Cancer Patients have power!!!

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Patients are often quite scared when they find out they have cancer and they typically feel helpless against the disease.  This is a normal reaction and it would be fairly unusual if one did not experience these feelings.  Another common feeling and/or perception is that one must listen to the doctor at all times and that the oncologist is following the most up to date and the most effective cancer management strategy there is.  This type of feeling and complete trust in the clinical doctor who specializes in cancer patients is completely understandable.  For many cancer patients, the combination of fear and trust in our clinical providers means that they may not have the confidence to ask questions, challenge the doctor about the treatment he or she selects, and often not get a second opinion.  Let me share with you a little story about several women who dared to challenge the medical establishment and helped to change the way cancer of the breasts were treated….changed it forever.  These women dared to ask, dared to complain, and dared to stand up for themselves.  For you see, humans- including doctors are creatures of habit, are creatures of circumstances, and in some cases are creature of dominance (they he or she possess all the knowledge that they need to make a decision and don’t need your input).

Breast cancer has a very interesting history and let me share it with you.  Breast cancer was first documented thousands of years ago in drawing and some hieroglyphics found in scrolls that date back to the ancient Egyptians.  As early as 1500 BC it seems as if  the Egyptians at that time were able to remove surface tumors by surgery or deeper tumors by use of hot irons with a procedure known as cauterization (burning the tumor off).  It is not really known how successful they were, however it can be assumed that many patients died of infections as nothing was known of microbes and infections from dirty instruments.

During the next 1400 years or so, the dominant thought about cancer and other disease is that they were caused by natural disruption of the four humors.  The four humors consisted of blood, yellow bile, black bile, and phlegm.  Different disease were attributed to the disruption of flow of one of these four and for cancer it was thought that black bile abnormalities resulted in these diseases.  Meanwhile during the Egyptian times as well as during the time of Hippocrates also attributed diseases as being the result of punishments by the Gods, but Hippocrates gave diseases some physical attributes by assigning them to humors within the body.  Galen who had later entrenched the idea of accumulation of black bile being the primary cause of cancer, further suggested that cancer can and should not be treated…as black bile was everywhere and that removing part of it simply allowed more of it to move in.  This idea stayed with the medical practice for years….try and use drugs if you can, but avoid removing the tumor as black bile was in abundance.

Anyhow, to make a long story short….when anatomy became a more serious practice in 1533 with Andreas Vesalius and then later with Mathew Baille in 1793, it was quite apparent that this black bile was nowhere to be found.  This now opened the way for doctors to consider using surgery to remove tumors as a means to heal their patients.  However, as neither anesthesia nor antibiotics were available for some time later, surgery was not a pretty affair and most patients needn’t worry about dying from their cancer, they most likely would not survive the surgery due to infections.  However, in the mid 1800’s both the discovery of anesthesia and the germ theory (infectious germs could cause illness) did the practice of surgery get a boost.  Patients could now suffer a lot less and many would not die of the result of the procedure itself.  The almost 2000 year old idea of the four humors causing all major diseases finally began to have less and less followers until it was a dead idea altogether.

Now back to breast cancer.  Surgery works well for very surface tumors or tumors that are small and caught early.  But, even in the 1800’s it was known that some patients had cancer that was more advanced and that could not be simply removed by simple surgeries.  Breast cancer was one of those, many patients who were diagnosed with this cancer did well for only short periods of time after surgical removal of the tumor in the breast.  Many relapsed with the same cancer and this time it killed them.  A surgeon named Halstead became well known for his then revolutionary concept, that is as simple removal of the breast did not prevent breast cancer patients from getting the cancer again due to spread of the disease, he would remove the breast, some muscle, lymph nodes, part of the collar bone, and so one and so forth.  In fact, his idea was so popular that his students and many other surgeons had decided that they had been to kind to breast cancer patients in the past and they all went deeper and deeper into the chest cavity to remove as much as they could.  This form of cancer surgery was known as ‘radical mastectomy’.  In reality, as it was a demanding surgical procedure and it was also perceived by Hallstead as being more beneficial then cancer recurrence, it became the pride of the surgical community.  Finally, surgery and serious surgery indeed elevated the status of the surgeon of being the lifesaver, despite the fact that it was an extremely disfiguring procedure of the female patient.  Thus in 1907, he presented data to the medical community that looked great….but that in reality showed that many patients were still dying of recurring breast cancer after four years despite the radical surgery.  In fact, all that the surgeries were most likely doing is allowing patients with early stage breast cancer to live cancer free, but the ones with more advanced breast cancer would never be cured with this procedure as the cancer cells went into the blood and throughout the body.  However, this flawed procedure gave patients hope (however false), became entrenched in surgical theaters, and helped put surgeon in the forefront of medicine.  For reasons that are hard to know, Halstead’s radical surgery strategies were hugely popular amongst surgeons during the 50’s and 60’s.

