Cancers - a sense of proportion

[Doc Alan]

Cancers cause over 8 million deaths annually worldwide, second only to cardiovascular disease. The good fortune of living longer brings with it an increased risk ; in the UK 2/5 people may develop a cancer ; 2/5 cancers are thought to be avoidable ; around half survive 10 years or are cured.


• There are at least 200 different types ( each with subtypes ), so one " cure for cancer " is impossible ! We are told frequently that " immunotherapy " – strengthening our natural immune defences - is the " new weapon " in cancer treatment ; along with " targeted therapy " for the genetic abnormalities in each cancer type. Chemotherapy with drugs that kill rapidly dividing cells ; radiotherapy ; and surgery WILL continue to be important, and relatively cheaper, however.



• " Breakthroughs " and " ground-breaking discoveries " in cancer treatment may give hope to more cancer sufferers in the future, but it’s being realised that such treatments would come at enormous cost ; they don’t work for all patients ; and we know neither the side effects, nor the actual length of survival which may be possible.


• Prevention is better than cure ! Most of us are aware of the main risk factors ( smoking ; poor diet and obesity ; alcohol excess ; environmental pollution ; radiation ; infections ; occupations ; and " bad luck " chance mutations increasing with age ).



• Early detection and screening have advantages also - but it’s not so well known that screening especially has its disadvantages ( treating cancers which may never have caused illness during an individual’s lifetime ).



• What may not always be realized is that – while cancers are increasing worldwide – the frequency and outlook for cancer types VARIES in different countries. Part of this is explained by " Human Development Index " / HDI. This takes account of life expectancy, educational attainment, and income. In low HDI countries communicable diseases and nutritional disorders are still relatively more important. The outlook for cancers which occur in low HDI countries is worse than those in high HDI countries.



• Commonest cancers in the world are :-

1. Breast
2. Trachea, bronchus, lung
3. Large bowel
4. Prostate
5. Stomach
6. Liver
7. Cervix
8. Non-Hodgkin’s lymphoma ( lymph nodes )
9. Oesophagus ( gullet )
10. Leukaemia


• Cancers causing most deaths in the world are :-

1. Trachea, bronchus, lung
2. Stomach
3. Liver
4. Large bowel
5. Breast
6. Oesophagus ( gullet )
7. Pancreas
8. Prostate
9. Leukaemia
10. Cervix


• In UK, commonest cancers are :-

1. Prostate
2. Large bowel
3. Trachea, bronchus, lung
4. Breast
5. Bladder
6. Non-Hodgkin’s lymphoma ( lymph nodes )
7. Stomach
8. Malignant skin melanoma
9. Pancreas
10. Kidney


• Cancers causing most deaths in UK ( very high HDI country ; non-communicable diseases cause 9/10 deaths ) are :-

1. Trachea, bronchus, lung
2. Large bowel
3. Breast
4. Prostate
5. Pancreas
6. Oesophagus ( gullet )
7. Stomach
8. Non-Hodgkin’s lymphoma ( lymph nodes )
9. Ovary
10. Leukaemia


• In Philippines, commonest cancers are :-

1. Breast
2. Trachea, bronchus, lung
3. Prostate
4. Large bowel
5. Cervix
6. Leukaemia
7. Liver
8. Thyroid
9. Uterus
10. Lip and mouth


• Cancers causing most deaths in the Philippines ( medium HDI country ; non-communicable diseases cause 2/3 deaths ) are :-

1. Trachea, bronchus, lung
2. Liver
3. Breast
4. Large bowel
5. Leukaemia
6. Stomach
7. Cervix
8. Pancreas
9. Ovary
10. Non-Hodgkin’s lymphoma ( lymph nodes )


• Frequencies vary both in type and severity between the UK, Philippines, and elsewhere in the world. This is due, as well as HDI, to different causal factors ( infections such as hepatitis B, and smoking commoner in Philippines ; obesity and alcohol abuse commoner in the UK ) ; awareness ; screening ; early diagnosis ; and treatment.



• Most Filipinos still seek medical advice only when they have symptoms and are at more advanced stages than in UK. This is due, not just to lack of knowledge, but of course mainly full knowledge and fear that they can’t afford treatment.



• News of immunotherapy for advanced cancers such as melanoma ( relatively uncommon ) or lung ( common ) - which may cost £ 100,000 for each patient - needs to be put in perspective ! Most of these cancers can be prevented in the first place by sun screens and not smoking. There’s much that can be done – relatively cheaply – to reduce the numbers and improve the outlook of cancers. The best way to maintain natural immune defences is through a healthy lifestyle.



http://oncology.jamanetwork.com/arti...icleid=2294966

[mickcant]

Very interesting to read Doc, will have to read this a few times to try and take it in.

