Health Series (For madical Students)

Treatment Choices

If a person is told that he has cancer, even if it is a small slow growing one, it may cause a lot of worry and stress. He may insist on having it removed. Or his doctor may urge him or recommend that it be removed or treated. The doctor may be overly cautious and might worry that he could be sued later if the cancer proves dangerous and kills the man. Or the doctor may need to pay some bills. You may not believe this but there are a few unethica1 doctors who don't hesitate to do operations that may not be absolutely necessary. An unnecessary prostatectomy or radiation performed on a small slow growing or indolent tumor may cause more damage to the person than the cancer. It is a major operation that can be quite traumatic and will have a serious impact on his quality of life.
If the doctor is not an expert at removing the prostate, it can leave the patient with urinary incontinence and sexual impotence. However, even if the person is impotent and cannot get an erection, he may still be able to have orgasms. (We will have more about this phase of the operation later.) Once a person has had a prostatectomy, it will affect his quality of life for the rest of his life. But if the operation is done properly and early enough, the person may live longer than a person who has never had cancer. The reason for a longer life is that the person may start taking better care of himself.
If the cancer is fairly small, at A or B stage and the biopsy shows a low Gleason grade, the doctor may recommend that the tumor just be closely watched and monitored. If there is any change in the PSA or the other prostate tests, then treatment can be instituted immediately.
If the person is over 75 years old, and the cancer seems to be growing fairly slow, the doctor may also recommend that it just be watched and closely monitored. If it appears that the patient has less than ten years to live, most doctors will not recommend a prostatectomy. Instead the patient may be given hormone therapy, cryosurgery or irradiation.
You should always remember though, no matter what the doctor recommends, it is your body, your disease and your choice of treatments. Of course, you should take into consideration that the doctor should know more than you do. But if you ask ten doctors what the best treatment would be, you would probably get ten different answers. You must endeavor to learn all you can, then make the decision. Later in this book, there are separate chapters on the major treatments that can help you make a decision.
In Greek mythology, Aphrodite, the goddess of beauty and love, sprang fully grown and mature at birth. Unlike Aphrodite, cancer starts from a single cell and grows. Your cancer is not going to kill you overnight. It may have taken 20 year to become significant enough to be detected. You have a bit of time to do your study. Don't let anyone rush you into a treatment that you may regret later.
The most important part of your decision is choosing the best doctor.

Cancer is not Contagious

Cancer may cause some people to avoid or shun a cancer victim or to be afraid of them. But cancer is not contagious. It cannot be transmitted to another person. Cancer is nothing more than a few of the body's own cells that have begun to multiply abnormally. Cancer can only derive from the cells in your body.

Cancer and Pain

Some cancers can be terribly painful, disabling and traumatic, not only to the person who has it, but to the whole family. If a close friend or relative is suffering, you may also suffer right along with them.
If the cancer is causing a lot of pain, there are several things that a doctor can do to alleviate the pain. Sometimes radiation will help. Sometimes it may be necessary to use morphine and other strong pain killers.
Often metastatic prostate cancer spreads to the bones and causes great pain. A radioactive isotope strontium 89 can often relieve the pain. Novantrone is fairly good at relieving pain caused by metastases.
There are some cancers that cause no pain or alarm at all until they have spread and metastasized. Since they cause no pain or alarm to the body, it is often difficult to find them before it is too late to properly treat them.

Some Cancer Signs

Here are some signs that should cause suspicion of cancer in men, women or children: Any increased skin pigmentation, a sore that does not heal, unusual bleeding, a thickening or a lump in the breast or anywhere in the body, indigestion or difficult in swallowing, rectal bleeding, a change in the bowel habits that persists, shortness of breath, fatigue, change in a wart or mole, bone pain, frequent urination, and decreased urinary stream. Older men who have to frequently get up at night (nocturia) and who have a small stream, should definitely get a checkup
Having one or more of these symptoms does not necessarily mean that you have cancer. Or you may have none of the above symptoms and still have cancer. It can be a silent killer. But it is very easy to have get checked out. We will say it again and again. If the cancer is found early enough, it can be cured. The answer to cancer is early detection.

Risk Factors

One other thing that should make you very cancer conscious is whether you have any close blood relatives that have had cancer of any kind. Statistics indicate that there is a hereditary and genetic factor involved in many cases. So be especially wary if there has been any kind of cancer history in your family. If you have a grandfather, father or brother who has had prostate cancer, then you share their oncogenes and you are at greater risk. You should make sure that you are checked at least once a year.

Cancer And You

There are several types of cancer and life threatening diseases that are preventable such as lung cancer in those who smoke, cirrhosis of the liver in alcoholics and AIDS in homosexuals. These diseases are often due to the person's lifestyle. It is their choice.
A recent study showed that one out of every eight heterosexual women will get cancer during their lifetime. The same study showed that one out of every three lesbians will get cancer. It is thought that the difference is due to the lesbian lifestyle. They usually drink, smoke and use more drugs than the heterosexual woman. In other words, they act a lot like some men.
It appears that prostate cancer may be caused by some sort of environmental factor and perhaps diet. A recent study done by Dr. Edward Giovannucci at Harvard Medical School seems indicate that fats from red meats are a contributing factor in prostate cancer. Animal fats are also highly suspect as a factor in breast cancer development.
In Japan clinical stage prostate cancer is very low. But if they come to the United States, their rate is about the same as for Caucasians. When autopsies are done on Japanese men in Japan they find about the same rate of undetected prostate cancer as that of American men. Because of the crowded conditions in Japan, they have very little land on which to grow cattle. Most meat is imported and is very expensive. So most families eat very little meat.
At this time we know of no sure way to prevent prostate cancer, breast cancer and several other cancers. Since there seems to be nothing we can do to prevent most cancers, we shouldn't feel guilty or depressed when we get it. We should only feel guilty if we do not take steps to detect it before it has a chance to spread.
We do know that there is one thing that does not cause prostate cancer. That is sex. Even overindulgence in sex acts of any kind or masturbation does not cause prostate cancer. This is one area where you can't get too much of a good thing.