There were some daring surgeons who used academic reasoning and looking into the data that realized radical surgery may not indeed be providing any real long-term benefit to patients compared to those getting simple mastectomies (much less complicated surgical procedures).  No formal proof actually existed that these radical surgeries were indeed better than other treatment.  In fact, the 50-60’s saw a huge explosion in chemical and radiation research that lead to the development of potential medical drugs/therapies that were now being tested in the clinic.  But, doing the right kind of clinical trial to actually test radical surgery to simple mastectomy in patients was almost impossible to do, because it needed participation of the very people who were very unlikely to want to participate…the surgeons themselves.

It took some surgeons who appealed to the patients themselves to start to make changes to the way that breast cancer was treated.  A few started urging women to say no to radical masectomies.  In fact, this was happening just as Jane Roe took the state of Texas to the supreme court to challenge the state for blocking her choice to have an abortion.  The woman’s movement was just starting to heat up in the US in early 1960-1. However, two female patients Betty Rollin and Rose Kushner started to write editorials in the newspaper and show up at medical conferences demanding to allow women to make their own choice concerning these extremely disfiguring surgeries for breast cancer.  The actually got women and men to start questioning the reliance on this extreme form of therapy and to started demanding to see the data that showed it was effective.

It took over ten years now that women were starting to realize that perhaps what the surgeons wanted and what they needed to beat breast cancer were not always congruent.  It took ten years for enough surgeons, patients, and hospitals to put together a proper controlled clinical trial to actually compare the benefits of radical surgery to simple surgery and to surgery with simple radiation therapy.  It turned out that despite the amount of work that the surgeon did to remove the breast tissue and all that he could around the breast tissue, that there was NO difference in the recurrence rate relapse or even death between any of the procedures.  Radical mastectomy was around for nearly 100 years and almost half a million women received that aggressive form of surgery when they easily could have received a much less disfiguring one.  Today, almost no racial surgeries are done for breast cancer.

Patients actually have a lot of power.  What many of us don’t have is knowledge.  However, it does not mean that the knowledge is not there.  We need to want to know!  We need to have confidence in ourselves.  It’s ok to be scared and have fear, but we can’t simply let them get in our way.  Challenge things you think don’t sound right, ask questions about things you don’t understand.  It’s your life!

Thanks…for more information on cancer please see Cancer Made Simple!

The cancer quiz (answers)

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Ok, in the last post I asked a series of questions about cancer and promised that I would answer them.  These were not very difficult questions and not really related to science per say.  So, here are the answers.

1. Is Cancer is a single disease.  True or False….FALSE it is a collection of close to 200 different diseases!

2. When a cure rate is achieved, does that mean 100% cure for the remainder of the life of the individual?  Yes or No. Answer: NO WAY. The rate is usually measured in five to ten year time frame.  Only a few cancer cures are 100% forever.

3. Is Surgery is the only real way to cure cancer….all other forms of therapy are not effective.  True or False  The answer is FALSE as radiation and/or chemotherapy and even alternative treatments can lead to cures (potential see above).

