LUNG CANCER

Cancer of the lung is the most common cancer in men and increasing rapidly among women in the United States. There are a number of types of lung cancer, but the most common is called bronchogenic, since it originates in the bronchial tubes. By far, the most common cause of lung cancer is tobacco smoking with the risk directly proportionate to the number of cigarettes smoked and the amount of inhaling. It appears that in the tobacco tar, we find not only benz-0-pyrene, but also dozens of other cancerproducing chemicals, as well as other substances that sensitize the tissues to the destructive action of these agents. Over a period of years the hapless smoker accumulates an increasing amount of tar, until some of the lining cells, which at first increase in number as a protective measure, finally become transformed into malignant cells, which invade local tissues and eventually metastasize.
Extensive research on tobacco was sponsored by The American Cancer Society. Also, momentous publications by the recent Surgeon General of the United States, especially his dynamic governmental Report on Smoking and Health, underscore clearly the detrimental effects of tobacco use and its potential for producing malignancy in vital organs. In spite of many medical and surgical advances in the treatment of advanced cancer, lung cancer still takes the lives of about 95% of its victims. Tragically, most cases are discovered too late for any hope of cure, although this disease is almost entirely preventable.
An individual developing cancer of the lung may have no symptoms at all until the cancer is far advanced. Others develop a cough that may be confused with the smoker’s cough of chronic bronchitis. At times the expectorated mucous may contain blood, a rather late sign in the development of this cancer. Some unfortunate cases have spread to involve vital blood vessels, the brain, or bones before adequate diagnosis has been made. Occasionally, the removal of the lung or part of a lobe may eradicate the tumor early enough to effect a cure.

CANCER of the UTERUS and CERVIX

Routine screening has decreases the incidence of cervical cancer in recent years. Called the “Pap smear”, this screening tool developed by Dr.Papanicoleau has allowed for the early detection of change in the cells of the cervix. Being less common in nuns, in Jewish women, and in those with less sexual activity, this type of cancer merits great interest from a preventive standpoint. A virus similar to the Herpes virus that causes cold sores has been implicated in the development of some of these cancers.
More and more nurses, as well as many midwives are learning how to take these smears, thus increasing the acceptance of the pap smear to many women as well as making the procedure more available. It certainly should be part of an annual examination from the time of marriage on through life. Early diagnosis with surgical removal of the uterus and cervix can well be curative.
Cancer of the lining of the womb (endometrium) is less common, but is still taking many lives. This has definitely been related to the use of estrogens, the female hormone used traditionally to lighten symptoms of the menopause.
Avoidance of these hormone preparations, as well as prompt medical treatment in the event of unusual menstrual flow can provide the early diagnosis needed. An outpatient procedure, using techniques similar to the pap smear (e.g. Vabra aspiration, or the Pipelle) can with less expense and discomfort provide the reassurance needed to evaluate this bleeding.

