The Cancer Directory. Dr. Daniel Rosy
If you are unsure about what to do, ask to see the consultant again or seek a second or third opinion
• Take steps to prepare and support yourself and your immune system throughout your treatment programme (see Chapter 7).
The main treatments used currently for cancer are:
• surgery
• radiotherapy
• chemotherapy
• hormone therapy.
Surgery
Often, the first step in cancer treatment is surgery. The aim of cancer surgery is to remove the whole tumour, leaving behind as much of the normal tissue as possible. The tumour must be removed in its entirety for the operation to be a success and the pathology department must find that there are clear margins of healthy tissue around the entire tumour. If not, then further surgery will usually be recommended.
You may have heard that operating on a tumour can encourage it to spread. That is a consideration your surgeon will take into account, and great care will be taken to minimize the risk of spread during surgery. If your surgeon thinks this might have occurred, he may well recommend that you have follow-up systemic treatment, such as chemotherapy, to take care of it.
Both orthodox and integrated cancer doctors agree that the risk of cancer spreading during surgery is far outweighed by the risk of leaving the tumour to continue to grow, metastasize and cause further problems. New evidence also shows that existing tumours secrete proteins that can facilitate secondary growth in other organs. So, the removal of all possible cancer from the body is vital.
Success with cancer surgery comes from knowing exactly how much tissue needs to be removed, so an accurate assessment of tumour size and shape is essential before deciding on the type of operation for your particular type of cancer.
Cancer Surgery: The Key Issues
• Find out what sort of operation is being proposed.
• Establish how experienced and skilled at this type of surgery your surgeon is.
• Find out if there are any new developments in surgery for that operation.
• Find out how long you will need to be in hospital and need to take off work afterwards.
• If you are having surgery done privately, make sure you know all the costs involved.
• If you have health insurance, make sure in advance that all the fees will be covered.
• Do not sign the consent form to surgery unless you fully understand what is being proposed and the potential long-term side-effects.
• Make sure you are prepared physically, psychologically and practically before you undergo the operation (see Chapter 7).
If you are told your tumour is inoperable, you should certainly consider getting a second or even a third opinion. There may be a great variance in opinion, depending on the particular surgeon’s skill and experience, and certain hospitals specialize in certain types of cancer. You may find a surgeon who is specialized in your particular type of cancer and is highly skilled in removing difficult tumours. For example, some neurologists will operate to remove bony secondary tumours from the spine and reconstruct the vertebra using a titanium prosthesis whereas, in other places, only radiotherapy is on offer. Your scans and X-rays can also be sent to specialists in other countries for their opinion of the possible surgical help for more complex tumours.
Following Surgery
If your tumour has been completely removed and no spreading to other tissues is detected, you may not need follow-up treatment. However, you will usually be offered either or both radiotherapy and chemotherapy, as well as hormone therapy if your tumour is hormone-dependent.
Radiotherapy
Radiotherapy uses ionizing radiation in the form of X-rays to treat cancer. Wilhem Roentgen discovered X-rays in 1895. Within a year, they were being used in the treatment of cancer. We have come a long way since then, and radiotherapy for cancer treatment is now incredibly sophisticated. Often, radiotherapy is given to effect a complete cure – called radical radiotherapy. Alternatively, it can be used after surgery to ‘mop up’ any stray cancer cells persisting around the operation site. Another important use of radiotherapy is for symptom control in palliative care.
Types of Radiotherapy
The most common type of radiotherapy is the use of an external radiation source produced by a linear accelerator, a large machine that delivers a precise dose of radiation to a particular site of the body. An alternative form uses internal radiation, where a radioactive source – such as radioactive needles or ‘seeds’ – is temporarily placed in the part of the body affected by tumour, such as the womb or prostate gland.
Different types of X-rays are used as each has a different level of penetration. Laboratory evidence tells us that radiotherapy works by damaging DNA in the nucleus of rapidly dividing cells. The DNA molecule has a particular sequence, creating a vital code for proteins that have important functions both inside and outside the cell. Radiation breaks the ‘backbone’ of the DNA molecule so that, when the strands join back together, the coding sequence is altered, resulting in the cell’s death. It only affects cells that are reproducing, which is why radiotherapy is given in multiple doses – to catch the cells at different phases of their growth cycle.
Radiotherapy damages cancer cells whereas normal tissue is usually able to repair itself. We have learned how to exploit this difference, and establish a balance between destroying cancer cells while causing minimal damage to normal tissues. Also, the delivery systems for radiation are now so precise that it is almost possible to irradiate only the tumour. However, if the individual survives for some time after radiotherapy, it is possible for a new, different second cancer to arise as a result of the radiotherapy treatment.
The Radiotherapy Process
A consultant radiotherapist will be in charge of your radiotherapy treatment and will help with decision-making. So, discuss any problems or questions you have with him. When receiving radiotherapy, the radiographers who deliver the treatment will see you on a daily basis. They are an excellent source of information and can often be far more helpful than the consultant. Despite a lot of adverse publicity, radiotherapy is a remarkably safe form of treatment. There are clear guidelines for the calibration of the machines, and it is a legal requirement that the machines be frequently checked.
Having decided on radiotherapy, the next part of the process is the planning. This is usually done on a machine called a ‘simulator’, which simulates your treatment on the X-ray therapy machine to set up the exact position of the intended treatment. The area to be treated is marked on your skin with an indelible pen so that the markings last throughout the treatment period. However, if the areas are complicated or where marks are unsightly or less likely to stay put, a perspex shell can be contoured to fit your body precisely and act as a marker. This shell can also prevent even the slightest movement during treatment so that the X-ray beam only strikes those tissues it is supposed to hit. If intended for the head, holes are cut out of the shell to leave your eyes, nose and mouth uncovered.
As no two individuals are the same, do not be alarmed if you compare notes with others and find that your radiotherapy is different from theirs. There are all sorts of reasons for this. If you are at all worried, question the