Hallmarks of cancer

English: Cancer cells photographed by camera a...

English: Cancer cells photographed by camera attached to microscope in time-lapse manner. (Photo credit: Wikipedia)

II was inspired to add another blog today after a friend/former colleague of mine came in to see me and mentioned he had been reading my blog (thanks Allan).  So, today I have decided to embark on describing the hallmarks of cancer as we now understand them (hopefully using simple words and concepts as some of this does get kinda’ murky).

In 2000, a well known cancer scientists named R. Weinberg and his colleague published a review of the major hallmarks of all cancer cells (and thus of cancer itself).  In that original publication, he described six hallmarks, that was an increase in the previously established two.  There are now about eight that are widely accepted.  So, let’s start with the original two.

We all have normal tissues and cells in our body and many of the cells turnover relatively frequently.  Cellular turnover refers tot he process of dying and dividing cells.  Thus, new cells are made from dividing older cells and other old cells die off.  As the new cells are made, some of them may acquire new mutations.  Some of the cells may also have old mutations or may even harbor mutations that were inherited.  If these mutations affect the survival of the cells than we call them oncogenes (#1 hallmark).  If these mutations prevent the killing (or what is known as apoptosis, or programmed cell death) then the cells don’t die when they are supposed to (the #2 hallmark of cancer).  We have known for many years that all cancer cells derive from cells that keep growing and that don’t die.

Later, we started to appreciate that there were some other characteristics that we could ascribe to all cancer cells in addition to these two.  Instead of needing to turn on and off growth signals like normal cells, cancer cells are self sufficient in growth signals.  That means that the signals that make the cells grow, don’t turn off.  As long as their is cellular energy, then the cells keeps going.  That is hallmark #3.  Another attribute that all cancer cells have is that they are actually insensitive to growth signals, this is in addition to the fact they they evade death signals.  So, the signals that they receive from death inducing agents are either ignored or fuel growth or expansion. That is the 4th hallmark.  Two additional changes occur that are universal to all cancers, but some early cancers may not progress o this state.  One of these is the promotion of sustained blood supply to the tumor and thus the cancer cell (supplying it with nutrients and oxygen, etc.).  This 5th hallmark is also known as angiogenisis.  Looking at cancers that have advanced it is clear that they have increased vascular supply than the surrounding tissues.  Finally, the 6th hallmark of cancer is that of tissue invasion.  Aggressive cancers and the cells that make them up typically run out of food supply and become more aggressive and seek out new areas of the body.  In order to do so they need to secret products that help them ‘digest’ their environment and all of the fibrotic material that accumulates.  This 6th hallmark of cancer is also referred to as metastasis.  The cancer is usually more aggressive and serious once it has moved onto and latches onto its new location.  It is also much harder to treat.

Two newly recognized and agreed upon processes occur in cancers as well (and thus the cells that make them up).  The 7th hallmark of cancer is the ability of the cancer cells to escape the immune response.  Normally, the immune response would look at mutated proteins (that are found in most cancer cells) and try to destroy them.  However, cancer cells evolve many unique ways to evade immune destruction and recognition.  Finally, the 8th hallmark of cancer cells is something called metabolic reprogramming.  This basically means that the metabolism of the cells itself no longer mirror what the normal cell has.  The genes, energy usage, and most metabolic processes have permanently changes into a more aggressive, energy hungry pro-growth state.

Thus, as you can see, cancer is not so simple.  The cells that make up the cancer have changed in so many ways.  This is partially why it is so hard to eliminate cancer once it has taken hold.  There are quite a number of pathways involved in all 8 of these processes.  Since the early 80’s we have really learned a lot about cancer; certainly we have learned how complicated they are.  We have developed drugs against every single one of these 8 hallmarks, but we have not been able to cure most cancers and permanently eliminate many tumors (especially of caught late).

Thank you for reading and i do hope that is made cancer a bit more easy to understand.
Do visit www.cancermadesimple.com for more information.

Dr. C


Vitamins that kill?

Ok…the title is a bit over the top I know, but new and some not so new evidence suggests that this supplement craze (most vitamins) that is ever so popular now may actually be damaging and not helpful. 

