Fight the good fight! This post’s topic is about a fight that not many of us pay close attention to unless we have a loved one or ourselves directly impacted by it. However, the formidable fight in question has been ongoing for decades in our homes, medical centers, families, support circles, and minds. For many people without a history of cancer in their family or friends, it may be a stigmatic term that one hears about and perhaps empathizes with but can easily ignore.
A relentless pursuit by medicine is ongoing to ultimately detect and treat this deadly disease that has impacted millions of people, their families, and their wellbeing. To understand cancer, one must first understand what cancer is: the genes in our body control the way cells function. Cancer is a disease of genes in the cells of our body which causes cells to malfunction, which means they grow and divide when they should not; or they fail to die when they really should. The abnormal cells can become cancer. If you do not know what cells are, well: they are the basic building blocks of all living things and provide structure to our body – taking in nutrients and converting them into energy.
Cancer starts and spreads within the body and is not contagious. With early detection, its spread can be curbed, and it can either be cured or treated. Cancer can impact a healthy person of any age group – some due to family history, others due to genes, lifestyle, or age – and others purely at random for reasons unexplained by science (Cancer.gov).
Every 6th death in the world is due to cancer. In numbers, that amounts to nearly 10 million deaths due to cancer prematurely every year around the globe – though this statistic is as of 2017, it highlights the place cancer holds in being the 2nd largest killer of humans after cardiovascular disease (Our World in Data).
This post shares some facts, knowledge, and emotions about cancer, and recognizes the human will and fight against it. My intention is to contribute to the already pervasive awareness about this disease and a precursor to my attendance at two upcoming galas in support for the fight against cancer: Shaukat Khanum Memorial Cancer Hospital, Pakistan, and the 2nd Annual Endless Giving Gala for Sick Kids hospital, Canada.
Hard Facts:
- In Canada, cancer is the leading cause of death and accounts for circa 28% of all deaths. On average, 641 people will be diagnosed with the disease every day in Canada, and 233 people would die every day (Cancer.ca).
- 2 in 5 (40%) people in Canada will be diagnosed with cancer during their lifetime.
- USA maintains the highest prevalence of cancer as a percent of population at circa 5.5% of its population as at 2017 (Our World in Data).
- Almost half of all people in the world who die from cancer are 70 or older. Another 41% are between 50 and 69 years old. In effect, 87% of all cancer victims are older than 50 years (Our World in Data) .
- Approximately 400,000 children are diagnosed with cancer annually (ACCO.org)
- Cancer is the leading cause of death of children from age six months to young adulthood. Unlike adult cancers, the causes of childhood cancers are largely unknown. In Canada, nearly 75% of children who survive cancer live with permanent side effects which include cognitive difficulties, and heart and kidney dysfunction (Kids Cancer Care).
- 80% of children with cancer live in developing countries and approximately 80% of these kids die because of lack of access to diagnoses and treatment. On this green planet, every three minutes, a child with cancer dies (Kids Cancer Care).
- Breast cancer maintains the highest prevalence of cancer globally, followed by colon, rectum, and prostate cancer. In numbers, breast cancer accounted for about 17 million cases globally as at 2017. Interestingly, one in five cancer deaths globally are attributed to cancer caused by smoking. Liver and gallbladder cancers maintain the lowest prevalence globally (Our World in Data).
- The average 5-year survival rate of all cancers in the USA has improved to 67% from 50.3% for the period: 1970 -77 to 2007 – 2013. Two main factors contributed to this improvement: early detection, and improved treatment. Prostate cancer survival rate saw a significant improvement during this period in the USA from 69% 5-year survival rate to 99%. Pancreas cancer has the lowest 5-year survival rate of 8.2% up from 2.5% during the same period. 5-year survival rate means: “the percentage of people who are alive five years after they were diagnosed with or started treatment for a disease” (Our World in Data).
