Saturday, October 3, 2009

The ABC's of Cancer

I wrote this for a patient of mine a few years back when we were discussing cancer developing from cirrhosis of the liver. Certainly he didn't understand 95% of what was going on with him medically... he just put all his faith in the docs. He had really low levels of education.. and I wanted him to have something he could understand. Feel free to use it (or parts of it) if you like...

Note: Often in these things I use words that aren't technically correct.... like using the word "chemical" generically instead of molecule, protein, enzyme, etc. Or "bug" instead of virus. Some patients can't sort out molecule from protein, but if you say "chemical" they get a mental picture of what you're talking about. Trust me on this.

Here goes..

The trick with cancer is that it's well, tricky. Just because you have a tumor doesn't mean you have something bad. A tumor is just an overgrowth of regular tissue.... some cells in your body have gone nuts and can't turn themselves off from growing and dividing. Lets just say a normal cell in your body makes a new cell every 2 days. A tumor cell might make a new cell every 2 hours... so it grows way faster than everything else.

So if you have an overgrowth or tumor of skin (like a wart)... that may not cause you any problems if it's just chilling on you finger. Tumors cause problems with they spread and start interfering with the rest of the body's ability to do it's job. So a wart or a mole might be no problem forever, or it could start growing out of control...eventually affecting the ability of your skin to protect your body... or in worse cases it might start growing deeper, affecting whatever is UNDER your skin. That's when a tumor becomes cancer.

The other tricky thing about cancer is what we call metastasis. That means that some of those crazy tumor cells got into your circulatory system... in your blood and lymph... and are traveling around the body to set up camp in other places.... possibly your liver, lungs, stomach, who knows? And of course having a tumor in those places is a whole lot more dangerous than having a tumor on your finger. Tumors on important organs can really start messing things up.... and there is no one way that tumors can cause problems. Just think about it. A growing tumor, depending on where it is, can do a lot of damage. It can grow against something...thus "pinching" something that's not supposed to be pinched... like nerves, arteries, or any "pipes" in your body like your esophagus. Tumors can also have a bully affect on other organs... basically stealing the blood and important molecules they need for it's own survival.... then your own organs start starving to death. Tumors can also pretend that they are part of your own body. For example, you have lots of organs in your body which make chemicals for your body to work... like your kidney makes a chemical that keeps your blood pressure normal, and your pancreas makes chemicals that keep your blood sugar normal. If one of these organs gets tumor cells attached to it, it can start going crazy, too.... maybe making too much or too little of a chemical. All of these tumors are considered "cancerous" or are said to have "metastasized".

There are three basic reasons why you can get cancer in the first place.... and unless it's really obvious to the doctor, it can be really hard to figure out why you got cancer.

The first reason is because of genetics. Basically, for whatever reason, people in your family have "genes" (a code in your DNA) which makes it more likely that you'll get cancer. It's just in your blood. Since most people don't know what genes they have, the best thing you can do to avoid genetic cancer is to be as healthy as possible... and to do all the check-ups your doctor advises (like colonoscopies, mammograms for women, etc.).

The second reason is that some behavior a person does is making your normal cells go crazy and turn cancerous. Things that are known to increase your chances of cancer are smoking, drug and alcohol abuse, obesity, exposing yourself to harsh chemicals (like pesticides, coal, smoke) for years, tanning in the sun too much, or having unsafe sex (basically having many sex partners without a condom). Of course, every person can control how much they do all of these activities... so reason #2 is controlled by you.

The third reason for getting cancer is basically no reason at all. Sometimes it can just happen. Nothing you've done has caused it, and it doesn't seem to run in your family. Sometimes the healthiest, most careful people in the world get cancer... and no one knows why.

If you do get cancer, there are some things we can do. Most everyone has heard about treatments called "chemotherapy" and "radiation". And these are just some of the things we can do. For treatment, we need to be able to 1) get the cancer out of the body altogether if we can, and 2) stop the cancer from spreading around everywhere.

The first part might involve just cutting out the tumor... basically you go in for surgery and they cut out the bad stuff, sew you up, and see what happens. Most of the time you'll have to take medicine to keep the cancer from coming back afterwards. Sometimes you end up good as new, sometimes the cancer comes back and we have to try a new treatment.

Stopping the spread might involve "chemotherapy" or "hormone therapy"... which is basically just medicine which we use to try to poison the tumor. Remember, we can try to stop the tumor from getting bigger... but we really can't dissolve tumors and get rid of them.... for that we need surgery.

The medicine can be pills that you take, fluids that you get through an IV, or medicine injected directly into the tumor with a needle. The hard thing about chemotherapy is that there are usually lots of side-effects... everybody reacts different, but you can bet at the least you'll feel sick like a dog. And this makes sense. We need a drug strong enough to shut down the cancer cells... but not strong enough to shut down YOU and all your normal cells. Tumors usually "like" the medicine more than the rest of your body does... so our hope is that most of the medicine will head to the tumor and poison it first. Unfortunately, some of the medicine we gives you goes elsewhere in your body... and shuts off some of your normal cells, which makes you sick. Bummer. Thousands of researchers in the world are trying to find better drugs that just jump on the highway to tumor and don't take any back-roads around your body to make you sick... but that's tough work.

Radiation is another treatment for cancer. Basically, doctors use a beam of light (similar to an XRAY) to kill the tumor cells. Just the same way the sun can burn your skin if you stay out too long... different types of light can kill different kinds of cells. Depending on what type of cancer you have, you might need to get radiation all over your body or just in the spot where the tumor is.

Treatments aren't always successful. Some types of cancer are almost always curable, and some types less than 5% get cured. And your body can change. Sometimes a medicine works the first time, then it stops working. Whatever treatment you choose, you have to remember that cancer is tricky. Cancer can't be 100% cured like pneumonia or a broken bone. Once you have cancer, it will ALWAYS be lurking around in the hidden corners of your body. Your treatment might work great, and you might be healthy, but you will have to get regular check-ups forever to make sure the cancer hasn't started poking around again.

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