At least I have somehow got to nearly 71 with no major illnesses and have had 7 years of retirement and hopefully a few more to come.
Mick.

[Dedworth]

A good write up Doc like Mick I will re-read - interesting bit about :-

( treating cancers which may never have caused illness during an individual’s lifetime ).

[Michael Parnham]

Great read Alan, very educational on the awareness and how it affects different parts of the world, thank you!

[cheekee]

Very interesting read.

Thank you

[imagine]

a good read and interesting read as always from you

thanks Doc

[Arthur Little]

Interesting article ... as we've become accustomed to from a highly~qualified specialist of your calibre, Alan.

Yesterday, I was a pall bearer at the burial of a cousin of mine's husband in South Queensferry. Aged 72, it turned out he'd been diagnosed with cancer of the *appendix less than a month ago.

Tbh ... ... that rather took me by surprise - if not, shock - since, despite being long aware that the disease can affect virtually ALL parts of the body, this was the first occasion I'd heard of its [specific] presence in *that short, closed tube attached to the small intestine and, believed, by many to be a superfluous organ, serving
no useful purpose. Hence, I suppose, its name ... appendix ... or just tagged on!

[Doc Alan]

Thank you Mick, Dedworth, Michael, Philip, Stewart and Arthur for your interest .

I appreciate it’s not an easy topic to understand – although the simplest definition " purposeless proliferation of cells " has stood the passage of time. The link I gave from " JAMA Oncology " seems to have the best estimates comparing worldwide frequencies of cancers. Only by knowing these can each country focus precious resources on diagnosis and treatment of the locally commonest and most serious types.


I’m sorry to read of your cousin’s husband, Arthur. Indeed the appendix is an unusual site of various cancer types, most of which are " low grade " ( not serious ) and may be discovered by the pathologist after an appendix has been removed by a surgeon for symptoms in keeping with appendicitis.

Of course acute appendicitis is common in the UK ( and also in the Philippines ), usually treated by surgical removal ( before it perforates and causes peritonitis ). Although it may occur in older age groups such as your cousin’s husband, it’s here that the possibility of a serious underlying cancer becomes less unlikely.

[Arthur Little]

I’m sorry to read of your cousin’s husband, Arthur. Indeed the appendix is an unusual site of various cancer types, most of which are " low grade " ( not serious ) and may be discovered by the pathologist after an appendix has been removed by a surgeon for symptoms in keeping with appendicitis.

Of course acute appendicitis is common in the UK ( and also in the Philippines ), usually treated by surgical removal ( before it perforates and causes peritonitis ). Although it may occur in older age groups such as your cousin’s husband, it’s here that the possibility of a serious underlying cancer becomes less unlikely.

Thank you so much for your kind expression of sympathy, Alan ... and, not least, for your informative explanation as to how cancer can, in fact (as in my cousin's husband's case) sometimes lurk in the body part mentioned - even mimicking the symptoms of appendicitis - without actually being detected until after the organ has been removed.

[Doc Alan]

Thank you Arthur . A serious topic, but if I may make a " Little " correction – the appendix is attached to Large Bowel ( caecum ) ; its exact position varies within the abdomen, so surgeons are aware of this when operating for suspected appendicitis ( " caecum and ye shall find " ! ) .


Immunotherapy is portrayed in the media as a new, fifth, way to " fight cancer " ( the others being surgery, radiotherapy, chemotherapy, and targeted therapy ). Each and all of the four have helped improve the outlook for most cancers. Immunotherapy is not even new – it’s been tried for half a century.


We know our immune system CAN and DOES attack cancers. People with weak immune systems ( through illness such as HIV/AIDS, or treatment of transplant recipients ) have increased risk of cancers ; the main known risk factors for cancers also affect the system ; and cancers themselves weaken it in several ways.


There is NO universal cancer vaccine to stimulate the immune system to reject cancer cells ; vaccines such as for cervical and liver cancer act against viruses known to cause them ( Human Papilloma Virus and hepatitis B ).


Much of the recent work has centred round making drugs which attack " checkpoint proteins " on cancer cells, so they can’t " fool " the immune system into letting them carry on proliferating.

