Stand-up comedian Kevin Knox gets paid to go to Las Vegas, play in golf tournaments, and say outrageous things. He also has cancer. Not so funny.

"You've been taken over by an alien that's trying to kill you. You feel betrayed by your body, and you feel devastated," Knox says.

Knox, 53, has stage-four melanoma and points out, "There's no stage five."

When his doctor delivered the diagnosis, he gave him a year to live. Knox wasn't shocked - and he wasn't accepting it. He'd done some research.

"I was pissed. I knew people could survive, and I felt he was just piling on," Knox recalls. "I said, 'Well, I understand that's your diagnosis, but I don't believe that.' He reiterated that I could believe what I wanted, but it is what it is.

"For him to dismiss me like that was really annoying. I wasn't in denial. I knew I had cancer, but I also knew how I wanted to fight my battle."

He'd been through this before, both personally (a cancerous mole removed 17 years earlier) and with his parents and a sister, all of whom died of cancer while receiving conventional treatments.

So Knox was prepared to follow an uncharted course of natural treatment. His research led to a regimen that included raw and organic foods, certain types of teas, essential oils, exercise and immunity-building injections and pills.

In February, it will be five years since the diagnosis. Knox isn't a zealot for his approach; he says it's up to each person to assess his or her needs. But he does know that the diagnosis can be a beginning, not an end - if you respond intelligently.

According to Cancer Research UK, it's estimated that there are 24.6 million people alive who have received a diagnosis of cancer in the last five years, Knox is one of them. You probably know one of them. Nearly four out of five Americans have a family member or close friend who has been diagnosed, according to the American Cancer Society. And every year in the United States, 1.4 million more are told they have cancer.

Here's what they - and their friends and relatives - should know about receiving that diagnosis and reacting to it.

Don't panic

Easier said than done. "Cancer" is a scary, overwhelming word. But it's also a vague word. The doctor giving you the news is probably not a specialist and doesn't know the nuances, says Dr Michael Fisch, the interim chairman of the department of general oncology at the University of Texas M.D. Anderson Cancer Centre.

Do this:
Breathe deeply. Once you hear the diagnosis, you need to calm down. "You won't die in five hours," Knox says. "When you panic, you can't accomplish anything."

Take notes. Before you leave the office, tell the doctor to write down the exact diagnosis. Get a photocopy of the pathology report - it will help when you call for a specialist's appointment, and it will also help in your research. Write down the physician's phone numbers and email addresses. As the news sinks in, you will probably have more questions.

Go online. But focus narrowly on established sites. cancer.org.au: the Cancer Council Australia) and healthinsite.gov.au/topics/Cancer: the Australian government's HealthInsite) have unbiased, updated information to help you know what to expect.

Reach Out

Resist the impulse to visit a specialist immediately, unless you have pain. "Common tumors are not galloping away on people," Fisch says.

Do this:
Assemble a team. In addition to your primary-care physician, you'll want to find a local oncologist, even if you plan on traveling for treatment; a social worker (your doctor or hospital has names); and an organised friend to help you and act as a firewall.

Make sure your friend is rational. "You want someone who's grounded," Knox says. "As a cancer victim, you have the tendency to become hysterical. You want someone who'll let you be hysterical for a little while--and then talk about your plan." You may freak at unrelated symptoms. "Every ache and pain isn't cancer. You need to be reminded that you're just human," he adds.

Find a guide. Eventually you'll want to talk to someone who has been through your kind of cancer, preferably a person who has gone through support-group training. Your hospital or the support society for your condition can help. Cancer Council Connect is a one-to-one support program that puts you in touch with a carefully trained volunteer who has had a similar cancer and treatment. Visit the website or call the Cancer Council helpline (13 11 20) to get connected.

Release the news. In general, telling people soon is easiest. Yes, it may be hard to say the words out loud - and harder to watch the reactions of friends and family. As for children, kids as young as three will know something's up. Not telling them breeds fear and mistrust. The best place to begin when telling a child about a parent's diagnosis is by asking the child what he or she has already noticed, says Dr Paula Rauch, the director of a program at Massachusetts General Hospital Cancer Centre that helps parents.

Break the tension. "People don't want to say goodbye to a friend," Knox says. "I had to break the ice." He says that he'd just walk up and ask, "What's up? You're acting like I robbed your house." Then they'd talk.


Vet the specialists

Shiny credentials and a recommendation aren't enough, Fisch says.

Do this:
Ask around. First, ask your doctor. The cancer.org.au has advice on choosing a specialists and provides a specialist directory. "You should feel comfortable and confident with your specialist," says a Cancer Council support specialist. "If you don't, then ask your GP to refer you to another specialist or find one of your choice.

Gauge the doctor's commitment. Watch how locked in he or she is. You want to feel that the doc is focused. You should walk out knowing what's happening with a course of treatment or the choices, Fisch says.

Ask, ask, ask. Some basic questions: what is it? What proportion of patients are cured? What is my quality of life going to be? What are the alternatives? What can I do to help myself and you? Are there any late effects? (These are side effects that arise a year or so after treatment ends - cardiac trouble, liver problems, or second malignancies, for example.)

Listen. If any answer is, "Let me worry about that," that's a red flag. You need to understand the process, and you need someone who will work with you. "Without that, you're out of control," Knox says.

Assume nothing

Treatment isn't a straight line. Setbacks are common. And your doctor can't know everything about your condition at day one.

Do this:
Step back. At two months, sit down with your doctor and revisit expectations. Ask, "Are you satisfied with my progress?", "Are we still on track?" "Is there anything I should be doing?". "Some physicians aren't great communicators," says medical oncologist Dr Derek Raghavan says, in which case you may want to reconsider your choice of a primary-care doctor.

Keep a journal. Note highs and lows and major changes so you can tell your doc.

Don't shrug off symptoms. People on your medical team can help you manage fatigue, pain, nausea, and constipation - if they know about them, Rauch says. Feeling better can help you spend more quality time with children and loved ones.

Remain open

After six weeks, your disease isn't a novelty. Still, there will be shifts. "You can map out the first segment, but then you just keep your eyes open," Fisch says.

Do this:
Reclaim your life. Return to the things you've strayed from - friends, golf, the gym. "You become obsessed with what you have to do for the disease, and your everyday life disappears. You have to find that again," Knox says. "You need your health and happiness." It may be hard for you to believe in the early weeks, he adds, but this attitude shift will come.

Help your partner. "You go from being lovers to nurse-patient," Knox says. "You become incredibly needy, but you need to remember it's not all about you." Call a back-up to drive you to appointments and give your wife or girlfriend the day off.

Be firm with friends. If you're in no mood for visitors, acknowledge their concern but send them away - nicely. You have the right to be caringly assertive.

Don't judge. Some people will be there at the start and then fade. Others will pitch in after the crowd dies down. Accept this; shed resentment, Fisch says.

Deal with the impermanence. "After a while, the initial shock wears off. You'll think, 'It's two-and-a-half weeks and I'm still not dead'," Knox says. "But things come in waves. You can have an amazing day, then all of a sudden, it could flip. It could be the slightest thing - a guy eating a cheeseburger - that throws you." Ride out the emotions and then get back to life.

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