- Though cancer prevalence shows a positive relationship to income, death rates from cancer incorporate several factors: cancer prevalence, detection, and treatment. When comparing cancer death rates across income, there appears to be no strong relationship between such measures. There is also no correlation between the level of income inequality in a country and the cancer death rate.
Cause: Genetic or External ?
In a 2015 paper Cristian Tomasetti and Bert Vogelstein, concluded that only 33% of cancers are attributable to environmental factors or inherited predispositions, and that the vast majority of cases result from bad luck. ‘Bad luck’ being random mutations which can occur when DNA replicates in normal non-cancerous cells (Our World in Data). The study argued that, “beyond some cancer types which are deterministic (D-tumors) and can be reduced through lifestyle factors or vaccines, the most promising approach to reduction of cancer deaths across most cancers (replicative, R-tumors) is early detection”. The research paper has received criticism and rebuttals within the scientific literature. A number of later publications provided rebuttals: suggesting analytical flaws, and epidemiological evidence which counter the conclusions drawn by Tomasetti and Vogelstein. The rebuttals have argued that “the role of ‘chance’ in cancer development was overstated by Tomasetti and Vogelstein, and the role of environmental exposures was understated”. Wu et al. (2016) published a study in Nature which concluded “that intrinsic factors (which relates to the ‘bad luck’ DNA replication) account for less than 30% of cancer development, with the majority resulting from extrinsic risk factors.
Detection:
The survival rates from cancer are greatly enhanced through early detection.
High or low levels of certain substances in the human body can be a sign of cancer. Lab tests of blood, and urine that measure bodily substances can help doctors make an appropriate diagnosis. However, abnormal lab results do not necessarily confirm the existence of cancer. In fact, roughly 10 to 20% of all cancer cases are misdiagnosed (Paula and Perkins).
If doctors find irregularities in routine lab tests, they may refer a patient for further testing. More advanced testing involves imaging tests that create pictures of areas of the body to help doctors ascertain whether a tumor is present. These imaging tests come in many forms and include CT scans, and MRI. A CT scan uses an x-ray machine to ultimately create 3D images of the body. An MRI in contrast uses radio waves to take photos of the body in segments. The segments are used to create detailed images of the body’s insides to show the difference between healthy and unhealthy tissue.
While CT scan and MRI may point to the existence of a tumor; in a majority of cases however, a doctor would need to conduct a biopsy to properly diagnose cancer. A biopsy involves extraction of a sample tissue from the body that is studied under microscope by a pathologist to determine if the tissue contains cancer. The results of a biopsy will be delivered in a pathology report which includes a cancer diagnoses and treatment options (Cancer.gov). As you can appreciate, a cancer diagnosis is a complex process and hence not easily attainable in the developing world.
Treatment:
Treatment options for cancer depend on a series of factors that include the type and stage of cancer. Typically most cancer types have 4 stages and substages within the main stages. In broad terms, Stage 1 cancer has not grown or spread and is easier to treat, whereas Stage 4 cancer has grown and spread to other parts of the body. Depending on type of cancer, the seriousness of the different stages, survival rates, and treatment options vary.
Doctors may conduct chemotherapy to reduce the size of a tumor and then surgically remove the tumor. Or they may conduct surgery to remove the tumor and subsequently conduct chemotherapy to kill cancer cells and to prevent reoccurrence.
In this post, I will highlight two major treatment options: chemotherapy, and radiation therapy. Each treatment option maintains its own set of effectiveness and side effects.
Chemotherapy: is used to reduce the size of a tumor, destroy cancer cells after surgery, or help other treatments work better. Chemotherapy is administered through different means: (i) Oral (via pills, or liquids), (ii) Intravenous therapy (IV) directly into the vein, (iii) Injection, (iv) Topical, (v) and other means (read here). IV is the most common means of administering chemotherapy. Chemotherapy can be administered at a medical center or at your home. Since patients respond differently to chemotherapy, its frequency, intensity, and length is determined by the type of cancer, and its stage within the body.