How so?  Well a number of studies have now linked the over consumption of vitamin A, C and E to the development of a number of cancers including lung cancer, bladder cancer, and prostrate cancer.  Statistical analysis also showed an increase risk in premature death is a cohort (a subset) of people such as post menopausal women.  

It seems as if the antioxidant observations in aging, first made in the 1950’s, with natural antioxidants found in fruits and vegetables has now grown into a multibillion dollar industry with man made vitamins in the form of pills.  It is now clear with more and more studies using correct scientific and clinical methodology, that ingesting large (or even moderate) amounts of these supplements not only do NOT prevent illness as prescribed, but result in increased mortality, increased risk of certain cancers, and in some cases increase risk for heart complication.  This is scary folks. This is dangerous folks.

So, what to do?  First and foremost, something that we all know but for some reason refuse to practice (many of us); eat healthy fruits and vegetables that provide you with all the vitamins, minerals, fibers, etc. that your body needs and in the correct natural form.  Avoid taking supplements unless instructed to do so by your doctor (e.g. a pregnant women taking folic acid is absolutely advisable).  Especially steer away from those vitamins which are in far excess of the recommended daily doses (e.g the USDA has recommended dosages).  Extra vitamins do not mean extra protection.  Furthermore, if you are a vegetarian or on a strict dietary regime (or do not eat fruits, vegetables, and nuts) than you might need to take some supplement (but look for those at lower doses).

  Remember, antioxidants can be found in many forms…coffee, teas, vitamins, fruits, vegetables.  However, we now know that oxidants are natural and helpful as well.  Our own body produced them to fight infection and kill microorganisms.  So, oxidants and antioxidants are both important.  Let’s not get carried away bu sales adds and such and buy buy buy, based on what marketing executives tell us.



Dr. C

The war on cancer: 3 challenges

Cell phone tower cleverly disguised to look li...

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This blog report is based on Dr. Mukherjee’s NY Times commentary made on July 16th.  To summarize his observations, cancer prevention faces an uphill battle due to three major forces; science, politics and society.

To explain this he brings up the highly contentious issue of cell phone usage and it’s link to cancer.  Scientifically, there is little proof that electromagnetic radiation that is emitted from active connections from cell phones lead to increased incidences in cancer.  The type of radiation that is emitted is so weak that it has never been shown in any experiments of any kind to damage DNA (a fundamental hallmark of cancer development).  However, an interphone study that was conducted that asked people to state their cell phone usage patients (low, medium or high) and then followed them for a period of time to look for cancer occurrence (brain cancer), found a link.  Other studies have since found that what people perceive as their phone usage is frequently very different from reality (that is of their actual usage).  So, this study is probably not very accurate.  Furthermore, it is easy to ask what the incidence of cancer was before the adoption of cell phone and after.  When one does that there is NO correlation at all to phone usage and cancer incidence.  However, this has not stopped the WHO to place cell phone usage in the ‘possible carcinogen’ category.  This may not be a mistake itself, but reminds us that despite science policy and warnings will still be made. 

Another issue that focused on politics was focused on formaldehyde.  This example is the exact polar opposite of the above one.  Here, it is well established that formaldehyde in the laboratory caused DNA damage that leads to cancer.  Furthermore, those who work in the formaldehyde industry do develop certain cancers at higher incidences (at least certain kinds of blood cancers).  These studies occurred over 30 years ago and only now did the National Toxicology Program only now issued a statement calling this chemical a carcinogen.  The large reason behind this was that science was finally placed before politics.  Lobbying efforts by companies who make the chemical have fought long and hard to stop any major governmental organizations from labelling this chemical as such.  They, of course would prefer if nothing negative is ever said about any of their many chemical/compounds/etc that make them billions of dollars.  I would bet my money on the fact that most if not all of the senior lobbyist and CEO’s of these chemical companies that make formaldehyde have not worked with the raw processing of this drug and certainly don’t suffer from the carcinogenic events (if they or their families did, I assume they might not put profits before safety). 

Finally, despite strong evidence from the 50’s onward, tobacco companies have been doing everything they possibly can to prevent any rules that are passed that might negatively impact sales.  Historic and unprecedented/massive lawsuits against the major tobacco companies did curtail the sales of cigarettes for some time but they seem to have been on the rise again.  Australia has just enacted some of the toughest laws on cigarette packaging in the world.  The US has just adopted some strict guidelines that require that graphic consequences of cigarette smoking be shown on the cartons despite huge resistance by the industry.  It has been shown that plain packaging and ‘gross imaging’ might just dissuade non smokers to avoid the habit causing agents.  The cost to health and healthcare is too great to ignore and the link of smoking to cancer is too great to ignore! 

