Rob Ford's tumour diagnosis: What goes through a patient's mind

Toronto Mayor Rob Ford has spent the last two days in hospital, after doctors found what they believe to be a tumour in his abdomen.

While the Ford family has confirmed that the mayor has a tumour, a biopsy is still required to determine if he has cancer.

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• Full coverage of Rob Ford on CBC News

The period between hearing the word "tumour" and waiting for biopsy results that provide direction on what to do next can feel like an excruciating eternity, believes Dr. Nihil Joshi.

He's a St. John's, NL physician, cancer survivor and host of the "Dr. C" series on CBC Radio. Dr. Joshi says there are five things that many patients ask or feel when they're initially told they may have cancer.

1. "Wh-what?!"

As patient and a physician, I've been on both sides of the "You have cancer" discussion. The first thing you say as a physician is, "We've discovered [something]." You never say cancer unless you're fairly sure of it. Diagnostic imaging is helpful in raising the possibility that certain masses may be cancer, but in most cases, a tissue biopsy is needed.

As a patient, you are floored. You hear nothing. You may pretend like you do, you may ask questions, but on the inside, you are utterly in shock. You have cancer. Everything in your life has instantly changed. Your dreams and plans are about to be irrevocably altered.

2. "Are you sure? Couldn’t it be something else?"

Perhaps a continuation of the state of shock, but nonetheless a pertinent question that many patients ask. The answer is no. No physician is sure you have cancer until the tissue is sent off for pathology and a trained pathologist diagnoses the type of cancer according to various histological characteristics. That’s when it becomes sure.

Up until then, yes, various masses and other abnormalities could be something else. In medicine, one problem can have six or seven possible causes. But by putting together the whole picture from the patient’s presentation, family history, physical examination and diagnostic and laboratory abnormalities, certain diseases become more likely.

As a patient, you ask this question because you feel a desperate need to not have cancer. To at least have the hope that it isn’t cancer. Because if it is, then the next logical question is…

3. "Am I going to die?"

The uncomfortable question that almost every cancer patient asks. This enters everyone’s mind - patients and providers both. The response boils down to the uncomfortable truth, which is that before full staging and precise diagnosis is given, we don’t know yet.

But for the first time in many peoples’ lives, the cold knock of mortality presents itself. Suddenly you realize this life we live isn’t forever, and that is something most people haven’t given serious thought to beforehand. Now you are truly scared.

4. "What next?"

Now that your whole world has been shaken to the core, you crave structure and a plan. You depend on your physician for a concrete plan of action, and suddenly, every moment – from being told you might have cancer to getting diagnosed and starting whatever therapy you require – is torture.

The days you wait until you know are full of anxiety and worry. At the same time, many patients need some time from being initially told they have cancer to starting treatment in order to appropriately digest the information.

Your life changes exponentially in the hours after being told you might have cancer - sometimes you need some time to ride out that wave. Any delay is tough mentally, and I believe most health centres across the country realize this and try their best to make the precise diagnosis as quickly as possible.

5. "What’s going to happen to the people I love?"

In most patients' cases, it isn’t their own suffering that preoccupies them once they are diagnosed - it is their family's. "What’s going to happen to my wife, husband or children? How will my family cope?"

This is unfortunately a question that medical science can’t answer – if you're lucky, the answer will be, "Everyone will do the best they can."

And life will unfold just one day a time. One test, one treatment, one round of chemo, one breath at a time.