The title does tickle, doesn’t it? Does it make you think? If it did, my job will have been well done. There are maximum number of myths around this word cancer, the crab that really eats into the victim’s body, and also his mind; the latter is the predominant disability of cancer, which needs care and not cure. Not a day passes without the news about miracles in cancer cures and unwanted premature deaths. It is the connection between death and disease that makes cancer that much more frightening. Man is ultimately afraid of dying. The medical fraternity keeps feeding society with all the wrong notions that diseases cause death. On the contrary, death is the only certainty in life, which has very little to do with disease. Diseases do cause disability, pain, and undue suffering. It should be the endeavour of the medical establishment to “cure rarely, comfort mostly, but to console always.”



The basic truth about cancer seems to be far removed from all these myths. Cancer, in fact, is not a disease. It is a process of ageing-some of us age slowly, yet others age faster. I am talking of cell ageing and not of morphologic ageing. That explains cancers occuring even in small children. Depending on the rate of growth of a cancer, it could either outlive the victim or precede him. When the cancer starts to grow inside the human body there is always an attempt by the body’s immune system to suppress it, or to overcome it. If, in the bargain, the immune system wins, the cancer dies prematurely. The unusually high incidence of cancers in those patients with AIDS clearly proves the point.



Biological cancer is a normal body cell, which has outlived its appointed time of death. Every cell in the human body, of which there are whopping one hundred thousand billion in all, have their life span cut out for them. They have to die a natural death, apoptosis (falling of a brown leaf, in Greek). A special gene, the suicide gene, which sends the message to every cell, when its time is up, governs this process. With such large number of cells belonging to so many varieties of organs and tissues, one shudders to think as to how this goes on in the majority of us without a hitch! If, for any reason, the suicide gene either fails to send the signal, or the messenger enzymes do not do their job well, the target cell might not receive the message at all. That cell could outlive its life span, but can not divide any further, since there is an upper limit for cell replication in every situation (Hayflick’s law). The cell that escapes death at the right time mutates to change its DNA, called the rogue DNA. The latter is the beginning of a potential future cancer, if it chooses to do so. It is; therefore, possible that every human being has some potential cancer or the other at all times. It is only an accident that one such could really become a clinical cancer. Ottoson in Sweden did minute postmortem study of two hundred and fifty consequitive deaths due to suicide, where he found the presence of a biological cancer in every one of them. Depression is the cause of suicide. Depression is now known to be associated with cancer, heart attacks, and many other major illnesses.



Clinical cancer is that stage where the rogue DNA of the cell replicates thousands of times to produce a mass of cells that could be felt as a lump (tumour) by the doctor. Even this stage of clinical cancer could be dormant for years on end, depending on the site of the lump. When that chooses to grow rapidly and/or to grow at distant sites in addition, causing local pressure symptoms, depending on the site and the function of the organ, the victim feels the symptoms due to the growth, this stage is called symptomatic cancer. Even then it could, at times, remain dormant for years on end. At the other end of the spectrum is the tumour that could grow very fast, and produce symptoms that are disabling in a very short span of time.



What is early cancer?



This is the greatest myth of the century. There is no way one could detect cancer at its biological stage. Even if we could do that hypothetically, there is no way we could gauge if it is going to be a clinical cancer or not. Even at the stage of clinical cancer we have no means of saying which cancer grows and at what pace. It is near nigh impossible, by the available means, to say what would be the outcome of the cancer. Even the cytological diagnosis of cancer is only a guess, as cancer cells are, after all, normal cells with some difference. The cytological diagnosis, at times, is very tricky and difficult. Most of the time a diagnosis is a false positive one for defensive purposes. Scientifically there is nothing called early cancer from the prognostic point of view. Thomas Lewis, the former President of the world famous Sloane Kettering Cancer Institute in NewYork, wrote in his famous book The Lives of a Cell that:



“ Illness and death still exist and can not be hidden. We are still beset by plain diseases, and we do not control them; they are loose on their own, afflicting as unpredictably and haphazardly. We are only able to deal with them when they make their appearance (it is better to conserve our meagre resources just for that!)…Majority of cancers can neither be prevented nor cured. We do not become sick because of failure of vigilance, diseases do not happen just because we are not preserving health.”



There is nothing called early cancer, any cancer even if it is discovered “very early” could be decades old biologically and could have had the seedlings in distant organs already. The concept of early cancer, is a very good business for the screening industry though, which thrives on that myth. Teleologically, one needs to intervene only when the so-called cancer starts to produce symptoms. We have very good methods of palliation, but no cure whatsoever for cancer as of now. No one, even the best cancerologist, could predict with certainty, as to the future course of the disease. They have, of course, been predicting the unpredictable, again a good business proposition!