These drugs may increase survival of various cancers by months, but don’t always work and are not curative. Huge costs make them lucrative for drug companies. Hopefully competing drugs will hit the market and immunotherapy will prove worthwhile, in ADDITION to the other four methods of treatment.


http://filipinaroses.com/showthread....-your-immunity

[Doc Alan]

World Health Organization ( WHO ) has now classed processed meat as a " definite cause " , and red meat a " probable cause " , of cancer. Processed meat means it’s been changed - through salting, curing, fermentation, smoking or other processes - to enhance flavour or improve preservation. It includes hot dogs, ham, sausages and corned beef. Red meat is unprocessed mammalian muscle meat such as beef, veal, pork and lamb. The type of cancer especially at increased risk is that of large bowel - one of the commonest cancers in many countries, including UK and Philippines.



WHO should have made more clear that while components ( chemicals ) of processed meat CAN cause cancer, the evidence being as strong as that for smoking, alcohol, asbestos and radioactive materials like plutonium ; the RISK is not as high . WHO is less confident about the risk of red meat, even when cooked at high temperatures ( producing more chemicals which may cause cancer ).



There’s an analogy between cancer-causing agents and accidents caused by cars or banana skins - the latter are both " definite " causes of accidents, but the risks are different. Most ( 85% ) lung cancers and about a fifth of ALL cancers are caused by smoking ; at most a fifth of bowel cancers and 3% of all cancers are thought to be caused by processed or red meat.



Processed and red meats do have nutritional value, in addition to being enjoyable to eat - vegetarian diets and diets with poultry and fish may have reduced risk of bowel cancer and other effects on health.



The good fortune of living longer brings with it an increasing risk - to about 1 in 2 - of cancer ; at least a third are preventable ; and treatments keep improving, helped by earlier diagnosis wherever possible.



Bowel cancer in particular has a good chance of cure if diagnosed early. Screening - either by sampling stools for traces of blood and/or examining the bowel by a thin flexible " scope " ( camera ) - is well developed in the UK ( less so in the Philippines ) for men and women in the age groups most at risk ( 9/10 are over 60 ). Other risk factors include being overweight, inactive, excess alcohol and smoking ; in some cases there is a family history ; and others - it has to be said - are down to bad luck ( chance mutations of cells lining the bowel ).


The theme of this thread is " a sense of proportion ". Despite the perhaps misquoted and misunderstood WHO findings, most informed medical opinion says it’s OK to consume processed and red meat in moderation and as part of a balanced diet. In fact " most things in moderation " is the usual conclusion at the end of most reports on food and health !



http://scienceblog.cancerresearchuk....-need-to-know/

[Michael Parnham]

Thanks for the new post on Cancer Alan, once again very informative and a great update.

[cheekee]

Thank you.

I do love sausages and have to admit that I have just eaten a lot of red meat here in the Philippines.

I guess cutting back and eating a more balanced diet is the aim as you say.

Have to say though I do suffer from gastritis in the UK but here I feel so much better.

Doc Alan I have been reading a lot about processed sugar and cancer. It's argued that cancer cells love sugar due to the fact they can grow in anaerobic environments.

What's your opinion on this?

[Rosie1958]

World Health Organization ( WHO ) has now classed processed meat as a " definite cause " , and red meat a " probable cause " , of cancer. Processed meat means it’s been changed - through salting, curing, fermentation, smoking or other processes - to enhance flavour or improve preservation. It includes hot dogs, ham, sausages and corned beef. Red meat is unprocessed mammalian muscle meat such as beef, veal, pork and lamb. The type of cancer especially at increased risk is that of large bowel - one of the commonest cancers in many countries, including UK and Philippines.



WHO should have made more clear that while components ( chemicals ) of processed meat CAN cause cancer, the evidence being as strong as that for smoking, alcohol, asbestos and radioactive materials like plutonium ; the RISK is not as high . WHO is less confident about the risk of red meat, even when cooked at high temperatures ( producing more chemicals which may cause cancer ).



.........

The theme of this thread is " a sense of proportion ". Despite the perhaps misquoted and misunderstood WHO findings, most informed medical opinion says it’s OK to consume processed and red meat in moderation and as part of a balanced diet. In fact " most things in moderation " is the usual conclusion at the end of most reports on food and health !


http://scienceblog.cancerresearchuk....-need-to-know/

Thanks for the clarification Doc Alan and the very interesting information you've shared

[grahamw48]

I've got one of those annoying spots that never heal (after at least a year) on my forearm...which I believe used to be a small mole, so off to see the doc this week to get it checked out.

Also just sent off my NHS Bowel Cancer screening test kit last week.

