English: Joshua Foer at the Athanius Kircher S...

Joshua Foer 2007

Palaces. Forgetfulness. Moonwalking with Einstein. What does a memory championship have to do with cancer?

In 2006, a young journalist, Joshua Foer, became the U.S. National Memory Champion.

Only a year before, he had been reporting on this competition when one of the experts there told him it didn’t take any special, genetic ability to be a competitor.

He promised to teach Foer enough to become the next year’s champion.

Foer was intrigued. He spent the next year training and, indeed, won the championship.

In his new book, Moonwalking with Einstein, he explains the technique, as well as the scientific reasoning behind why the technique works.

The thrust of the argument is that man has almost always lived in an environment where spatial memory, like where the best animals eat and can be captured, was more important than memorizing lists of data, like phone numbers or remembering people’s names.

Using this natural ability at spatial memory and associating things you want to remember with places, in a spacious palace, or in a familiar home, for instance, is how memory champions memorize decks of cards in minutes.

They train themselves to place each card in a familiar spot as though they were walking through their house.  They reinforce the image by associating it with something silly or memorable.

Then, they can mentally retrace their steps and find each card.

How Does This Relate to Cancer?

What if you don’t want to remember the random order of a deck of cards?

Instead, you want to remember what doctors are telling you about a new cancer diagnosis.

Most cancer survivor books will tell you to take someone with you to take notes at all doctor meetings, because the emotional impact of what they are telling you is too great to allow you to hear everything or remember much.

But, there is a different time, when you are trying to understand what the doctor’s advice means to you to help you make decisions, when you need a new way to integrate all the new information that is coming to you.

This is when memory techniques come into play.

Mind Mapping

One of these techniques, described briefly in Foer’s book, is called Mind Mapping. This is a graphical representation of a subject.

Tony Buzan, who teaches mind mapping to consumers, also promotes it for the classroom, where it has some advocates.

One classroom teacher uses it to help his students remember their entire U.S. history textbook.

But scientists have discovered that it is the framework of information that is important, whether in visual images or not. They demonstrated the value of having an expertise in baseball, for instance, in remembering the details of a specific baseball game.

For newly-diagnosed cancer patients, this is important.

They need a framework of information that new information can fit into. This makes it easier to understand, remember and act on new information.

Building a Framework for Understanding Cancer 

Cancer research is divided between three areas: prevention, diagnosis and treatment.

For a new cancer patient, the order of interest is slightly different: diagnosis, treatment and prevention of recurrence.

Diagnosis Framework

Some years ago,  I was just beginning to research a promising cancer treatment. I had a professional background in software engineering and no scientific training.

I spoke to the CEO of a company researching oncology treatments.

“Cancer is organized by body parts,” said John Holladay, PhD, founder and former CEO of EntreMed.

To my blank look, he continued, “You have lung cancer, breast cancer, skin cancer.  Cancer types are related to where they first appear in the body.”

This is still how most people know their type of cancer.

Doctors care about the primary site of a tumor, where it first appears, because, if it spreads, or metastasizes, other sites (sometimes called mets) will have the same kind of cells as the primary site.

That is, breast cancer cells that have metastasized where they can be seen on a scan, will still be breast cancer cells, no matter where they are. It is helpful to know this for treatment.

Seriousness of Diagnosis

Cancers are assigned one of four seriousness numbers: Stage I through IV, with Stage IV being the most serious.

The numbers relate to whether and how far a tumor has spread from its original site, from not having spread at all (Stage I) to having spread to several places far away from the original site (Stage IV).

Sometimes the size of the tumor is included in the Stage designation. Tumors are measured in centimeters (cm). A centimeter is a little less than half an inch.

Whether a tumor is benign (not spreading) or malignant (spreading), is also a consideration in seriousness of diagnosis, with malignant the more serious. Click here to read more about the definitions of benign and malignant from live strong.com, Lance Armstrong’s informational site about cancer.

Treatment options may vary depending on the Stage. Some treatments, like surgery, may work fine for a tumor that has not spread and may not work or have little chance for a tumor that has spread.

Different cancer types may have other diagnostic numbers or other tests that are important.

Prostate cancer has Gleason scores, with 7 being of moderate seriousness.

Breast cancer patients are checked for ER (estrogen receptor) and HER2 (human epidermal growth receptor). The results may guide treatment choices.

Treatment Framework

Treatments carry over the body parts designation. All treatments are in relation to the primary site of the tumor, if known.

When a clinical trial is conducted to see if a new drug is safe and works, organizers recruit people with the same type of cancer – breast, lung, and so on.

If the results of the trials are positive, this is considered evidence that the new treatment will work for many people with the same type of cancer.

