Wednesday, March 27, 2013
The Cancer Pendulum- Does It Toll For You?
The Cancer Pendulum- Does It Toll For You?
(Even though this post is filled with complex concepts I have to tried to explain it in as simple a language as I could make it for everyone to understand but if you still find the medical jargon too difficult to grasp, please excuse, for it comes from a longstanding habit of writing in the obscure language so beloved by peer-reviewed scientific journals which never publish any article which can be understood easily or is in simple English)
A few days ago I had a patient a female patient around 60 years who had consulted me for a long standing ulcer which was not healing and she was worried that it might be cancer. When I checked the patient I found out that she it was not as she had told me, she did not have the same ulcer for a long time but she was repeatedly getting new ulcers in the same area, but they were healing normally until a new one formed again. Based on the visual aspects I could see that it was not a cancer ulcer as the typical cancer features were missing, but the current trend being defensive medicine, i had to of course CYA with a battery of tests to rule out every possibility including cancer. As expected, all her tests came back negative and by the time the test results had come, her ulcer had also healed and she walked out both physically and emotionally satisfied. As she left she did something which is always abhorrent to me (typical Indian practice), she tried to fall on my feet to express her thanks. I scolded her that she was my mother’s age and shouldn't be doing this to embarrass me. And then she confessed that she had been living through hell for the past month or so, in fear of cancer and she couldn't eat, sleep or even think about life till i had told her it was all normal. After she left i thought over how much people fear the very word cancer. It’s as if a death sentence is pronounced on them with the very word of it. And that’s how the idea for this post came about - to explain the media hype on cancer and all the misconceptions about it.
Nowadays if you open any newspaper or any magazine the science section contains a screaming headline which says "such and such cancer was discovered" and then urges the government to take it as an urgent menace and allocate funds to investigate it. This is not just media hype because even the scientific community is reporting an increase in cancer cases worldwide with newer and newer varieties of cancer being reported daily which in turn leads us to the question of whether we are really developing so many new forms of cancer all of a sudden or are we just identifying more and more of them with modern and better diagnostic equipment? My vote would be for the later explanation.
Simply because, if say, a 100 years ago a small nodular thing was seen on an xray of the chest- what is known in trade language as a radiolucency of the lung- it would have been immediately attributed to that fall guy of all chronic diseases -tuberculosis. But not now- for with our current technological advances we have lots of different diagnostic methods to find out what it is - we can take a CT, or take a Contrast Ct (which involves injection of a colored solution- a contrast medium into that spot and again taking a ct to check for differences in color because cancer cells have a different color than normal cells), or take a FNAC (which involves pushing in a hollow needle called an aspiration needle into that spot and pulling out a little bit of its contents along with the needle to check under a microscope), or take a biopsy (which involves cutting up a little bit of tissue from that area and checking it under the microscope to see if they are indeed cancer cells) to see what it is.
Any and sometimes all of the above tests are employed nowadays whenever we see something the least bit suspicious. But in fact they are not all needed for each one of these tests can produce authentic and clear results without any doubts about the diagnosis. So much so that even small self healing conditions now become major health crises. The small nodule in the chest becomes a major cancer worry and whether it is just suspicious looking or definitely pre-cancerous the patient undergoes either surgery or radiation or chemotherapy to catch it an early stage - good riddance to it or what’s called as the prevention theory of medicine we currently follow.
But one thing we have to remember is, we still don’t know what caused the nodule to develop and what if anything made it turn cancerous. Because we still don’t know what causes cancer or specific cancers. Oh don’t take me wrong, the scientific community has dozens of theories and causes for cancer formation- the most popular being the nature vs nurture theory. The first one says that cancer is natural- a result of the broken gene- all cancers are caused by our normal genes suddenly going bonkers and becoming cancerous. And a further offshoot of this is the theory that cancers are heritable- that we get not only our parents genes from them but also their cancers. The other end of this pendulum is the theory that cancers are environmental diseases and that you get them from abusing your body and the environment around you. Everything and anything can be a direct cause for developing cancer unless you live cleanly and follow healthy living guidelines.
To explain this further let’s take the case of the most popular of all cancers- breast cancer (35/1000 women). I don’t call breast cancer as the most popular because it is the most commonly found cancer- it is because the American public believes that it is and what the American public believes is good for the rest of the world. Pardon me if I sound a little cynical here but i am not kidding but merely stating facts- the majority of medical research is financed by only one nation- America but the benefits are shared by all of us-the rest of the world. As such the Americans have a direct and disproportionate say in which disease they want to research or to find a cure for.
To extend this example further the American public is often scare mongered to support certain specific diseases by cleverly manipulated public relation campaigns. Hence as public clamor rises, more funds pour into that specific disease from the American government and from philanthropist foundations like the Gates Foundation. When university research teams hear about these new funds available they simply switch over to these new diseases because all researchers needs funds to sustain themselves and having readymade grants for research allows them to hire more people to work for them. And as they work more and more on that specific disease they popularize it more and more to attract and retain their sources of funds. It becomes a cycle- if the disease is famous; the money is there and because the money is there the diseases becomes famous. And that’s how certain diseases suddenly become popular in the public consciousness and become the next big fright...be it AIDS, Cancer or the Obesity Epidemic.
