Not All Cancers Are the Same

It looks like I am really dumb trying to write an article with such a title. Everyone knows that there are many different types of cancers. Some people have breast cancer, others have lung, liver or brain cancer. Who doesn’t know that all these are different cancers? Yes – you are right on this score, at least on the first level. However, know this – that the more you know, the more you don’t know! Let’s see what you may not know when we start to “dig in” deeper .

  1. Cancer is not a single disease. Cancer has one name, but many illnesses. It is not a single disease but probably a mix group of more than 200 different diseases. By definition, a disease is called cancer when the cells have lost their ability to control their rate of duplication. Secondly, a cancer has an abnormal ability to spread to distant sites. 
  2. Different cancers in different organs are different. For example, skin cancer is different from liver cancer. Everyone should know this!
  3. Not all cancers that develop in the same area of the body are the same. This is what I mean by “not all cancers are the same”. For example, not everyone with breast cancer has exactly the same type of cancer, meaning not all breast cancers are the same. Similarly, not all cancers in the brain are the same and not all lung cancers are the same.

The following two statements are very important aspects of cancer which we all need to know.

     4.  Not all cancers have the same growth rates – some are fast growing while others grow slowly.

     5.  Not all cancers eventually grow out be become full blown cancers that can kill us.

The above statements can best be explained by the diagram below:

Source: Gilbert Welch, Should I Be Tested for Cancer? pg.55

  1. The arrow labeled “Fast” represents a fast growing cancer. This type of cancer can quickly cause problems and kill us fast.  No treatments can save us from this type of cancer.  No matter what we do, we will die.
  2. The arrow labeled “Slow” represents a slow growing cancer. It takes some years to cause us problems and eventually kill us. With treatment we may be able to influence or modify the path and outcome of disease. This is the type of cancer we hope can be helped by treatments – be it medical or alternative therapies.
  3. The arrow labeled “Very Slow” represents a cancer that never causes problems because it grows very slowly. This cancer grows slowly enough that we may just die with the cancer (not die because of the cancer). We may die of other reasons, such as heart attack, diabetes, accident, etc.
  4. The arrow labeled “Non-progressive” represents a cancer that NEVER causes problems because it is not growing at all. In other words, they are only cellular abnormalities. The “experts” say we have something that meets the pathologic definition of cancer. Such “cancer” may even stop growing or perhaps even shrinks or disappear later in our life. We don’t have to treat such harmless “cancer.”

From the above it is clear that all cancers are not created equal. Some grow rapidly and invade other tissue, others grow slowly and remain non-invasive, and some don’t grow at all or may even recede. Unfortunately doctors will not be able to know with absolute certainty which cancer belong to which type although they do carry out some tests to try and differentiate them.

I am indeed glad that I got to read and understand this idea in Dr. Gilbert Welch’s book, Should I Be Tested for Cancer?    

Implications for Treatment of Cancer

Now we have a few more things “on our plate” and let us think critically.

  1. Not all cancers are the same – agreed? Some need to be treated aggressively some need gentle treatment while others may not need treatment at all (i.e. just wait and see!)
  2. In the same way, can we say that not all cancer patients are the same? Different people will react to treatment differently.
  3. In more of the same way, can we say that not all cancer doctors are the same? Yes? Different doctors do and also tell us different things about a cancer. Different doctors offer different approaches to solving the same problem. No?

Where do these statements lead us to then?

  • First, it appears to me the appropriate word to describe the situation is UNCERTAINTY – in cancer, nothing is predictable – there is no black or white answer. Every cancer is a different shade of gray.  Is it not chaotic, having to deal with different cancers, different doctors and different patients all at the same time? It is like going into a race, each fighting for his / her own survival.

  • Second, a cancer treatment that works for one patient need not necessarily work for another patient. And yet we are being taught that modern medicine is proven and scientific. They give you a one-size-fits-all-treatment. No?

I often wonder and ask myself.

Patients ask their doctors if the chemo-drugs that they are about to receive for their cancer are going to be effective or not. Often the answer given is, “There is no guarantee! Just try and it all depends on the person.” Such answer sound rather odd, primitive and even unscientific!  Why do I say this? Oncologists administer chemo to hundreds of patients everyday or every month. And they have been doing this for years. In other words, they have been administering this treatment for years to thousands and thousands of their patients.  I would want to believe that in their hearts, they can sense (and know for sure) that what they are doing is going to be effective or not. After all they have the blood test results, CT scans, MRI or/and PET images to guide them.  I am sure there must be a certain “feeling” in them  or their sixth sense, to say that based on their vast experience what they are about to do is going to be helpful or not. But in spite of that, patients often get this standard answer, “I am not sure. I cannot guarantee. Let’s try.”

I understand why oncologists provide evasive answers. Initially I thought they have to safe guard their rice bowls.

 

But now I understand. Their answer reflects the reality of the complex situation. How can anyone know the exact outcome of the treatment when the cancer is actually different even if it is given the same name called cancer? To make things more difficult, the patients are also different – they react differently to the treatment.  Doctors treating the disease are also different.  The only same thing is the poisonous chemo-drug.

Because of complex variables involved we see that some patients survive while some patients die even before the cancer is done with; some are “cured” while for others the cancer spread to other organs.

Unfortunately, no one is able to predict with absolute certainty what is going to happen after the treatment is administered to a patient.  No one is sure of the real “ingredients” that make good successful treatment. One patient was told, “It depends on the One Upstairs!”  Now, they say it all depends on God!

 

 

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