Haven't touched a cig for 18 months now.

[Doc Alan]

Thank you for your responses Michael, Rosie, Philip and Graham , with a few issues raised :-



Few specific foods or drinks have been convincingly shown to raise or lower the risk of cancer - clearly it’s hard to design studies accurately looking at single items of diet, as our diet is so complex and varied.



We do know that being overweight raises the risk of several diseases including two of the most common cancers ( breast and bowel ), and several other types ( womb, stomach, gullet, and pancreas ). Extra body fat has various harmful effects on our cells, such as producing hormones and growth factors. Up to a tenth of cancers could be prevented through " healthy diets " including fruit and vegetables ; with limited salt, processed and red meat. It’s increasingly thought that a range of diets may help weight loss - provided they are maintained.



There have indeed been concerns about the health effects of dietary sugars - especially obesity and diabetes. All cells in our body are " programmed " to die, ideally making way for new healthy cells to grow. Cancer cells tend to avoid programmed cell death, using a faster metabolism at the expense of other cells in the body, which is why cancer patients lose weight. While all cells need sugar, cancer cells increase sugar consumption - but I’m not aware of good evidence that starving patients of sugar gets rid of cancer, or that sugar causes cancer ( other than indirectly through obesity ).



Screening for bowel cancer from the age of 60 ( 50 in Scotland ) is sensible on balance ; having your doctor look at ( and perhaps remove for microscopic diagnosis by a pathologist ) worrying skin lesions very sensible ; and giving up smoking has well known benefits .



Doctors’ primary job is to make people better ( with advice, not orders ) ; after accurate diagnosis which often involves pathology tests ( my specialty ).


Screening for evidence of illness and listing risk factors for possible diseases in people who have no symptoms is of secondary importance ( http://filipinaroses.com/showthread....cks-worthwhile ).

[grahamw48]

Thanks for the advice Alan.

[mickcant]

Hi all, my weight has gone from 16 stone 10 1/2 pound when told I now had diabetes in May this year to currently 13 stone 6 pound giving a loss of 3 stone 4 1/2 pound, my new aim is to get to 12 and a half stone.

I have a diabetes review in 2 weeks and hope that I might be able to reduce or come off the Metformin I was put on.

I just had the nothing detected from my yearly bowel screening test.
Mick.

[Michael Parnham]

Very well done Mick, nice to know your Bowel Screening result was good!

[KeithD]

I eat a lot of fish. Although it is not helping with my natural selection as I can't swim. Well I can, but my fused neck means that I can't breath while swimming, so drown

I've also been on NSAID's since 1987, and research now shows that they reduce the potential of getting cancer such as bowel. Good news..... until I get run over by a bus

[Doc Alan]

Well done Mick !


" NSAIDS " - non-steroidal anti-inflammatory drugs - like ibuprofen, and especially aspirin, may either stop cancer of large bowel ( and possibly breast ) developing, and/or prevent such cancers recurring. Unfortunately it may take several years for the results of a new trial comparing patients already treated for bowel, breast and other cancers, who will take daily aspirin with those taking " placebo " / " dummy " tablets. Unless you’re on the " Add-Aspirin " trial, it’s NOT advisable to take either aspirin or other NSAID drugs in the hope of preventing cancer .



Cancer has also been in the news recently - an audit of about a thousand London patients showed that a quarter of cancer diagnoses came through A & E. These patients tended to have advanced disease, such that a quarter died in 2 months and only about 2/5 survived a year. Cancers of lung and large bowel were among the commonest types.


This may well reflect the situation elsewhere in the UK, as we know that the UK has the worst survival rates for cancer in Western Europe ( Swedish survivals at 5 years being about a third longer than in the UK ). Reasons for the poorer rate of early diagnosis in the UK include slow referral to specialists and lack of rapid access to " tests ". However, these tests take time and skilled interpretation. They include ultrasound and other scans, and taking tissue samples - requiring more investment in modern equipment and laboratory doctors / scientists.


Early diagnosis and treatment undoubtedly improves the outlook for patients with cancers. Family doctors / GPs have been blamed for missing signs of common cancers - not altogether fair, as they see many patients with similar signs and symptoms NOT due to cancer, and have to select who they refer.


Many people are still unaware of cancer signs and symptoms, and don’t visit their doctor soon enough - not helped if appointments are delayed. The situation is worse in the Philippines, where people may be less likely to understand the possible cause(s) of their symptoms - and be unable to afford a doctor, even if they DID suspect cancer.


