I am due to have a major operation to remove a cancer. I am very worried, because I am diabetic and need to eat regularly. Does this mean I won’t be able to have the surgery?
No. Diabetes is a common condition and surgeons are used to operating regularly on people who are diabetic. Usually they will put up a drip, into a vein in the arm or back of the hand, before the operation. This will then be used to give insulin and sugar solutions to keep your blood sugar at the correct level throughout the operation and will continue until you can eat and drink normally. Throughout this time your blood sugar level will be regularly checked and the drip adjusted as necessary. This means it will be perfectly safe for you to go ahead with the surgery that you need.
My relative has been told that their treatment is no longer working and that there is nothing more that can be done, they have had lots of different treatment. Is this right, what about all the treatments I read about in the papers?
Understandably, ‘nothing more to be done’ is a phrase that can cause alarm, despondency and despair. So it is important to be clear just what this means. It isn’t the end of care and support for your relative. What it does mean is that their specialists do not think there is any treatment left that has a reasonable chance of actually controlling the cancer. There is no further ‘active’ treatment, that is treatment which is given to contain or reduce the cancer, that they can usefully offer.
This decision will change the emphasis of your relative’s medical care from ‘active treatment’ to ‘supportive care’. Their GP, Macmillan nurses and the team from the local hospice team will become more involved and you may find that the hospital will play a smaller part than before.
The emphasis of care is attention to easing, and preventing, upsetting symptoms of the cancer and giving practical support, both physically and emotionally, to your relative and the family. Quality of life will become most important and, perhaps surprisingly, people with advanced cancer often find that at this late stage of their illness their quality and enjoyment of life can actually improve.
Part of this improvement can be because they no longer have the
inconvenience of regular hospital visits and tests and the physical
effort and burden this may involve when faced with an advanced cancer.
Less disruption to a person’s daily life, and not having to cope with
the often unpleasant side effects of treatment can be a benefit,
particularly if the treatment is not helping to control the cancer.
It is natural to feel despair when the specialists say there is nothing more that can be done. So your question is one that is frequently asked. Very often, however, it is asked by relatives and not by the person who actually has the cancer. Sometimes this is because that person has come to terms with their condition and is quite willing, and possibly even relieved, to go along with the change in their care. At the same time their relatives, with the best of intentions, still feel they shouldn’t ‘give up’ and that ‘something must be done’. If your relative is still looking for active treatment there are two things they can do.
The first is for your relative to talk to their specialist (a phone call to his or her secretary should easily arrange this). They can ask about any experimental treatments and clinical trials that may be suitable. It may be that they will say there really is nothing to be offered or they may tell them about new or experimental treatments which are being tested at another hospital and might offer to refer your mother there for advice.
There are always new drugs and treatments being tested for cancer, unfortunately many of these do not prove to be successful or the benefits are likely to be small. Despite this reality, many new experimental treatments do get enthusiastic reports in the media, which all too often raise false hopes for patients and their families. Sadly this happens frequently.
However having active treatment helps some people feel positive and hopeful even though they know the chances of benefit are small. People sometimes find it easier to cope if they feel they are doing something active to try and treat the cancer, and many people are also happy to be contributing to the advancement of knowledge about cancer and its treatment. The downside is the disruption, and possible distress, from treatment and its side effects that your relative might have to go through. Also, even when there is a response to these treatments it is, at best, usually a matter of prolonging life by a few weeks or months.
If your relative doesn’t want to see the specialist, or if they feel the interview was not satisfactory, then the second thing you or they can do is ask the consultant or GP to arrange a second opinion from a consultant at another hospital. Doctors are usually happy to do this, as they appreciate a persons need to find any available treatment that may help. Even if you do this, however, it is likely that the new specialist will not be able to offer anything more. But at least you will then know that they have explored every possible avenue for their future care.
My husband has been told he has incurable cancer. I have asked the doctor how long he might live but his answers seem very vague. Why can’t he be more precise?
When someone has incurable cancer it is very natural that their relatives want to know how long they might live for (even if the patient themselves does not want to know) so that they can plan and start to come to terms with such a distressing situation.
Unfortunately it is usually difficult, even for the most experienced cancer specialist, to give an accurate answer. This is because every patient is a unique individual and will be affected differently by their illness. Even two people of the same age, with the same type of cancer, which has spread to the same extent, can have very different survival times. This can happen because many other things influence survival including general fitness, will power, the response to treatment and the development (or avoidance) of unexpected complications.
