What comfort can you offer when somebody tells you she or he has cancer or, more challenging, that cancer has returned or spread? There is no etiquette book for this topic. We usually rely on our hearts. Other times, it is more the foot in the mouth that inspires. Mostly we do the best we can.
"I am so sorry!" is a good start.
Compassion informs care, commiseration and comfort. Whatever we can say that expresses our concern and sympathy will go a long way towards comforting – unless the person is not somebody who welcomes sympathy. In that case, we need to share "considerate compassion." Considerate compassion means that we consider just how much sympathy a person can handle and turn that compassion up a notch.
"I cannot begin to understand how you must be feeling," works. Let the person lead the conversation. Go with the flow.
"What can I do to help?" is another tried-and-true response, but save it for after you share some compassion.
For those of us who have experienced cancer, reactions are a little different. At the same time that we are seeking words to reach out to the person with the bad (or awful) news, inwardly we might be feeling so much empathy that we want to cringe. It is OK, I want to say, to cringe on the outside, too. There is no way to disguise the pain in our eyes when a friend or family member is surprised by a diagnosis. Empathy informs compassion.
"I feel bad about your diagnosis" is OK to say.
This is better: "Cancer is just awful, isn't it? I know you must feel bad about your diagnosis."
"I am so sorry" is always a good standby.
Commiseration is a little different than compassion. It can be awkward to commiserate too much too soon, especially when shared experiences are not analogous. I do not recommend responding with an anecdote about your migraines when somebody discloses a diagnosis of an aggressive cancer. It is not the time to talk about your aunt who had the same disease. Save that until you test the waters. Better yet, let your experience with your aunt or migraines inform how you help later.
When cancer is a bond, commiseration is inevitably wrapped up in our compassion. It might seem that the two concepts are interchangeable. "Commiseration," however, tends to be what happens when the compassion grows out of a mutual understanding of the gravity of an illness. We show compassion by sharing our experience, commiserating, without letting our experiences overshadow compassion.
"I wish that you didn't have to go through this (again)" is not a bad thing to say.
"I would do anything in my power to make life easier for you, if I could" is another.
This is more like what I might say: "What is your chemo regimen? And when do you start?"
"Let me know what questions you have about your chemo cocktail" is another.
But do not go into graphic detail about how the first time you had chemo it felt as if a freight train ran into you. Or how you broke out in splotches all over your body the second time, etc. Take the lead from the person who is sharing her news. If somebody asks you if you ever doubted yourself, or your chemo cocktail, it is OK to answer honestly. Just do not start out by sharing a sob story that will tip the scales of commiseration and make you the subject of compassion. This is not your turn for compassion.
"What is the prognosis?" is a question we might need to ask.
There are many responses from the practical (Will you need a ride to chemo?) to the philosophical (God works in mysterious ways). You will never run out of words to say if you connect a cancer announcement with comfort, compassion, care and commiseration.