Cancer Research

Animals and plants are also made up of cells very much like those of your body. You may not be surprised to learn that forms of cancer affects the cells of animals and plants in much the same way that humans are affected. Much of whet we have learned about cancer has been made possible because of studies using animals. Regretfully, a few animals have been sacrificed in these studies. But many people are alive today because of animal studies. All life is precious. The sacrifice of a few animals has taught us things that can help preserve and save lives. Even animal lives.
There are some fantastic advances being made in some types of cancer research, especially in the gene splicing field. But a lot more could be done if more money was spent on cancer research.
The Congressional Research Service of the Library of Congress submits reports of health and research spending to Congress annually.
Here is part of a report, dated March 9,1995. The report is titled AIDS and Other Diseases: Selected Federal Spending and Mortality Statistics. The report was submitted by Judith A. Johnson, Specialist in Life Sciences. (Figures cited are in millions).

	FY91 Actual	FY92 Actual	FY93 Actual	FY94 Actual	FY95 Est.	FY96 Req.
AIDS	$1888	$1960	$2077	$2566	$2702	$2901
Cancer	$1795	$2059	$2140	$2263	$2384	$2491
Heart disease	$ 696	$ 739	$ 759	$ 785	$ 809	$ 834
Diabetes	$ 278	$ 295	$ 303	$ 325	$ 338	$ 347

Causes of deaths 1991
AIDS	29,555
Cancer	514,657
Heart disease	720,862
Diabetes	48,951

The death statistics have gone up a bit since 1991, but proportionately, they are still the same. It doesn't seem fair that the AIDS people get so much more Federal money than any other group.
You can request your own copy of the Congressional Research Service Reports, but the CRS will not send them to you. You have to ask your Senator or Congressman for them. Call your Senator or Congressman at (202) 224­3121. Or write to your Senator at the Senate Office Building, Washington, D.C. 20510, or House Office Building, Washington, D.C. 20515.
Note how the money for AIDS has gone up each year so that now AIDS gets more money for research than any of the other diseases. About 50,000 people died from AIDS in 1996, over 550,000 died from all types of cancer and over 760,000 died from heart disease. This certainly proves one thing very clearly, it pays to be organized. Cancer and heart disease patients should adopt the same lobbying tactics used by the Gay Rights activists .

Cancer Affects Us All

There are very few people in this world who have not been affected by cancer, one way or another. Ask almost any one and they will tell you that a close relative or friend has had it. Or maybe they have had it themselves.
Cancer can be very expensive. It can easily devour a family's entire life savings in a very short time. This is one more good reason why the entire nation should have some sort of health insurance that covers catastrophic type illnesses.

Causes of death

Ordinarily cancer cells alone do not cause death. The body is a fantastic machine. It is also very adaptable and can survive and overcome unbelievable traumas and injuries.
I still have most of my textbooks that I used while studying Chiropractic. One of them is a fifth edition of Boyd's Textbook of Pathology, published in 1947 by Lea & Febiger, Philadelphia. The following is quoted from this book, page 14:
"... disease is not a state; it is rather a process ever changing in its manifestations, a process which may end in recovery or in death, which may be acute and fulminating in its manifestations, or which may represent the slow aging of the tissues brought about by the sharp tooth of time.... (a) lesion (may have) been present during many years of life, and its presence is not sufficient to explain the final end....the pathologist has to try to explain not only why the patient died but how he was able to live". As Boycott remarks (Lancet, 1933, 2 846 ) "I do not wonder that people die; that is easy enough. What I marvel at is that they go on riving with bodies so maimed, so disordered and worn out"".
One factor that makes prostate cancer so life threatening is that it affects mostly older men. The "sharp tooth" of time has dulled and weakened their normal body defenses. Thus they may be more susceptible, and less immune, to the many lesser infections and opportunistic diseases.
Unless the cancer destroys a vital organ such as the brain, lungs or heart, it does not directly kill the host. It can kill by cachexia (kakos is Greek for bad, hexis means condition). Cachexia is a state of ill health, malnutrition and wasting. Many cancer patients lose their appetite which causes malnutrition. We mentioned earlier that tumors are believed to produce factors that cause angiogenesis, or the development of new blood vessels. Some believe that the tumors also produce factors that cause cachexia.
When prostate and breast cancers metastasize, the cells often set up new colonies in the bones of the vertebrae. The bones may become eroded. The calcium from the eroded bones may be taken up by the blood stream. The body must have a certain amount of calcium. But if there is too much in the blood stream, it may cause hypercalcemia.
Hypercalcemia may cause a change in mental alertness, anorexia, nausea, vomiting, constipation, excessive thirst, frequent urination, muscle weakness and a diminished muscle reflex. Kidney failure is common. Hypercalcemia is very serious and is associated with a high mortality rate. Prostate cancer may also cause blood coagulation problems.