Cancers - a sense of proportion

[Arthur Little]

Within the past year, research was published suggesting that 2/3 adult cancers were down to " bad luck " rather than genes. Now there’s a new study suggesting at least 2/3 are in fact due to environmental factors such as smoking. Both are from USA, each is in a " respectable " journal - and widely reported in the media.


No wonder the public are confused, and perhaps justifiably cynical .


We know that the many different types of cancer result from " stem cells " dividing out of control ( rather than " mature " cells becoming immature ). The argument has been about intrinsic factors - risk of mutations every time a cell divides - versus extrinsic factors, like smoking, alcohol excess, diet, sun exposure.


The two factors ARE related. Mutations every time cells divide are more likely to result in cancer if there are also external influences, like cancer-forming substances from smoking.


A " sense of proportion " is still needed ! All these apparently conflicting studies suggest is that a greater number of cancers than previously thought may be down to " lifestyle factors ". They may therefore be preventable. There’s still an element of luck - we all know of smokers who have lived to 100.


None of this affects my specialty of cancer diagnosis and treatment. I never judge lifestyle - whether by choice or necessity. But this latest study should - in my opinion - at least make people think about how they might improve their chances of a healthy and happy future in the New Year .

ANOTHER excellent post, Alan ... and may I CONGRATULATE you on attaining your third Silver Star!

[Doc Alan]

Thank you so much for your kind response Arthur

[mickcant]

... AGAIN well done, Mick ^ ... keep "at" it, and you definitely will reach *that

Thank you Arthur, at slimming club last night I had lost another 2lb, I do not feel deprived by my new diet and will let nature take me to whatever weight, within reason.
Thanks again, happy crimbo all,
Mick.

[Doc Alan]

Well done indeed Mick !


We all know the benefits - including decreased risk of some cancers - of losing excess weight ... and how difficult it can be to do so. The commonest New Year resolution is to lose weight. Encouragement would seem better than threats to achieve this goal .

[Doc Alan]

This week's " Lancet " medical journal has an editorial on lung cancer, concluding that " despite advances, prevention is still best ".


It's the commonest cancer in the world, 1.8 million people being diagnosed each year. While overall less than a tenth of patients survive 5 years, the outlook for each individual depends on various factors. Most important is stage at diagnosis ( size, and how far it has spread ). The 10-15 % of cancers occurring in non-smokers have a better outlook ; treatment also varies according to type ( 80% " non-small cell " cancer ; 20% " small cell " cancer ).


There are many types of cancers, possibly every patient being unique, with far more being treatable or curable than in the past. It may be unhelpful to talk about " the big C " or " the battle against cancer " when the outlook for so many is improved.


Even with lung cancers, there is hope.


Early detection would obviously help when so many present at an advanced stage. Screening of " high risk " populations ( current or former smokers ) by CT scans is recommended in the USA, although not yet in Europe.


If lung cancer is detected at an early stage, surgery is the main hope. If it’s not possible to remove the cancer ( often the case with " small cell cancer " ), radiotherapy and chemotherapy offer the best chance.


1. " Targeted " treatment for patients with genetic changes ( mutations, chromosome rearrangements ) DO improve the outlook in a small proportion of patients. Unfortunately the cancers may become resistant to these drugs.


2. Another hope is for immunotherapy, perhaps combined with 1.


3. Over two years ago, Miriam Defensor Santiago ( a non smoker ) announced she had " Stage 4 " ( advanced ) lung cancer, apparently involving left lung but not other parts of the body. She appears to have had a type of " biological therapy ", blocking growth of cancer cells. She has survived, although was recently admitted to Makati Medical Center.


One of the problems with these types of treatment is the high cost.


Despite advances in TREATMENT of cancers originating in lung, MOST are preventable. In the UK, about a fifth of adults still smoke ( 22% males / 17% females ). In the Philippines, a quarter of adults smoke ( 45% males / 8% females ).


It’s unlikely tobacco products could be banned completely when so many people still wish to smoke ( or at least can’t give up ). Illicit cigarette smuggling and forgeries would take the place of taxed products. BANNING advertising and display of products for sale, branded cigarettes, and smoking in public places; with " VAPING " ( e-cigarettes ), may all help. Surely everyone nowadays knows the dangers of smoking ! Other forms of air pollution - such as from traffic - also cause significant lung diseases including cancers, and need tackling more effectively in future.


The first duty of doctors is to make people better - and, in my case, provide an accurate diagnosis. They should not be judgemental. Screening and prevention of illness in apparently healthy people is a secondary role. On this public Forum I hope to simply inform members whom I don’t know personally.

[Steve.r]

Thank you Alan.

[grahamw48]

Thanks Alan.

I had always assumed that everyone died (fairly quickly) from lung cancer.

Thank goodness it is now 25 months since I last smoked a cigarette.

I have no intention whatsoever of starting again.