Certain factors like age may preclude the effectiveness of chemotherapy and in some cases it may be deemed ineffective. Chemotherapy can last 4 weeks to more than 6 months; and during the period, several side effects surface. Common side effects include hair loss, a weakened immune system, infections, fatigue, and loss of appetite. Since chemotherapy is extremely hard on the body and the person’s emotional wellbeing, it is imperative to have a support network in place with friends and family. The fight against cancer is not just a fight via medicine and therapy, but also a relentless fight of the mind against cancer.
Radiation therapy: there are two main types of radiation therapy: (i) external beam, and (ii) internal. The type of radiation therapy depends on the type of cancer, the location and size of the tumour, and general health of the patient (among other factors). External beam therapy aims radiation at the cancer through various angles at a specific part of the body via a large machine. For instance, external beam radiation would aim for the chest in treating lung cancer. Internal radiation therapy in contrast involves inputting a source of radiation inside the body via a solid or liquid source. Internal radiation treatment travels in the blood to tissues throughout the body to seek and kill cancer cells.
Like chemotherapy, radiation therapy also aims to treat, prevent, or slow the growth of cancer. It can also be given before surgery to reduce the size of the cancer to make its removal easier, and its return after surgery less likely. The side effects of radiotherapy include hair loss, fatigue, nausea, and loss of appetite among many others. The intensity of radiation therapy depends on the type and stage of cancer, and the medical history of the patient. Like chemotherapy, radiation therapy is an intense form of treatment that demands immense human will, emotional support, and bravery (Cancer.gov).
Life post cancer:
Many cancer patients return to normal life after treatment. Their lifespan may mirror the normalcy of a healthy person without a history of cancer. However, depending on medical history, and type of cancer, short and long-term health problems may continue to persist. Unfortunately, there is no straightforward path with life during cancer or after. A history of cancer would involve at least an annual medical check for many years to ensure the cancer does not return. Sadly, in some cases it does return and at times in more aggressive form, which may limit treatment options. Recurrence rates for cancer vary on the type of cancer. For example, the recurrence rate for breast cancer is roughly 30% overall, and 85% for ovarian cancer. Lukemia (childhood) has a recurrence rate of 15% to 20%. These figures are as at 2018 and are rough estimates and it is difficult to ascertain recurrence since several factors have impact (Cancer Therapy Advisor).
Concluding Remarks:
This November I took part in Movember for the first time. It started as a solo effort but I have got a few friends and acquaintances aware and thinking. Movember raises awareness for men’s health particularly prostate cancer, which affects 1 in 8 men in Canada. Movember is a chance for you to spread awareness. Not to mention an opportunity to grow a stash. I am far from gaining whiskers at this stage but perhaps next year I will give myself a headstart.
So there you have it! Be aware, share the message, contribute however you can, and spread the love. Life can be interrupted and ultimately taken unexpectedly for reasons that may be unfair, unclear, and utterly random. But never give up! There is colossal hope and bravery in the fight against cancer. To the mothers, fathers, daughters, sons, and friends who have fought and continue to fight – humanity owes you much gratitude! If you care to help there are many avenues to consider, and my suggestion is to attend a charity event locally where you may meet cancer survivors and hear their remarkable stories. Fight the good fight!
Cancer explained with visuals:
References and Disclaimer: Cancer.gov, Cancer Therapy Advisor, Our World in Data, Paula and Perkins, ACCO.org . Please note that this briefing contains paraphrased summaries and attributes the original content to the news and research sources. Readers are encouraged to visit the online links to access the full article/paper in its original form for a thorough and complete view. You may need to subscribe to the news agency and source for access. This blog entry contains figures and statistics that may be inaccurate. The post also makes broad generalizations that must be reviewed with caution and demands further research. The blog entry also provides descriptions about certain treatments and spread of medical diseases that may be outdated or become outdated in the future.
Photo Credit: Healthline, and Positive Bioscience.