4. Do Solid tumors never enter the blood and blood tumors never become solid.  True or False.  The answer is again FALSE.  Solid tumors can and sometimes do enter the blood and blood tumors are known to become a solid tumor (e.g. many Lymphomas).

5. Do Diet and exercise play a role in controlling one’s chances of getting cancer?  True or False  The answer is YES they do. There is more and more data showing that both contribute strongly to cancer development if your diet is bad and you don’t get enough physical activity.

6. When scientist/doctors/healthcare professionals talk about cancer risk, the number they give you (e.g. chances of getting this or that particular cancer) is fairly fixed.  True or False  This is FALSE. Nothing about cancer risks are fixed.  These numbers are estimates made from looking at history and cases before you.  As more and more cases add up the numbers may change and even if they don’t change a risk is not fixed in stone.  It is more like a guideline!

7.  You should not rely on what your doctor says to you 100% without questioning.  Yes or No  The answer is YES! Your doctor is human and can make mistakes or just not know all the answers.  You should ALWAYS question things you don’t understand and remember, your doctor is not the only one who you should listen to…start with yourself!

8.  Clinical trials are designed to test agents using human patients and cost a huge amount of money.  True or False  The answer is TRUE as they are expensive and by definition must do done with humans as the subject matter.

9. Breast Cancer in women and Prostrate cancer in men are one of the most common cancers known.  True or False  This is true!

10. Cancer is curable.  Yes or No or Maybe , This is more of a trick question as no one really knows whether all cancers will one day be cured 10o% or not.  It is likely that more cancer will be cured to some extent but not all cancer to the entire extent! So the answer would be MAYBE.

Thanks and I hope this was fun!  Empower yourself, learn more, and build confidence in the subject of cancer!

Visit Cancer Made Simple for more solutions~!!

The Cancer Quiz

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How much do you know about cancer?  If you have kept up with my blog or have learned about cancer…the practical stuff, that is, then you will do well.  If you haven’t and find yourself not knowing the answer to these questions, then you might wish to learn more.  It is important to you and your loved one(s) lives.  So, here it goes:

1. Cancer is a single disease.  True or False

2. When a cure rate is achieved, does that mean 100% cure for the remainder of the life of the individual?  Yes or No

3. Surgery is the only real way to cure cancer….all other forms of therapy are not effective.  True or False

4. Solid tumors never enter the blood and blood tumors never become solid.  True or False

5. Diet and exercise play a role in controlling one’s chances of getting cancer. True or False

6. When scientist/doctors/healthcare professionals talk about cancer risk, the number they give you (e.g. chances of getting this or that particular cancer) is fairly fixed.  True or False

7.  You should not rely on what your doctor says to you 100% without questioning.  Yes or No

8.  Clinical trials are designed to test agents using human patients and cost a huge amount of money.  True or False

9. Breast Cancer in women and Prostrate cancer in men are one of the most common cancers known.  True or False

10. Cancer is curable.  Yes or No or Maybe

I will give the answers in the next blog.  Good luck and if you want to write down your choices for us to see, please do so in the comment section.

Thanks….Dr. C   Cancer Made Simple!

World cancer day

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84 million….now that’s a big number.  That is approximately the total number of deaths that will be claimed due to cancer from about 2005 to 2015.  The World Health Organization or WHO came up with that estimate, and you better believe that they did TONS of research before they came up with those numbers.  For you see, many countries including the US look at the WHO data to plan their health care policies including how much money to spend.  So, that number is large and you bet more and more countries will want to start setting aside money for both treatment and care relating to people with cancer.  Of the approximately 7.6 million people who died of cancer in 2005, 70% of them were from low to middle-income regions.  This means that cancer is not a rich man’s disease.  It also means that low to middle income countries are not doing so well a treating and/or preventing cancers in their countries.

So the WHO has made comprehensive goals and recommendations for their member countries to follow to achieve better anti-cancer results.  The broad areas include six major areas of focus; planning, early detection, prevention, diagnosis and treatment, palliative care, and policy and advocacy.  These are aimed at member states and not necessary at individuals.  This is what policy members should be looking at and then getting the message through to health care providers and individuals.

