Cancer

The Basics

For those of us who have had a cancer diagnosed, it can often be overwhelming and frightening. We know from experience, however, that cancer is a journey which can have surprising results. The treatment and expectations for many cancers are far better now than they were even a few years ago, and continue to improve. There’s also an enormous amount of complementary help and things we can learn to do in our own lives to get more benefit and less damage from our treatment. In addition to its dark and sometimes awful aspects, the cancer journey can be enlightening, love enhancing and bring great depth to living.

Our pages on cancer are intended as a clear and simplified guide to some of the information available. Combining advanced medical practice with supporting and complementary therapies makes it increasingly possible to do what the very excellent Penny Brohn Cancer Care (formerly Bristol Cancer Help Centre) describes as its goals:

• Have quality of life in the presence of illness
• Live well with cancer
• Have an impact on your own well-being and health

It’s because things have changed so much that we include cancer with the “chronic conditions” common to older people. The realism of the goals above mean that many cancer conditions are now effectively chronic, in that we can to learn to live well and have quality of life with them.

Let’s not pretend that most cancer has become a stroll in the park. It hasn’t. Sometimes, and for some forms, it can be an extremely hard journey. Our job here is to help you find your way as directly as we can to the knowledge, assistants, protection, and good discoveries you’ll need along the way.

Medical treatment will of course play an absolutely central role in dealing with any cancer. It will seek to stop or at least limit the disease, help to overcome the sometimes damaging side-effects of treatment, and deal aggressively with pain. We emphasise this and will say more about it because there is no point to being, and no need to be, in unnecessary pain. It can and should be alleviated. Advanced medical treatment is the bottom line. That said, cancer specialists and caring organisations are clear that Complementary Techniques and self-help are not side issues when it comes to cancer. The professionals who deal with it know from experience that there is no such thing as a separate body and mind. What we can learn to do mentally, emotionally and spiritually can both change the course of our disease and completely transform the experience of living with cancer. We are not talking about the far reaches of alternative thinking or religion here. The Bristol Approach is just one demonstration of the fundamental and medically accepted importance of complementary approaches.

How we’ll deal with Cancer

It’s important to have the factual basics, so we’ll start with a summary drawn from some of the sites and organisations we recommend. This will include information you may already have about what cancer is and the medical approach to it. Our medical overview of the cancer territory is broad and can never be completely up to date, but our Health Information we Trust lists provide easy signposting to sources we trust for further information.

Once we’ve laid out the medical territory, much of our focus will be on the Complementary Therapies and Self Help aspects of dealing with cancer. By this we mean techniques, lifestyle changes and learning which support and help improve the outcome of medical treatment. Everything from unavoidable fear to physical weakness gets in the way of healing. These are not side issues. They’re important. Dealing with them can promote healing from cancer, and also healing, deepening and getting more from our lives than we ever thought possible.

The sea of information about most chronic conditions is enormous, and can easily be confusing. The information available on living with cancer seems endless, often contradictory and of very variable quality. We will limit ourselves to sources we have reason to trust and be thankful for. If you think we’ve missed anything in focusing down like this, please let us know by contacting us here.

An age related disease?

Merck Geriatric tells us that: although cancer occurs in people of every age, it is fundamentally a disease of ageing. Sixty percent of new cancer cases and two thirds of cancer deaths occur in people 65 and over. Incidence of many cancers levels off after age 80, however, suggesting the possibility of resistance to the development of cancer in late life.

Using our Health Information we Trust list sources, let’s begin with a digest of factual essentials:

Older people and Cancer: It has been said that the only reason we don’t all get cancer in our later years is that most of us die of something else first. Half of all cancers appear in people aged 70 or over – so it pays to know your body and talk to your doctor about any unexplained symptoms, even if they only seem to be vague changes. Screening techniques can discover cancer developing at an early stage. Your GP can and will advise.

Health problems can be very intimidating and cancer is possibly the biggest taboo of all. It’s tempting to just not want to know. Life is tough enough without thinking about cancer. Big mistake. The earlier a cancer is diagnosed and treated, the more likely you are to be in a position of living very well with and overcoming it. Try not to put new symptoms or changes in your body down to “just my age” and ignore them.

Compared to the rest of Europe, people in the UK tend to have a more advanced stage of breast and bowel cancer by the time they are treated. There are a number of possible explanations for this (such as waiting times for hospital appointments) but one factor may be our national characteristic of being a bit reticent. In the case of cancer we need to start standing up for ourselves. We’re a durable and philosophical age group. We don’t need to be shy about this. We can save ourselves and the health service a lot of grief by telling our doctors about any unusual physical changes.