This summarizes what was written.  Science should triumph over lobbying efforts to reveal truth to Americans (and to those living in all countries), politics should not be allowed to dominate over policies regulation safety, and social norms (such as smoking) should be kep in check by aggressive policies to assist people avoid bad habits. 

 Thanks….Dr. C Cancer Made Simple!

Cancer treatments: traditional or not?

Logo of the Natural Products Association.

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There seems to be a battle between those who passionately believe in traditional (evidence based) medical treatment and those who believe in non traditional (less evidence and sometimes no science-based) treatments.  Usually people are polarized one way or the other.  I would love to get a nice dialogue with folks who support one or the other and what the reasons are.  So let me start off by getting some of the terms spelled out and trying to categorize various types of treatments.

Pharmaceutical versus naturaceuticals:  The former is chemical based products designed and manufactured by pharmaceutical companies while the later is non-chemical based natural products (of course they can be chemical in principal, but not made synthetically) or extracts from natural products (such as seaweed, plants, oils, etc.). .

Traditional versus non-traditional (alternative medicine).  This is the western defined definition…traditional refers to surgery, radiation and chemotherapy while non traditional refers to things outside of this.  Traditional methods requires clinicians while non traditional may not.  Examples of non traditional treatment include vitamin C therapy, coffee enema, vegetable soups, etc.

Western versus Eastern medicine:  This usually refers to drugs and treatments designed to be used in modern health care and include drugs dispensed by trained cancer doctors while the later refers to things such as traditional chinese medicine, indian healing and traditional indian herbs, etc.  These might be dispensed by trained TCM practitioners but often given by parents and relatives of patients.  Some of these have many years of experience behind them but often have limited scientific studies behind them.

There are many other classes of treatment that do not have such nice and neat categories.  For example, I have a colleague who promotes holistic healing using energy (eg. from ones own self or from other sources).  Others believe that psychotherapy can help and some fo the techniques used include hypnosis.  Others belive that specific diets can starve cancer cells while normal cells grow well.  I have another colleague who calls himself Doc (not to be confused with Dr.) who uses a technique that analyzes hair samples and helps to identify (again using some interesting energy source) the cancer a person has but more importantly the source of the illness (e.g he belive that cancer is a result of other imbalances of the body).  He then embarks on a treatment plant (diet and natural products and alignment techniques) that corrects the underlying deficiency in the body that cures the patient.  There are many other types of proposed therapies and this only scratches the surface.  I would love to hear from you…the reader as to any treatments that you know about, swear works, or have suspicion about.

Let me finish by discussing some things that people tend to criticise about these types of therapies.  First of all major criticisms about modern therapies such as pharmaceutical based drugs and treatments include the following: 1) They are too expensive, 2) They don’t work- well they only target the cancer cell but not the underlying conditions that made the cancer grow in the first place, 3) They are not natural and thus inherently toxic, 4) Drug companies are in cahoots with Doctors and hospitals to milk the customer (the cancer patient) for as much money as possible so these companies can get larger and richer and 5) These companies spend so much on making these drugs (hundreds of millions) that many of these drugs can’t fail and the investment is too big and thus the claims for their effectiveness are exaggerated.  Common criticisms of other therapies include: 1) They are not tested well and have almost no scientific or clinical evidence for efficacy, 2) People who say they work base their assumptions on the one or two people who claim that they work but ignore the hundreds of people who they don’t know who had witnessed no recovery using these methods, 3) The few people who say these methods work could have gotten better for reasons we don’t know, 4) Some of the natural products that people take can actually be toxic in large amounts (especially for the liver or kidney), 5) Like pharmaceutical companies, companies that sell these so-called natural products for cancer treatment are also very biased, hide negative data, and try to sell inexpensive natural products at high prices to make a profit and have no real care for the patient. 

