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CANCER: THE STORY OF ONCOGENES

admin — Sat, 26 Mar 2011 11:27:17 +0000

Oncogenes (literally ‘cancer genes’) were first discovered in the genetic material of viruses that are capable of causing cancers in animals. The immediate importance of oncogenes in human cancer became clear with the discovery that most of the virus oncogenes had very close relatives that were present in the normal cell.
• A particular type of gene was first discovered in viruses that can cause cancer in animals by altering the cells in the animals which they infect.
• These genes were then found to be closely related to genes in normal human and animal cells.
• Such genes are called oncogenes.
• It is now known that our oncogenes normally control the proliferation and differentiation of our cells in a beneficial way.
• It is now also known that if our oncogenes become altered or disordered, they can contribute to the development of a cancer.
• Alterations in oncogenes can be brought about in a number of ways.
• It is thought likely that at least some of the ’causes of cancer’ that we shall identify, such as smoking and radiation, produce cancer by altering oncogenes and other genes.
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DETECTING CERVIX CANCER

admin — Fri, 31 Dec 2010 11:12:15 +0000

Abnormal vaginal bleeding is the main symptom that causes a woman to present with a cancer of the cervix. This can occur in the middle of a period, it can occur following the menopause, or after intercourse because of scraping of the cancer in the cervix by the penis.
Vaginal discharge, which can often have a foul smell, can also occur. In late stages, pelvic pain due to infiltration by cancer of the nerves and the ligaments supporting the cervix may happen.
The doctor when doing a vaginal examination can usually see cancers of the cervix. A tiny biopsy, sometimes called a ‘punch biopsy’, is taken in the doctor’s office to confirm the diagnosis. Sometimes the cancer is not visible, and is usually diagnosed when a Pap smear comes back as abnormal. In these cases a ‘cone biopsy’ or ‘loop excision which takes a bigger sample of tissue is performed under anesthetic and the cancer is found in the removed tissue.
Before treatment is undertaken, further investigations are performed to determine how advanced the cancer is i.e. what stage the cancer is at. Several tests will be done which involve at least a chest x-ray, kidney x-ray and examination under anesthetic so that the bladder and rectum can be checked. If the equipment is available, a CT scan, MRI scan or PET scan will be undertaken.
If the tumour seems confined to the cervix and/or upper vagina, and is less than 4 cm in diameter, a radical hysterectomy and pelvic lymph gland removal is undertaken. The term ‘radical’ means that the surgeon operates widely around the possible area of involvement or extension of the cancer. Supporting ligaments of the cervix are removed, which involves displaying the tubes coming down from the bladder to the kidneys and making sure that they are not damaged as a result of this surgery. The upper vagina is also usually removed so that any microscopic spread, which is not visible to the naked eye, is removed with the specimen.
If the cancer has spread to the lymph glands, or the tumour has been found to be invading areas near the cervix, then pelvic radiation therapy combined with chemotherapy is usually given. In some cases, even when there is no obvious spread, radiation and chemotherapy are still used because there is a high risk of the cancer coming back in the area of the hysterectomy.
When the cancer is diagnosed later, i.e. when it is more than 4 cm in diameter or has spread to local organs, such as the middle or lower vagina, or the ligaments supporting the cervix, then the treatment is usually radiation therapy. This is given in two ways. The first is external therapy to cover the whole pelvis including the areas where the lymph nodes are located next to the pelvic bones. Nowadays, chemotherapy is given at the same time. The second is an internal treatment after the primary tumour has shrunk down to deliver high dose radiation directly onto the cervix itself.
If the disease recurs, then treatment is usually palliative and aimed at prolonging and improving quality of life. If it recurs after surgery in an area that has not previously been irradiated, then chemotherapy and radiation therapy is the treatment of choice and may cure some patients. If it recurs in the middle of the pelvis after chemotherapy and radiation therapy it may be curative. If the area is not able to have radiation, such as the lung or the liver, then chemotherapy may be given. The balance between the side effects and benefits of chemotherapy needs to be discussed extensively between the patient and the doctor.
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WEIGHING COST AGAINST BENEFIT

admin — Mon, 18 May 2009 07:01:34 +0000

Say you have a cancer that fulfills all the conditions I have described—one for which cure by surgical removal seems possible. Perhaps you are prepared to pay any price at all for any chance at all of cure. If not, you still need to weigh the likely benefit against the likely cost before agreeing to the ODeration.

Check the questions I listed at the beginning of this chapter. What is the chance of cure? What other ways, if any, are there of achieving a cure? Some cancers which can be cured by surgical removal can also be cured by radiation treatment. Surgery has certain advantages—diseased tissues are actually seen, removed and examined under the microscope for completeness of removal. There is no equivalent way of being sure that radiation treatment includes the whole of the primary cancer. Surgery takes a few hours and a week or two in hospital, radiation treatment can take six to eight weeks. On the other hand, radiation treatment can be less mutiliating. For example, patients with cancers of the tongue, lip, throat, larynx (voice-box) and breast are likely to be much less disfigured if treated with radiotherapy than if treated with surgery.

Ask whether your chances would be improved by combining surgery with other forms of treatment. Radiotherapy and chemotherapy are very specialised types of treatment so your surgeon will probably not know a lot about them. Ask to be referred to these specialists if you suspect or know that they could play a useful part in your treatment.

Make sure you have answers to all of the questions at the beginning of this chapter before making your decision. Surgery aimed at curing cancer should not be rushed into but, rather, carefully planned. This means there should be plenty of time to get all the information you need.

Consider every aspect of the possible ‘cost’ and benefit that is important to you, not just what your surgeon accepts as important. You are the one who will be stuck with any disfigurement, discomfort or inconvenience, not your surgeon! Anything you think is important, is important. Don’t be talked out of what you know about yourself.

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