuscule each day, but over time it adds up. An article from the American Journal of Preventive Medicine tells us how our risk of getting cancer increases with age.


Uzma was not one of the 87 percent. Her diagnosis and death came before she turned 50 years old. That still doesn’t change what the data tells us about the link between age and cancer for the majority of us.

As an interesting aside, the table above tells us that or risk of dying from cancer is about one in five across most age groups. But after age 60 those odds start falling. That’s because, as we get older, a greater number of chronic diseases — heart disease, kidney disease, consequences of over-consumption of food, alcohol or drugs — start competing with cancer to kill us.

The longer more of us live, more of us will get cancer. This relationship is vital to keep in mind when looking at the link between cancer and modern life. Let’s take a look at world life expectancy.


It is only in the past 50-100 years that people started living past the age of 50 years, the cutoff after which almost 90% of all cancers are diagnosed.

So, it’s true, we are hearing of more people being diagnosed with cancer than our grandparents did. But it’s mainly because more people are living longer. Yes, there is evidence of all other sorts of risk factors. Smoking, alcohol, and obesity carry cancer risk. As do sunlight, air travel, and certain chemicals. And managing those risk factors will lower the odds of getting cancer.

But the number one risk factor for cancer is age. Is a non-modifiable risk factor — that is, we can’t do anything to stop that we age. And that simple fact leads to only one lesson — each day that we are alive, we must truly live.