Despite how you feel there are likely to be real pros and cons for any type of treatments that you use if you have cancer.  No one is likely to be able to provide you with the miracle cure.  The comfort level and the background fo the patient is always going to play an important role and education can never hurt.  So, please do comment on this and let me know what you think!  Would love to see an active discussion going?  What do you favor or disfavor and why?  Can you challenge the status quo?  Do you have stories to share of how you may have changed your views about treatments?

Thanks for reading….. Dr. C

Cancer made Simple




A word on cancer therapies

...of course, this was prior to the actual zap...

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I thought I might go over a few concepts of cancer therapies for those of you who are interested but might not have the background to make sense of some of it.

Surgery: If surgery for the cancer can be done it will.  Surgery is often curative (long-term survival with the cancer or with the complete absence of the cancer).  Surgery refers to the complete removal of the tumor and it is usually performed when the cancer is well-defined (like a solid tumor) and works well with cancers that are caught early. Some cancers are small but located in areas that the surgeon may not have access to (like parts of the brain stem, parts of the spinal column, or even near some major arteries, etc.).  If the surgery might end up killing the patients, then it is not performed.  If the patient is very old or has heart conditions, the surgery for cancer removal might not be performed as well.

Radiation therapy:  high energy frequencies that are directed at the cancer with hopes of ‘burning it off’ and causing the tumor and surrounding tissue to die.  Better and better forms of radiation therapy are available in some centers that allow for more accurate focusing on the beam of energy to the tumor and not the healthy tissue.  Not all cancers are radio-sensitive.  Radiation has several side effects and too much radiation damage can also lead to cancer down the road….so killing one cancer but inducing another is not a good idea.  Sometimes the addition of radiation therapy to surgery can help kill off any remaining cells that were not removed during the operation.  Many times radiation is not a one time deal, but must be performed numerous times and the patient must come back to the hospital for all the cycles.

Chemotherapy:  There are many kinds.  In essence, they are drugs that kill cells that rapidly divide.  Cancer cells rapidly divide and thus are usually very sensitive to this form of therapy.  Many types of chemotherapies are used against many types of cancers including solid and liquid cancers (or blood cancers).  These types of agents can kill cells directly, poison them so they can’t make DNA, stop them from cycling (a terms used to describe the process of cell division), starve them from nutrients, or prevent their DNA repair machinery from working, etc.  These agents have a lot of side effects as they almost always target other cells that divide in your body in addition to the cancer cells.  For example, they target hair follicles (and the hair will fall out) or they hit the cells lining the gut which turn over quickly and cause patients to vomit severely sometimes.  Some patients can be on several of these drugs at a time and often they are combined with surgery and/or radiation therapy.  These are not fun to take, but in some cases they do help to reduce the cancer to a very small size and allow patients to live longer.  However, many people who get treatment with chemotherapy do see their cancers come back after some time and thus it is not curative in most cases.

Transplantation:  One can have the entire organ transplanted if it has cancer or one can get a type of blood transplant know as a hematopoetic cell transplant.   In the latter case, the patients own bone marrow is killed off using drugs and radiation and then a new bone marrow from another person is given to them.  It is a horrific procedure that used to kill many patients and sometimes still does.  However, it can be curative and the patient can live cancer free for the rest of his/her life in some cases.  There are a lot of complicated things that the doctor must do before performing this kind of procedure and the younger the patient is the better.  For some childhood blood cancer, this procedure has been short of a miracle.  It is best used when cancer of the immune system are detected.  This procedure can cost hundreds of thousands of dollars in some countries and is very dangerous.

Immunotherapy: This is a newer type of therapy and refers to any product of the immune system that is given to patient to help them fight off their cancer.  For example, a potentially curative form of this therapy works for a type of skin cancer and renal cell carcinoma.  The drug is IL-2 a cytokine or protein mediator that helps activate T cells and these cells then look for and kill the cancer.  However, only 10-15% of patients respond to this drug well and most patients do not and subsequently die of their disease.  High-dose IL-2 therapy is also very toxic.  Another form of this therapy is being used now (just recently developed) on advanced skin cancer and uses another immune molecule called CTLA-4.  Blocking this protein seems to enhance T cells to kill the patients own cancer cells.  Again, this only works well in a small fraction of people with this type of skin cancer.  Many other forms of this therapy are being tested now and it is hoped that this is one way that some cancers may be cured in the future, but honestly we are quite far from that at the moment.  These drugs cost a huge amount and are not very well tolerated by many patients (too many side effects).  They also try to use the patients of immune system and thus can cause other damage in many cases.