Anyway to get back to breast cancer- at one time it was thought that breast cancer was a genetic disease spreading from mother to daughter. But as the researchers started investigating more and more into the genes which were seen in breast cancer patients (called BRCA's- the genes associated with breast cancer- which simply means they were found in breast cancer patients) and as more research was done, more and more such genes were found to be associated with breast cancer and scientists were naming them -breast cancer gene-1, gene-2 , gene-3 and so on and so forth till they themselves realized that there was no single identifiable gene which can be blamed for causing breast cancer and then the breast cancer specialists were caught in quandary about how to explain their own findings when some researcher somewhere suddenly thought up the cancer complex idea. Which merely means that if you cannot blame cancer on a single gene malfunction you can still blame it on all of them together and say you need a cluster of cancer genes- a whole bunch of genes to misfire - to cause cancer. This is still a theory and much of it is based on computer simulation and lab modeling and not verified on the ground. So the geneticists are hanging in there, still working their gene-counters trying to find the genetic holy grail of breast cancer.
And on the other end of the spectrum we have the environmentalist theorists. These guys have blamed everything from having sex at an early age to not having sex early enough- delayed virginity as cause for breast cancers. They have blamed wearing tight bras for breast cancer and they have blamed not wearing a bra at all as cause for breast cancer. They have blamed breast feeding for breast cancer and not breast feeding for breast cancer. In short they have blamed anything and everything without a definite clue. Anyone who follows these fast changing developments and the "scientific" advices will soon start doubting everything wondering which is safe. But till now, neither gene nor environment theories can wholly explain why breast cancer attacks certain patients, some in their fifties, some in their thirties, some with no children and some with plentiful grandchildren. No one knows anything with 100% certainty unless you happen to watch TV shows where the anchor confidently states that such and such new development means an end is found at last for this disease.
And so American women who keep getting these breast cancer updates on popular media are often scared enough to undergo extensive surgeries at the slightest bump they feel are often the driving force behind this entire scare mongering industry. Well you can’t really blame the Americans - their government is ready to throw unlimited amounts of money into bottomless wells on the chance that someday a cure might be found. Unlike our Indian government which operates on the principle that if they wait long enough we would all die of some communicable disease and save the government the trouble of providing funds for research on preventable diseases.
So to return to the original premise of this post- we still don’t have a reliable clue for why cancer occurs. We say that smoking is strongly associated with lung cancer- that is persons with lung cancer are often smokers. We say that HBV -the hepatitis B virus is associated with liver cancer. We say that HPV- the human papilloma virus is associated with cervical cancer. And this has kick started the most recent craze for finding viruses associated with cancers in the hope that cancer might be a viral disease and we can cure cancer by killing the virus or prevent cancer by vaccinating against the virus. The evidence is still out on that one and i for one would wait a bit more before agreeing wholeheartedly. And the most recent one i heard somewhere is the news that IVF or in vitro fertilization for childless couples can in some way cause uterine cancer. I am still digesting that news, working out how it can be and still don’t understand and am waiting for further authentic news.
Finally we come to the alternate lifestyle theorists who label that stress and everyday anxiety can cause cancer and practicing a healthy lifestyle choice can prevent cancer - that is no smoking, no drinking, no sex and go live in an ashram and practice meditation for 20 hours a day. This is one of the most popular theories seen on line by the evidence of the popularity of the shared advice columns seen on facebook and is also popular with the television media - as the photogenic new-agey gurus who propagate this kind of "stress kills you" theories are often seen on TV spouting blatant lies and pseudo-scientific drivel. These quacks and charlatans wouldn't recognize a cancer cell if they tripped and fell into one. All their mumbo-jumbo of transcendental meditation and achieving oneness and kriya yoga and stuff like that curing cancer is pure baloney and as believable as mother Teresa curing cancer by touching the patients. If somebody can show me that cancer can be cured with meditation- i would eat my hat, although i don’t wear one currently. And village people get as many cancers as city people do, just that they don’t recognize it or get treatment for it as much as the city folks do. So living in an ashram doing meditation does not guarantee you won’t get cancer and neither does being a vegetarian or a tee-totaler or a fitness freak or anything else you read in wellness magazines.
So to sum up, cancer is not really a common disease, and we need not live our lives worrying about it striking us. The reason for a perfectly normal cell to suddenly turn into a cancer cell is still not known definitely, for all we have are theories. We don’t have a single clear and guaranteed treatment for cancer because we still don’t understand how it works. The treatments we have available now- surgery, radiotherapy, chemotherapy etc work fine with some cancers but not all- for these can come back at any time (recurrence). All of these treatments are based on destroying all the cells of that particular affected area in the hope of destroying the cancer cells also- which is pretty drastic when you compare it to burning down the house to get rid of termites. There are certain new treatments in the pipeline- like interleukins, interferon’s and immuno-proteins of which much is expected in the future. Finally nothing keeps a person as healthy as having a robust immune system. Every day, somewhere, some cell of yours is going crazy and turning cancerous, but that efficient and ever vigilant guardian of your body, your immune system is cleaning it up pronto without alarming you. Throughout an average person’s life their immune cells clean up a hundred different cancers from their body without their knowing anything about it at all till they die of old age. And finally we should hope- fingers crossed that somewhere, someone, some lonely scientist in a laboratory is even now working out the definitive reason for what causes cancer. Let’s cheer him on, shall we?
P.S. pictures are always borrowed from Google Images available under open source. Ethically I am not permitted to use my actual patient photos under the doctor-patient confidentiality clause.