[SimonH]

Not sure how I missed this thread, but I'd just like to add my thanks to Alan for taking the time and effort to post

[Terpe]

Alan, I may not respond to every posting, but believe me I do read them.
Like Simon, I'm so appreciative of your posts. They're not just highly informative but also totally objective and up-to-date.

I said it before and I'll say it again, this forum is head and shoulders above others thanks in a large part to your postings on health issues.
We are very lucky. I do hope you will continue.

Additionally, having met you in person, I can say you're a really nice bloke too.

I'll add that all the forum members I personally met on our memorable Scarborough get-together are also number one folks.
You all know who you are.

One of these days I reckon we'll be having a forum members meet-up here in Philippines. That'll be a special time.

Anyway, just to return to the subject of health and smoking. I can say I finally gave up December 31st 2010 and have never touched a single cigarette since.
I felt so much better even after a couple of weeks.

Anyone out there still smoking with a idea to quit should set a date and follow it through to the end. Everything to win and nothing to lose.
Just do it!!!!

Thanks again Allan. I count myself lucky to be on the same forum, to have met you and to know you.

[Doc Alan]

Thank you Steve.r, Graham, and Simon for your responses .


Peter ( Terpe to those who don’t know him ), thank you also for your kind comments.


It’s hard NOT to be judgemental, but I try. My Dad, a GP, died in his late 70s after 20 years of indifferent health due to smoking. He started the habit long before the ill effects were realised. Good luck to Graham, Peter, and all other members who may now be ex-smokers .


Peter’s words reminded me of that epic get-together in Scarborough, which could be hard to repeat as we’re not all living in the UK now.


There’s no question that meeting in person cements friendships, and you really know people so much better " for real ". If only more members could do that, but I know how difficult it is to arrange.


However, Peter’s suggestion of a Forum members’ meet up in the Philippines sounds great. Who could possibly arrange it ?


Members will have a break from my posts soon, as I will be visiting my daughter in Switzerland. Of course I’m looking forward to that trip, and happy to have received such a ringing endorsement of my Forum contributions before I travel .

[Michael Parnham]

Appreciated Alan, keep them coming

[grahamw48]

Philippines meet sounds great for me.

The beer is cheaper !

[Rosie1958]

Some excellent posts, well done everyone and especially to Doc Alan

[Michael Parnham]

Some excellent posts, well done everyone and especially to Doc Alan

Nice to see you again Rosie

[Harry T]

Thank you for your posts Doc Alan, you are a very valuable member on this forum, and like others have said whilst i may not comment (I dont want to look stupid) i do read them. I have previously had two bouts of Bladder Cancer but even so, I have to admit i am a smoker who finds it so difficult to stop so Iv been toying with the idea of trying to stop again.. so Im starting a Topic on the subject..

[Doc Alan]

ANY cell in the body can form a cancer as long as it can divide. Genetic changes can be inherited or acquired. While all copies of cells should be the same, " mistakes " or mutations may occur, especially with increasing age. Most of these mutations are corrected by DNA repair.


However, with some genes, uncorrected repair eventually results in purposeless cell division or cancer. If the cancer spreads to other parts of the body, the cells continue to divide and new mutations appear.


Understandably for a disease which kills ~9 million people worldwide in a year, second only to heart disease, there is hope that " one day cancer will be cured ". Three quarters of such deaths occur in low- and middle- income countries such as the Philippines.


First, the good news . Many cancers ARE now highly treatable, with either long term survival or complete cure. People in whom cancers are diagnosed early, either by screening or when they have symptoms, generally have a better chance of successful treatment. Surgery, radiotherapy and anti-cancer drugs ( chemotherapy ) are now better focused to treat with minimum damage to normal tissues.


There are ~200 different main cancer types , and many more subtypes. Every patient has a cancer with a unique genetic profile, which changes with time. It’s therefore highly unlikely that ONE cure could be found regardless of cancer type, or stage ( how far advanced it is ).


We now realise that the molecular features of a cancer, such as its genetic traits, are more important than where it started growing ( such as lung, breast or bowel ).



This is the era of " precision medicine " whereby molecular testing of a cancer biopsy ( sample ) may find mutations which could be matched with drugs designed to tackle that type of cancer. If the cancer has spread, further biopsies could be impractical, but it IS possible to find cancer DNA in blood samples. A stage further is " personalised medicine ", whereby a patient’s own cells are " re-engineered " to attack their cancer.


Cancers MAY also have mutations which are common to those starting in different sites of the body. There are already drugs which target ALL cancers having a particular mutation, and/or stimulate the patient's immune system.


The bad news is that such newer forms of treatment are very expensive, and cancer cells constantly mutate to develop drug resistance ( just like bacteria and antibiotics ).


Not all cancers can be prevented, although lifestyle changes could reduce their numbers. Ideally any treatment should be proven to work with good evidence, and affordable - whether paid for directly, through insurance / taxation, or donation / charity.


We DO have better hope than ever before that cancers will become either curable - or at least chronic, allowing many years of survival .