Targeted or Individualized therapy:  This is a large and new area of development in the anti-cancer arena.  Here patient as well as cancer specific molecules are attacked by certain drugs that recognize them.  The most well-known example of this is a drug called Gleevec(Tm) that is used for the treatment of a blood cancer called CML.  It targets a very specific cancer protein that only affects the CML cancer cell.  The drug basically poisons this cancer protein and kills the cancer cell.  It needs to be taken for life and can be very expensive.  The other problem is that about 15% of all patients develop resistance to the drug (or rather the cancer cell changes before it is all killed and starts to make a protein that does not bind the drug). A very new example is used with some success against advanced skin cancer to target a very common mutation in a protein that is essential for the cancer cell to grow.  So a drug is used to bind to that very specific mutation (50% of all patients with advanced skin cancers have this mutation present) can block this survival factor for the cancer cell and it is then killed.  Many new proteins are being targeted such as those that cancer cells use to get blood supply, allow the cancer to move to different areas in the body, and so on.  In all the cases, these drugs are aimed at blocking these things that the cancer cell need to survive.  In many cases, these are unique to the cancer cells and not to the normal cells in the body.

Unique category:  The last type of therapy I wish to discuss is a rare but successful type of anti cancer drug known as a vaccine immunization type.  For bladder cancer there is a drug that is injected into the area of the bladder…the drug is actually the same thing that is used to vaccinate children and some adults for tuberculosis: BCG.  Intrathecal BCG (or intravesical) works very well in about 50-60% of patients with early stage bladder cancer. It works by stimulating the immune response against the cancer, but besides that we do not know much about the mechanism.  It is one of the most successful drug therapies used today for cancer….but no one really understands it and it does not seem to work well against other cancers.

There are other examples, but the most common ones have been mentioned.  I hope you have found this information useful.  I kept it general and vague intentionally.  I know that some of you may be looking for more specific information and want more detail.  Do ask me if you want more information or do check out some of the additional resources that I have one my web page.

Thanks D C – Cancer Made Simple

Red meat….love it or leave it?

A large tray of meat

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For red meat lovers out there…this is definitely not your day.  The now more definitive report that links red meat to certain cancers is fairly strong and may spell ‘well-done’ to those of you who love to see your steaks moving before they are cooked.  Probably nothing is going to make you give up red meat but perhaps reading this blog and the new report from the World Cancer Research fund will inspire you to consider reducing your red meat intake.

Here is the scoop on red meat and bowel cancer.  It turns out that the evidence (although still pretty associative) is fairly overwhelming; that red meats such as pork, beef, or lamb in addition to ham and salami are quite harmful when looking at the risk of bowel related cancers.  UK scientist as well as groups from other countries have looked at over 24 independent papers in addition to 260 plus general papers on diet, excercise and lifestyles and their impact on cancer.  The overall data when just looking at the red meat portion of those studies is that, substantial data now more accurately links red meat consumption to increased risk in bowel related cancer.  This means that each study itself may not be significant, but after 2007 where the controversial findings were reported, enough additional material continues to support the hypothesis.  Thus, enough papers exist now that really make this red meat-cancer danger hypothesis more likely to be true.

It is actually not all bad news, as the cancer group recommended that one can eat red meats but that he/she should reduce that consumption to no more than 70g/day on average.  This is a reasonable amount for most of us as it equals to about 2 regular burgers or one lamb chop.  However, those who eat red meats twice a day would need to consider cutting down substantially.  In addition to reducing the red meat intake and eliminating processed meats such as salami and processed ham, the reduction in bowel cancer is seen better with those who take increased amounts of fiber with their meals.  So, to make things better one could reduce the meat component of their meal and replace it with a higher fiber substitute such as whole wheat, fruits or even vegetables.  The estimates are that out of the 36K people who develop bowel cancer in the UK a year, about half of them could be cancer free if they were able to adhere to these recommendations.