See a doctor if you notice:

• a lump, or a sore which does not heal, including in the mouth
• a mole which changes in shape, size or colour
• any abnormal bleeding
• a persistent cough or hoarseness
• changes in your toilet routine
• any unexplained weight loss

None of these mean you have cancer – but important to check. Some cancer screening has been turning up too many false-positives and unnecessary interventions. Nevertheless, please consider carefully with your GP.

We’ve heard people in our age group say that they feel or have been told that there’s little point or hope in seeking advanced medical treatment for cancer because they’re too old. You are never too old to be treated for any condition and that includes treatment for cancer. More about this later under Self-Help.

What Cancer Is

Our bodies are made up of cells that regularly duplicate and renew themselves in a controlled and limited way to stay healthy. If this process of healthy renewal goes wrong, some cells can grow out of control and start to harm the healthy tissues around them. With the body unable to correct the mistake this uncontrolled growth becomes cancer. If cells in the bone marrow start to duplicate out of control it’s called leukaemia. In all other parts of the body, the extra duplicating cells develop into solid lumps called tumours. Pretty much any part of the body can be affected by cancer.

A tumour is benign when it isn’t growing aggressively and affecting the healthy cells or tissues around it. The term malignant is used if a tumour is growing quickly and affecting other tissues. Cells can break off from a malignant tumour and start to grow in another part of the body, this is known as a secondary tumour.

Stages of Cancer

There are over 200 different kinds of cancer. Each kind is a separate condition with its own characteristics, but there are general terms like ‘staging’ used for most. The stages describe how advanced the progress of a cancer is. In many cancers there are four main stages:

Stage one: The tumour is very small and has not spread outside the original site. There are usually no symptoms and the tumour cannot be felt. Stage one tumours are normally detected by chance or during a routine medical examination.

Stage two: The tumour is still localised, but may be felt during examination or may show up on scans.

Stage three: A tumour which has spread to tissues immediately alongside the original site.

Stage four: A tumour which has spread more widely to other, often distant, organs such as the liver, lungs and the lymphatic system. This is known as secondary cancer, or metastatic disease. The cancer has metastasised, or spread.

Cancer Research UK has websites providing truly extensive information about the forms, diagnosis and medical treatment of cancer. Drawing from their information we can start to look at the crunch question:

I have Cancer. What am I dealing with and how can it be treated?

Cancers start to develop because some of the information carried in the cell’s DNA becomes altered in certain ways. This altered information can tell the cell to carry on and on growing and dividing instead of stopping. There are many different types of cells in the body and any of them can become cancerous, so there are many different types of cancer.

Because cancer cells carry on dividing, cancerous tumours grow. As the cancer grows, it invades the body tissues surrounding it. This is harmful to the body because it damages these surrounding normal tissues. The ability of cancer to spread further increase the harm and can make the disease extremely difficult to deal with. The staging system we describe is a way of describing how advanced a cancer is and whether spreading (metastasising) is a factor.

When cells become cancerous they don’t just keep multiplying out of control, they can also have a tendency not to hold together well. This means that they can spread and start to move around the body.

Some cancers are more likely to spread than others. Doctors know where cancers are likely to spread – different cancer types are more likely to spread to particular parts of the body. Because doctors know where a cancer is likely to go next, they may often attempt to prevent it getting there.

Causes of cancer may include genetic, environmental (sun, chemicals and other work environment hazards) diet, smoking, certain viruses and others. It seems likely that a number of different factors are often combined. Why did you get cancer and not someone else? Chance as much as anything. A combination of causes. A technical term Cancer Research UK uses is “ bad luck”, but… some things make it more likely that someone may be unlucky enough to get cancer. Some people have genes that make it more likely that they will get cancer. Some have genes that protect them. Things around us can also damage our genes and make a cell cancerous. This includes poisons in cigarette smoke and radiation. Age is a major additional factor. Genetic damage piles up over time, so just ageing can make cancer more likely.

Genetic malfunctions and damage leading to cancer can come in many forms. Some genes encourage cells to multiply or ‘double’. Normally, in adults, this would not happen very often. Cells would only multiply to repair damage, for example after a wound or operation. But if these genes become abnormal, they tell the cell to multiply all the time. These are referred to as oncogenes (meaning cancer genes).

Tumour suppressor genes exist in cells specifically to stop the cell multiplying or doubling. They act as the brake to the oncogene’s accelerator. If one of these ‘tumour suppressor genes’ becomes damaged and stops working, then the cell may carry on and on multiplying. In other words it becomes immortal, which is one of the properties of a cancer cell. The best known tumour suppressor gene is called p53. This gene normally stops cells with other damaged genes from reproducing and encourages them to commit suicide (apoptosis). p53 is damaged or missing in most human cancers. In addition, genes that normally repair other damaged genes can themselves be damaged.