Despite all this, if the doctor knows the type of cancer and how far it has spread then they will be able to offer ‘average’ figures for life expectancy. But, very importantly, these are only averages. This means that some people will live a little longer, and a few will live a lot longer, than predicted, whilst others may survive a shorter time.
So, in many ways, even an expert opinion of life expectancy for any individual patient is little more than informed guess.
Sometimes, however, even if doctors explain the uncertainties, patients and their relatives will still put great faith in the time they have been given. (This can then lead to problems if someone deteriorates sooner than expected).
Because of this uncertainty some doctors are reluctant to offer survival times to their patients (or to relatives). Most specialists, however, will be prepared to discuss the issue, realising that people do need some idea of time scales in order to plan their lives and cope with things. But their advice is still only a guide to what might happen and not a precise forecast of what will happen.
Anal cancers are rare with only about 300 new cases in the UK each year.
Despite the small numbers several different types of cancer can occur in the anal region.
The majority of these (more than 4 out 5) arise in the lining cells of the wall of the anus or the skin around the opening of the anus (the anal margin). These cancers are called squamous carcinomas.
In the past pathologists have described several types of cancer which when seen under the microscope look slightly different from normal squamous carcinomas. These include transitional, cloacogenic and basaloid carcinomas. Despite their differences in appearance these growths all seem to behave exactly like squamous carcinomas and so are treated in exactly the same way.
Other cancers that may occur in the anal region include adenocarcinomas, malignant melanomas and basal cell carcinomas. These cancers do behave differently to the squamous carcinomas and require different approaches to treatment.
My mother has been told she has a squamous cancer in her anal canal. Her doctors have recommended a long course of radiotherapy and chemotherapy. Wouldn’t an operation be better?
The anus is the name for the muscular area at the end of the large bowel. It includes the muscle, which opens and closes to control bowel movements, and is where the bowel opens to the outside. The internal part of the anus is called the anal canal.
The anal canal is quite short, being a cylinder of tissue about 2-3 centimetres long (about one inch). This means that any operation to remove a cancer of the anal canal will have to take away the whole of the anal canal to be sure of clearing the growth. This surgery includes the removal of the muscle controlling bowel movements and so leads to permanent incontinence. Because of this a colostomy is always necessary afterwards (this involves bringing the end of the bowel out on to the front of the abdomen and having a bag to collect the faeces). The skin where the anus was is then sown together.
This is obviously quite a big operation and also has the disadvantage that your mother would be left with a colostomy for the rest of her life.
During the 1980s doctors wondered whether giving radiotherapy, together with chemotherapy, might offer an alternative to surgery for squamous caricnomas of the anal canal. Clinical trials have now shown that the chance of cure with this non-surgical treatment is every bit as good as with an operation. Although it does involve quite a lot of treatment over a period of several months it does, of course, avoid the need for a colostomy.
Another point worth bearing in mind is that if your mother was one of the unfortunate minority of people for whom the radiotherapy and chemotherapy failed to completely clear the cancer, so that it came back at a later time, then an operation could always still be done, giving another chance of a cure.
My uncle has been told he has an anal cancer. A friend has said these cancers are caused by a virus. Is this true?
Cancer of the anus is quite rare with only about 300 new cases in the United Kingdom each year. Like most cancers the cause for the great majority of anal cancers is unknown.
A minority of anal tumours are, however, associated with infection by a virus called the human papilloma virus (HPV). This virus can cause warts in the genital area and very occasionally, often after many years, a cancer may develop in one of these warts. Anal cancer is commoner in the receptive partners of anal intercourse and HPV infection may be a factor in this.
Anal cancer is also commoner in people who have AIDS. No one is sure whether this is due to the presence of the HIV virus (the human immunodeficiency virus, which causes AIDS) or whether the reduced immunity of AIDS patients makes them ore at risk to the possible cancerous effects HPV.
My mother has been told she has an anal cancer. At her first visit to hospital the doctors had quite a long talk about whether she had an anal canal or anal margin cancer. We did not really understand what they were saying. Can you explain?