Cancer is really considered a chronic disease like diabetes for example and is not a one-off thing.  It is often a long-term sickness that can and needs to be managed carefully.  Successful treatment is sometimes expensive and may explain why poorer countries are not doing as well and richer ones in saving people from dying of cancer.  But, there are many other factors including perception and family values.  In some places, people with cancer are closed up and hidden, they are considered an embarrassment.  In other countries surgery and radiotherapy is considered too expensive for many. The WHO hopes to slowly change this.

So, even though Feb. 4th was World Cancer Day and most of us did not even know this….let us remember that cancer control starts with knowledge.  Read sites like this and others to empower yourself and understand what we are dealing with.  Protect yourself.  And stay healthy.

Thanks for reading….Dr. C

for more info please see … Cancer Made Simple

the new WHO directive about cancer

US 1988–2007 No Leisure-Time Physical Activity...

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Well the WHO (world health organization) has just come out with very strong recommendation to help one prevent cancer.  They recommend that one should exercise for at least 150 minutes a week in order to help reduce one’s chances of getting several of the main cancers.  In fact, their estimates (and yes, this is only an estimate) is that one can improve their chances by 25% in avoiding both breast and colon cancer by doing this much physical activity per week.  Another way of saying this is that if you do 150 minutes of exercise a week you may reduce your risk of getting some cancers by 25%. The exercise in question need not be intensive but can be moderate…e.g. a 30 minute brisk walk or jog five times a week.

This may alarm some people or may delight others.  150 minutes is a lot of time for many people. Indeed this is 2.5 hours per week.  Actually, let’s not kid ourselves here, some people (not all) really don’t have so much time in their day…with kids, school, and a host of other activities that take up their time.    Some people really don’t like to work out or exercise for that long if at all.  Some people live in cramped areas and in cities where finding a decent place to walk may be tough.  Anyhow, despite this….this is the recommendation and it is a very good idea for many reasons.

Let me tell you about some of these reasons.  It has always been know that inactivity leads to weakened immune system function and cold fighting ability in general (although this is hard to quantify exactly).  People who do not get much if any physical activity suffer from many ailments and in fact it is now known that physical inactivity is the fourth leading contributor to deaths worldwide.  This means that for of all the risk factors out there such as smoking, eating processed foods, etc., not getting enough exercise is the fourth worst one to have.  I am not sure what classifies as not enough activity, but those who sit around and watch TV all day and never go out (including children) are at high risk.  It turns out that this is so common that in in three people in developed world are at risk and may be classified as low physical activity folks.

Where did that number come from and how accurate is the information that went behind their recommendation? The short answer is I don’t know.  The longer answer is that a panel of experts were called together and they looked at all the published data out there and came up with this magic number of 150 minutes and the risks.  This does remind me of something else I have read and seen and that is that one should walk at least 10,000 steps per day to be healthy and to lead a healthy life.   This is one reason I personally went out and bought a pedometer, to see if I was achieving this.  Those of you who work in offices all day, you might be sadly disappointed to see how you might be well under that threshold of steps.  It is not easy to reach that number.

None of this is easy.  It is all about making sometimes difficult lifestyle  choices.  We have no problems tweeting, facebooking, and eating by the computer or TV.  We have no problems going for a beer in our cars, and eating unhealthy fried foods and watching movies in the theater.  But, do we also go jogging, running, hiking, walking, rock climbing, biking, doing yoga consistently?  Do we really make sure that we get enough exercise?  If the answer is no, then that should perhaps become a priority.  The movies can wait….facebook will still be there when you finish your jog.  However, physical inactivity can slowly (or quickly) rob you of your health and your life…and then facebook will not be there anymore for you.

Anyhow, for those of you who don’t get much physical activity…time to SERIOUSLY consider doing so.  Do you 150 hours minimum.  Go out and have fun.

Thanks for reading….Dr. C

For more information about cancer and to get more resources….please see Cancer Made Simple!