Again, this is not proof that says…”hey red meat causes cancer.”  But, it goes along way in saying, hey “if you eat large amounts of processed meats and red meats every week, you will increase your risk in developing bowel cancer.”  Again, as I have mentioned time and time again, the doctors can try to help you once you get cancer (surgery if possible, radiation or chemotherapy), but you too, have a role to play in your own health.  The reduction of red meats in your life is certainly not impossible.  It is a lifestyle choice.

ps.s the cancer we most talk about when we say bowel cancer is colon or rectal  cancer or colorectal cancer.

Thank you for reading: Dr. C

Cancer made simple

Cancer info…watch what you read!

"seeds" used for brachytherapy of pr...

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Hello again.  Today I want to mention a few things about information that you will encounter on weekly basis in news, blogs, TV and such.

The first piece of advice (coming from a long time cancer researcher) is to simply be careful with the information you read.  Unless you are trained in the area of cancer, or statistics, or sometimes even psychology; it if often very hard to tell if the authors are being truthful or not.  Even if they are for real, it is very difficult to tell if the conclusions they make from their statements are true.  For example, people who love to drink coffee will look at the recent studies which show a positive impact on coffee drinking and prostate cancer and they will state that the studies now prove that all men should drink lots of coffee to avoid prostate cancer. If you don’t read the original information (and how many of us go back tot he original source these days)  and rely simply on the one blog you read, you may miss out on the fact that this study is an association study.  That means that there is no proof at all, only a link between those who drank lots of coffee or ten to twenty years and the risk of one kind of cancer.  You wont know that for women and breast cancer the studies are not the same as for men and prostate cancer.  So, read lots of stuff and stay informed, but read things carefully and with a grain of salt.

As you start to read more and more you will find that you can spot more and more errors or exaggerations more easily.  It comes only after you have started to see themes repeated over and over.  Then and only then can you start to pick up on how some folks will mold the truth around something they feel strongly in and hide certain details that will detract from their biases.  We all have biases one way or the other and that is OK, but the reader must understand this and should over time read things (about cancer in this case) from people on both sides of the same issue if possible.

What kind of blogs and information web sites are there and which ones should you be more careful about.

1.  The information only website.  The NIH and other cancer information promoting websites are usually going to be pretty good and trustworthy.  These wont bias you so much in one way or the other, but they will usually steer you away from alternative forms of therapy or avoid other issues that have less scientific validity.  There is nothing wrong with that and you just need to go see other websites if you want to learn more about those other area.  Many of these (like mine at Cancer Made Simple) will have trained scientists on their staff.

2.  Blog from people who had or have cancer.  These are a great source of information from people who have been there and done that.  These can be very fun to read and full of interesting information.  They are very useful for people who have the same or similar type of cancer that the blogger had or taking care of someone with that condition.  They, however can be subject to a lot of bias and it all depends on the prior experiences and disposition of the blogger him or herself.  Either way, they make great reading and tend to be less scientific but more day-to-day experiential.

3.  Blog or websites from retailers- be most careful with these (even with large companies).  Larger companies that have drugs or agents that are FDA approved and based on years of very good clinical data are of course more trustworthy that those who don’t have that.  However, companies are very VERY good and making their data look good and have huge budgets for marketing their products (of course legally) but often can mislead us.  However , the biggest problem out there lies in these very small companies or have no or little direct clinical data on cancer treatment, but who still try to sell you an anti-cancer therapy, drug, or agent anyway.  There are so many of those out there.  If the agent is perfectly safe, pure and clean, non toxic, and not too expensive, then it might not be a problem even if it is not effective.  If the product, is harmful (e.g. they ask you to take too much and it damages your liver), has undeclared chemical gents inside (e.g. melamine in milk from China), is very expensive for sugar-water, or is 100% useless (has no value at all), then it should not be consumed.  However, you won’t be able to tell so much.  You will know if they have done the proper studies and they will tell you and most of all show you by directing you to the published data.  Most don’t have it and never will.  Much out there is pure crap.  So, read these sites as they will talk about cancer and push you towards buying their products.  But, their information will be very biased….so use caution.

TV can also be highly misleading so ignore as many of the adds as possible as marketing is always greater than truth.  The news is a great source of information but when the anchorman or woman makes judgement about cancer related information- ignore these.  They have no clue and are just adding their own two cents and can often be way off the mark.

There are many other kinds of websites and blogs relating to cancer.  So read and learn as much as you can!  Just use caution.

Thank you….Dr C  Cancer Made Simple