This year the UK National Institute for Health and Care Excellence ( NICE ) produced new guidance on referral for cancer intended for " healthcare professionals ", but including advice about symptoms which might not be recognised by the general public. Of course the " worried well " may over-react to any symptoms they may have, but as we now have about 1 in 2 chance of developing some form of cancer during our lifetime it’s a serious topic. I will summarise it in the next post.

[Doc Alan]

Here is a summary of NICE guidelines for hospital referral by their doctor where cancer is suspected ; in most cases for adults aged over 40. There’s much more detail here ( http://www.nice.org.uk/guidance/NG12...ecommendations ) - but this might just help a few members or their loved ones, without causing alarm.


LUNG :- 1 or more symptoms ( smokers ) or 2 or more symptoms :- cough ; fatigue ; shortness of breath ; chest pain ; weight loss ; appetite loss.


STOMACH and OESOPHAGUS ( gullet ) :- difficulty swallowing ; upper abdominal pain ; reflux ; indigestion.


LARGE BOWEL :- weight loss ; abdominal pain ; change in bowel habit / bleeding.


BREAST :- lump with/without pain ; discharge from / change in shape of nipple ; lump in armpit.


OVARY :- “ bloating “ of abdomen ; feeling full and / or loss of appetite.


WOMB :- bleeding after menopause.


CERVIX :- bleeding/ ulceration/ pain unrelated to period.


KIDNEY / BLADDER :- blood in urine.


PROSTATE :- increased frequency / urgency / nocturia ( passing urine at night ).


TESTIS :- non-painful enlargement.


MALIGNANT MELANOMA of skin :- change in size, shape, colour, ulceration of " pigmented mole ".


BASAL CELL CARCINOMA / “ rodent ulcer “ of skin :- persisting ulcer.


ORAL / mouth :- persisting ulcer ; lump in neck.


LEUKAEMIA :- tiredness ; pale.


LYMPHOMA ( lymph node cancer ) :- enlarged lymph nodes ; weight loss.



Obviously these symptoms / signs may NOT be due to cancer . That is the difficulty for people BEFORE they decide to visit their doctor - and the doctor to decide WHO to refer for further tests ( too many and the system can’t cope ; too few and the doctor is blamed for " missing a cancer " ).

[Arthur Little]

Hi all, my weight has gone from 16 stone 10 1/2 pound when told I now had diabetes in May this year to currently 13 stone 6 pound giving a loss of 3 stone 4 1/2 pound, my new aim is to get to 12 and a half stone.

's GREAT news, Mick ... keep it down (the weight) ... and I'm sure you'll soon reach your intended target.

I have a diabetes review in 2 weeks and hope that I might be able to reduce or come off the Metformin I was put on.

Fingers crossed ... you're certainly heading in the right direction!

I just had the nothing detected from my yearly bowel screening test.
Mick.

[grahamw48]

Got my 'all clear' letter from the Bowel Cancer screening people this morning.

Doctor next week to look at the scratched mole on my arm that never heals up.

Trying to stay alive as long as possible !

[Arthur Little]

Thank you, again, Alan ... for this latest *update to your thread, along with *its most helpful link to recognising and detecting [POSSIBLE] cancer symptoms.

[Arthur Little]

Got my 'all clear' letter from the Bowel Cancer screening people this morning.

Doctor next week to look at the scratched mole on my arm that never heals up.

Although I'm very confident ALL will be fine in 'this department' too, Graham ... it's reassuring to seek medical advice as an added precaution.

[Michael Parnham]

Brilliant update once again Alan, one can never get too much information on this subject. Been taking Cod Liver Oil capsuls daily for as long as I can remember, but don't really know what benefits they have reference Cancers? Thank you!

[Doc Alan]

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 .

[mickcant]

Thanks Doc, all info is well worth getting into.

Since my being told I was now diabetic, and my "at last" attempts to change my eating lifestyle I quite enjoy cooking more from scratch, before I was a "Ready Meal" man.

Into home made veg soups now too.

I have reached my original target at Slimming club to get from: 16 stone 10 1/2 lb to 13 Stone, and am now trying for 12 1/2 stone.

Mick.

[Arthur Little]

Thanks Doc, all info is well worth getting into.

Since my being told I was now diabetic, and my "at last" attempts to change my eating lifestyle I quite enjoy cooking more from scratch, before I was a "Ready Meal" man.

Into home made veg soups now too.

I have reached my original target at Slimming club to get from: 16 stone 10 1/2 lb to 13 Stone, and am now trying for *12 1/2 stone.

Mick.

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