Role of Cancer Screening:



Another one of those myths sustained by intense propaganda in the medical world. Audit of all most all the properly conducted screening studies has given equivocal results. This is very obvious in the field of gynaecological cancers. Judged by the enormity of the problem this propaganda is well worth the effort and the money spent of it. In one year in the USA alone, 69,00,000 hysterectomies (uterus removals) were done for preventing cancers, based on the screening data. The story of mammograms has been still more interesting. Some governments have, at last, put a moratorium on screening young ladies. There are a couple of unconfirmed reports that wonder if mammograms could even stimulate a biologic cancer to grow faster!



Although the incidence of breast cancer is very high in elderly ladies, there is very little done in that age group. Doctors, in old ladies, do not usually do even the routine breast examinations, leave alone screening. The paradox is very glaring here.



There are stray reports that early detection of cancers in their pre-symptomatic stage might send the wrong signal of a death sentence to the harassed patient that makes the cancer grow faster, to produce its deleterious effects on the organ concerned. The resultant disability might even kill the victim faster. It is a well-known fact that fear could kill! Cancer could be predicted in the herd, but not in the individual. The incidence of herd cancer has not changed a wee bit over the last few decades although individual cancer incidences have shown changes. For example, the Japanese have very low incidence of stomach cancers but they compensate by very high incidence of many other cancers, compared to the Americans. The overall incidence has not changed though the numbers are higher, obviously because there are more people in the world now compared to the past!



Are cancers hereditary?



Herd cancers are hereditary. In individuals there is no unequivocal proof that cancers are hereditary. Environment and genes together work in any disease.



What of cancer treatment?



Another one of those medical myths. Small is as good as large would be a good surgical dictum in cancer surgery. The heroic surgery, with the poor patient in the hero’s role, is not warranted. Scientific studies have amply proved that lumpectomy, or local surgery to clear the pressure symptoms, are as good as the most radical extensive mutilating surgeries. The final outcome did not appreciably differ in such heroic patients. Repeated surgeries are another thing altogether. This was practised even in the distant past. Sigmund Freud had thirty-three operations over a period of sixteen years for his oral cancer. He did not die, though!



Chemotherapy and radiation are again done for the overkill. Both these could kill normal cells as well as cancer cells. In fact, they kill fast growing cells more effectively, resulting in hair loss, oral mucus membrane loss, loss of testicular function, and the like. There is now a growing feeling that chemotherapy and radiation also should be done just about enough for good palliation, and symptom relief, rather than for radical cure. The latter is a pure myth in cancer. One of world’s leading cancerologists, Sir David Wetherall, Regius Professor of Medicine at the Oxford University, wrote in his recent book The Science of Medicine and its Quiet Art (Oxford Publications, 1997) thus:



“The way we burn our cancer patients with powerful drugs and radiation reminds one of the branding done routinely for diseases by our forefathers. Our future generation will not forgive us for this blunder.”



Having said all this, I am aware of the anger and wrath I shall incur from my friends and colleagues. I used to get upset about it when I was young, but I have grown to ignore that now. I was reading in the recent issue of the British Medical Journal about the lamentations of its brilliant editor, Richard Smith, about the abuses heaped on him week after week, when his journal reaches the readers. “The earlier you are fired the better for the nation”, “ You should end up as a street sweeper after being fired from the editorship of the BMJ” etc. I am not alone in this world in my travails. There is good company. Richard Smith is a very fine man and an excellent scientist, in addition, he has been considered one of the ablest editors of that prestigious journal, which has undergone sea changes after Richard took up the challenge as its editor!



If what I have written gives courage to the hapless victims of cancer, and makes my colleagues to start thinking, my efforts will have been amply rewarded. Cancer need not kill always- with or without treatment. Fear kills faster! Cancer might even keep one alive and kicking for as long as thirty to forty years. If one takes its biological state into consideration, it could be even fifty to sixty years. Many cancers, especially of the prostrate gland, have outlived their owners! Happiness of the mind is known to kill cancers or suppress their growth, while depression is known to stimulate biologically quiescent cancers to grow very rapidly and wildly.

Prasanna aatham indriya manaha Swastha Ithyabhideeyathe.

( Happiness keeps you healthy!)



“Never try to live for ever, you will certainly not succeed,” wrote Bernard Shaw in the Doctor’s Dilemma.