It can take a long time before enough mutations happen for a cell to become cancerous. This is why many cancers are more common in older people. There has been more time to be exposed to all kinds of damage, and for accidents when cells reproduce.

Primary and Secondary Cancer

The place where a cancer begins is called the primary cancer. From there cancer cells can break away and be carried in the blood or lymphatic system to other parts of the body where they can start to grow new tumours. Cancers can also spread to nearby body tissues. For example, lung cancer can spread to the lining of the chest, the pleura. Ovarian cancer can spread to the lining of the abdomen (the peritoneum). Tumours from cancers that have spread are called secondary cancers. The areas of spread are called ‘metastases’, and a cancer that has spread has ‘metastasised’.

The various organs of the body are made up of different types of cells. Any of these cell types can grow into a primary cancer. Cancers from different cell types behave differently. They can:

• Grow at different speeds
• Have various effects on the body by releasing chemicals into the blood
• Be more or less likely to spread in the blood
• Respond differently to drugs or radiation treatments

Cancers can cause different symptoms in different people because of where they are located. A cancer may press on a nerve, or another body organ that is nearby. They can also cause symptoms by releasing chemicals or hormones into the bloodstream. The place where the cancer starts also affects what treatment can be used, because doctors have to take into account the risk of damaging neighbouring organs.

Grade of Cancer: The grade of your cancer refers to how well developed or mature the cell looks under a microscope. The more the cancer cell looks like a normal cell, the more it will behave like one. The more normal a cancer cell looks, the lower its grade. Cancer cells are more primitive and less well developed than normal ones, and tend to get increasingly primitive. A cancer cell is assigned a higher grade the more primitive and abnormal it is. Differentiation refers to the grade of cancer cells. A well differentiated cell is close to normal, grade 1. A moderately differentiated cell is more primitive and abnormal, or grade 2. A poorly differentiated cell is primitive, very poorly developed and abnormal, or grade 3.

Although there are several ways of talking about grade and differentiation, it all comes down to the same thing. A low grade cancer is likely to be less aggressive in its behaviour than a high grade one.

Types of Cells / Types of Cancer

Over 200 kinds of cancer. We will not waste time cataloguing them. Let’s just say that they have similarities. There’s one disease called cancer, not many diseases. That said, different cancers behave differently and have very different meanings in terms of your health and what you can expect. Cancer is one disease, but some forms once treated may have little impact on your ongoing health. Others may have a very big impact, and some may not be effectively treatable other than in terms of protection from pain and dealing with symptoms and quality of life.

Briefly and in the spirit of overview, cancer type is determined by the type of cell which has become cancerous:

Epithelial Tissue is basically skin tissue that covers and lines the body. As well as covering the outside of the body, epithelial cells cover the inside too. They cover all the body organs, for example the organs of the digestive system and line the body cavities such as the inside of the chest cavity and the abdominal cavity. Most cancers are cancers of the epithelial cells. Cancers of the epithelial cells are called carcinomas. Carcinomas make up about 85% of all cancers.

There are different types of epithelial cells and these can develop into different types of cancer. For example, epithelial cells can be:

• Flat surface covering cells called squamous cells
• Glandular cells called adenomatous cells
• Layers of stretchy cells called transitional cells

So you can have:

• Squamous cell carcinoma
• Adenocarcinoma of glandular cells
• Transitional cell carcinoma

Squamous cells and adenomatous cells are found in most body organs. Cancers are named after the body organ they grow in as well as the type of cell. So a cancer of the squamous epithelial cells covering the lung would be ‘squamous cell lung cancer’.

Connective Tissue is the name for the supporting tissue of the body, the bones, cartilage, tendons and fibrous tissue that supports the body organs. Connective tissue cancers are called sarcomas. Sarcomas can develop from
bone, cartilage and muscle.

Sarcomas are much less common than carcinomas. They are usually grouped into two main types – bone sarcomas and soft tissue sarcomas. Altogether, these make up less than 1 in every 100 cancers diagnosed (less than 1%).

Blood and Lymph Tissue – There are many different types of blood and lymph tissue cells. These are really specialised connective tissue cells. The blood cells are made in the bone marrow in tissue called haematopoetic tissue. Blood and lymph tissue can develop into

• Cancers of the blood cells – leukaemias
• Cancers of the lymphatic system – lymphomas

Leukaemias and lymphomas make up about 7% of all types of cancer.

Other Body Tissue cells can become cancerous. But these types of cancer are very rare. The biggest group of these rare cancers are brain tumours. Brain tumours develop from the cells that support the nerve cells in the brain, called glial cells. These cancers also get their names from the cells they developed from. So cancers of the glial cells are called gliomas.