The anus is the name for the muscular area at the end of the large bowel. It includes the muscle, which opens and closes to control bowel movements, and is where the bowel opens to the outside.
The internal part of the anus is called the anal canal. It is a cylinder of tissue about 2-3 centimetres long (about one inch). The patch of skin immediately around the opening of the anus is known as the anal margin. Sometimes doctors talk about the point where the anal canal and anal margin meet one another as being the anal verge.
Anal cancers are quite rare, with only about 300 new cases each year in the United Kingdom. The great majority of these tumours will develop in the anal canal but about 1 in 5 will be in the anal margin.
It is important for your mother’s doctors to be certain whether her cancer is in the anal canal or anal margin as the treatment of the two types of tumour can sometimes be different. Most anal canal tumours will normally need a course of radiotherapy and chemotherapy, which usually results in most people being cured, but an anal margin tumour, if it is small, can often be treated with a minor operation.
I am having chemotherapy for a bowel cancer. They are giving me 5FU and folinic acid. I asked my doctor what folinic acid was and he said it was a vitamin. How can a vitamin help treat my cancer?
For about fifty years 5FU (5-fluorouracil) has been accepted as the
most effective chemotherapy drug for the treatment of bowel (colon)
5FU works by blocking an enzyme in the cells. The blockingof this enzyme means that cells are not able to correctly make the nucleic acid DNA, which they need in order to reproduce. This can then lead to a slow down in the growth of the cancer.
During the 1980s it was discovered that giving folinic acid (also called leucovorin), which is a form of the vitamin folic acid, increased the duration and extent of 5FU’s blocking of this enzyme. Clinical trials have since confirmed that giving 5FU with folinic acid in the treatment of bowel cancer is more effective than giving 5FU on its own.
I had an operation to remove a cancer of my large bowel a year ago. I am now getting low back ache. Does this mean the cancer has come back?
Backache is a very common problem and has many causes other than cancer, so chances are that your back problems have nothing to do with your previous tumour.
It is possible, that your backache could be due to the cancer. This could happen for one of two reasons. Either because invisible, microscopic remnants of the tumour which could not be detected, and had not been completely removed at the time of the original surgery have started to regrow (a local recurrence of the tumour), or because of minute seedlings of tumour which had spread to the bone before your surgery, forming secondary cancers in the bone, which have now begun to grow. Secondaries to the bone are, however,very uncommon in colon cancer.
It is important to make sure that the backache is not related t the colon cancer, both for your own peace of mind and to get the right treatment to make things better. So do see your doctor as soon as possible and get his or her advice on the problem.
My mother has been told she has a bowel cancer. What is the bowel and which bits of it can have cancer?
The bowel is made up of the intestines which join the stomach to the anus. The intestines are in two parts, the small intestine (or, small bowel) and the large intestine (or, large bowel). The large intestine also has two parts, the colon and the rectum.
The small intestine is a narrow tube made up of layers of muscle, lined with a moist mucous membrane. It is five or six metres in length and lies coiled in the abdomen. As partly digested food from the stomach passes along the small bowel essential nutrients are taken from it and pass into the body. Cancers can develop in the small bowel but they are extremely uncommon.
The first part of the large bowel is the colon. This joins the large bowel low down in the abdomen on the right. This first part of the colon is often called the caecum. The colon then runs up the right side of the abdomen to the level of the diaphragm (the muscle that separates the chest from the abdomen). This part of the large bowel is called the ascending colon. It then runs across the top of the abdomen as the transverse colon. Next it turns and lies down the left side of the abdomen and is called the descending colon. The last part of the colon is a short curved passage at the lower part of the abdomen linking the colon to the rectum and this is called the sigmoid colon. The rectum is the last 20cm or so of the large bowel which joins the colon to the anus, where the bowel opens to the outside.
Like the small intestine, the walls of the large bowel are made up of layers of muscle, lined with a moist mucous membrane. As the undigested, liquid, remains of food pass along the large bowel water is taken from them to make them increasingly more solid, finally forming the faeces, or stool, which is stored in the rectum.
Both the colon and rectum are common sites for cancer. In the United Kingdom each year there are almost 20,000 new cases of colon cancer (which is slightly commoner in women than men) and almost 12,000 new cases of rectal cancer (which is slightly more common in men than women). By contrast there are less than 500 new cases of cancer of the small intestine discovered each year.