CANCER of the GASTROINTESTINAL TRACT

For the last three decades, cancer of the stomach has been decreasing in frequency in the United States. It remains high in Japan and certain other Oriental nations, and is probably related to the intake of certain foods, some highly seasoned, and others extremely hot. The second most common type of cancer in our country is cancer of the colon and rectum. This often produces a change in bowel habits, the stools becoming more constipated or of small caliber. Bleeding from the rectum is occasionally seen. This is usually red when the tumor growth is low in the colon and darker, brown to black (called melena) when the lesion is high in the colon or coming from the small intestine or stomach. This color change is due to the partial digestion of blood products by bacteria and enzymes in the bowel.
The rectal examination is helpful in detection of many cancers in their early stages. A ten-inch tube with attached light, called a sigmoidoscope can be used to look into the lower bowel, where nearly three-fourths of the cancers are seen. This should be done in conjunction with a complete annual exam for individuals over the age of 40. A new technology in fiber optic viewing, called endoscopy, has developed instruments that can examine the stomach and duodenum (gastroscopy), and the entire colon (colonoscopy).
These procedures are often done on an outpatient basis, and provide even more adequate confirmation than the traditional barium x-rays. The cause of these colon cancers is still somewhat uncertain. It is felt that a high fiber diet, which increases the rapidity of transit through the bowel, will decrease the incidence of cancer. This is probably because the waste products contain many toxins. In contact with the mucous lining of the bowel these can cause irritation and eventual malignant change in the cells. A number of foods, most notably meat, contains toxins (carcinogens) that can be directly associated with cancer. The benz-0-pyrene in a charcoal-broiled steak may be equivalent to that found in about 600 cigarettes. Methylcholanthrene is also a dangerous substance found in many types of meat. Recently discovered is the chemical malonaldehyde, which seems to be increased when the meat is cooked! Certain vegetables are not exempt from association with cancer. Moldy corn, peanuts, soybeans, and other seeds contain a factor called aflatoxin, which has been associated with liver cancer in several countries. It is interesting to note that the incidence of cancer is increasing in many fish that inhabit polluted streams and rivers. Problems with meat inspection also contribute to risk of cancer, in that certain portions of an animal carcass may be preserved for food, while another part of the animal may have actual malignancy.
All of these danger signals are turning more food buyers to a vegetarian diet. In fact the numbers are growing rapidly in the United Kingdom, where a disease called bovine spongiform encephalopathy was discovered in 1985. It will undoubtedly spread to other nations. Often called the “mad cow disease,” this condition results from using animal products such as a bone meal in cattle feed. The cows after a few years go crazy, and become violent. A virus-like particle called a PRION is found in the animal’s brain. Currently it is resistant to most germ killing procedures, including boiling, radiation, and disinfectants. Modern cancer virus research points out the “ounce of prevention” at your supermarket being worth much more than “pounds of cure” in the hospital. Another bit of good news in the treatment of cancer of the colon is that some types can be removed without radical resection of the organ. Many snares, cauteries, and forceps have been devised to remove these cancers from the rectum through the sigmoidoscope. Sometimes when the malignancy is present only as a growth on a stalk, the area involved can be followed with periodic examinations. Other times the removal of a portion of the colon is necessary to effect the cure. The possibility of metastasis to the lymph nodes or liver makes it important to achieve early diagnosis and therapy, if life is to be maximally prolonged.

BREAST CANCER

Cancer of the breast is the leading cancer among women in Western countries. It appears that this cancer is caused by one of several viruses and is increased in certain population groups. As mentioned before women who breast-feed their babies seem to be protected. Those with fibrocystic disease, a condition where the mammary glands enlarge and become engorged with sacs of fluid have an increased risk of breast malignancy.
Recent evidence points to the intake of caffeinated beverages, such as coffee, tea, and colas as factors in the production of this fibrocystic change. Beverage alcohol is believed to be one major risk factor in breast cancer. Men may also have breast cancer, but it is about 1/125th as common. Periodic self examination is an excellent aid to early detection of breast cancer, especially if it remains the same throughout the menstrual cycle.
A great deal of controversy is raging in the medical world concerning the best treatment for breast cancer. Some types seem to be adequately treated by locally excising the tumor. The removal of a portion of the breast obviously preserves normal anatomy and is far less mutilating than the more traditional radical mastectomy.
Many types of breast cancer are quite adequately treated and often cured by a modified approach removing the breast only, while preserving the muscles in the chest and dissecting the lymph glands in the arm pit only when the risk of metastasis is high. This to me seems like a much more “middle-ofthe- road” approach, avoiding the extensive mutilation and more serious
complications of the radical surgery commonly performed.

BENIGN TUMORS

Benign tumor growths, although not true cancers, share some of their same characteristics, such as viral causation, transformation of cells, and autonomous growth. A number of specific viruses are known to cause benign tumors. They are by far the most common of any new growths a person might have.
Warts are benign tumors that occur in almost any location. They are very common on the hands. However, in spite of folklore rumors, they are not caused by handling frogs! A wart virus penetrates the skin and transforms dermal cells causing this unusual growth. When it occurs on the sole of the foot, around the nail beds, or in the genital organs, it may be difficult to eradicate, even quite painful.
Warts can usually be frozen with liquid nitrogen, or may be removed chemically, such as with strong acids. Many physicians prefer to destroy the wart with an electric current (cautery) after appropriately anesthetizing the skin. Many of these can be successfully frozen or removed at home, if appropriate antiseptic precautions are observed.
Skin tags and papillomas are growths that protrude from the skin or mucous membrane. Some of these can be tied off with a strong silk string, while others with a larger base require local excision, freezing technique, or chemical cautery. Soft lumps of varying sizes under the skin are often lipomas, fatty tumors that usually develop autonomously in the fatty tissue beneath the skin. Sometimes for cosmetic reasons these are removed by a simple surgical procedure done under local anesthesia. Fibrous tumors (fibromas) and various types of moles also can be removed to prevent cosmetic blemish, irritation, or the avoidance of further growth.