Treatments are considered primary and adjuvant. Adjuvant treatments are those that are not sufficient by themselves, but may increase the effectiveness of other treatments.

Treatments are also organized by the way they are delivered.

Delivery of treatment comes in variations of three forms: surgery, chemotherapy and radiation.

Much of the research work being done today is to refine classes of cancer to see if they can determine more accurately, in advance, which people in a class the treatment will work best for.

Chemotherapy Framework

Most people think of side effects when they think of chemotherapy – loss of hair, loss of weight. But, scientists and doctors think about who it will work for.

Within chemotherapy, one organizing principle is how a treatment works, or its mechanism of action. Understanding this makes it easier to predict which people it will work for.

Targeted therapy typically has identified a protein on a tumor that a drug can be aimed at. Not all tumors have such a protein.

Tamoxifen, a targeted therapy, used for ER-positive breast cancers, prevents estrogen, which promotes growth of the tumor, from binding.

Customized vaccines use a patient’s own tumor cells to develop a vaccine against them, boosting the immune system’s ability to fight the tumor. This is what Steve Jobs’ doctors were doing for his pancreatic cancer.

There are two preventive cancer vaccines. Children are now routinely vaccinated against Hepatitis B (HBV), an infection that can lead to liver cancer. Gardasil protects against the human papilloma virus (HPV), an infection that can lead to cervical cancer.

Anti-angiogenesis drugs stop or delay the hyper-growth of blood vessels around a tumor in order to let other drugs shrink or kill the tumor while its blood supply growth is restricted.

Avastin, for lung, colon, and kidney cancers is in this category. Its use in breast cancer was not found to have a life-extending advantage.

Important Terms

Off-label means a drug was not approved by the U.S. Food & Drug Administration (FDA) for a specific condition, but has been approved for other conditions.

Doctors may, at their own discretion, choose to use drugs that have not been approved for the condition they are treating if they have reason to believe that its success for a similar condition suggests it may work for their patient.

They typically only do it if the recommended treatment does not work or is causing severe side effects.


This does not mean running for office.

In the cancer world, being a candidate for a procedure, like surgery, means it is likely to work for you.


The tumor stopped growing so fast, stopped growing at all, shrank, or disappeared. That is, it responded to treatment.

Disease-free Survival

Doctors and scientists rarely talk of a cure.

Despite this country’s long war on cancer, we have learned that cancer is especially good at getting around treatments that appear to work initially, only to allow the tumor to return.

One of the exceptions to this is pancreatic cancer. The Whipple Procedure, surgery that removes the tumor, is considered curative.

However, only 15% of those with this rare cancer are candidates for this procedure.

Instead, doctors and scientists use several other terms to describe cancer survival.

No evidence of disease (NED), disease or tumor-free survival or progression-free survival (the cancer is not getting worse) are the most common terms you will see. Click here for a further explanation of cancer survival terms.

Since experience has taught doctors and scientists that cancer has a sneaky habit of recurring, they measure success by how long survivors show no return of tumors, what used to be called remission.

Five years with no recurrence used to be considered the milestone after which people were called cancer survivors.

Now, cancer survivors are those who have finished their treatment.


National Cancer Institute (NCI) 

NCI keeps a database of how many people have which kind of cancer, by state, gender, and race. Called the SEER database, for Surveillance Epidemiology and End Results, every state submits information about the incidence of cancer in their borders.

American Cancer Society (ACS) 

The American Cancer Society is a non-profit organization that keeps an easy-to-understand description of the latest treatment options for cancer.

ACS also has a Cancer Survivors Network forum and discussion board that is active and useful for getting answers to practical questions from other survivors.

Clinical Practice Guidelines

Panels of doctors get together on a regular basis to review the scientific literature and recommend or update recommendations for treatment. Their recommendations are published in a clearinghouse open to anyone for free.

By reading the recommendations that your doctor is reading about your cancer, you can get a better idea of what to expect.

Click here to search for a type of cancer to find suggested diagnostic tools and recommended treatments.

This summary of how the cancer world is organized, terms and references, gives you a framework for understanding your own cancer, if you’ve been newly diagnosed, or that of a loved one.

Click here if you want to order Josh Foer’s book, “Moonwalking with Einstein: The Art and Science of Remembering Everything.”

Click here if you want to order “Steve Jobs,” the biography that describes not only his and Apple’s rise, but his final journey with pancreatic cancer.

To you and those you love who have fought or are fighting cancer.

Carol Covin, Granny-Guru

Author, “Who Gets to Name Grandma? The Wisdom of Mothers and Grandmothers”


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