About Cancer

Radiotherapy uses a type of radiation, called ionising radiation, to destroy cancer cells. There are several types of ionising radiation including x-rays, gamma rays and beta rays.  Most radiotherapy treatment for cancer use x-rays.

Ionising radiation works by releasing chemicals in the nucleus of cells. These chemicals, called free radicals,  damage the DNA, the genetic material that is vital for the cell to multiply.  If the DNA is sufficiently damaged by the radiation then it will not be able to divide and will die off.

In order for the radiotherapy to release the free radicals that damage the DNA there needs to be a good supply of oxygen in the cells.   If the cells are starved of oxygen then this actually protects them against the effects of the x-rays and makes treatment less effective.

Oxygen is carried to the tissues and cells in our bodies by the haemoglobin in the red blood cells. If we are anaemic then the haemoglobin level in the blood is low, and so the amount of oxygen carried by the blood to our cells is reduced.

So in order to get the best results from a course of radiotherapy it is important to be sure that you are not very anaemic before you start treatment. 

If you are anaemic then your doctors may well suggest a blood transfusion before you start your treatment.  This will boost your haemoglobin level and will increase the oxygen in your blood, which will increase the chances of success from your radiotherapy treatment.

Very often when a cancer is treated the treatment will take away all evidence of that cancer: symptoms will disappear, physical examination and special tests (like blood tests and scans) will all go back to normal. All the appearances will suggest that the problem has been cured.


But sometimes there will be microscopic traces of the cancer left behind. Because they are so tiny these traces will not cause any symptoms and they will be too small to show up on even the most careful of examinations and most sensitive of special tests. These tiny clusters of cancer cells may lie dormant for months or years but may eventually grow and the cancer may come back.

Since these minute cells that might have been left behind cannot be detected in any way it is impossible to give an absolute guarantee that a cancer has been cured after treatment.

Having said this, very many people are cured of their cancer by modern day treatment. The chances of getting a cure depend on the type of cancer that someone has, how advanced (how large it was and how far it had spread) at the time it was first discovered (this is sometimes known as the ‘stage’ of the cancer) and how well that cancer responds to treatment.

There are now masses of statistics which doctors can use as a guide to predicting the chances of a cure for any particular cancer at any particular stage. These show that for some of the more curable types of cancer the chances of the cancer coming back after treatment are very small indeed, particularly if it was discovered at an early stage. Whereas for other types or  cancers diagnosed when they were more advanced, the outcome is likely to be poorer.

These figures are only ‘statistics’ which means they cannot absolutely predict what will happen to an individual but they do give a good idea of the ‘chances’ of whether, or not, someone will be cured. So doctors rely on these figures for deciding what the likely outcome is for each person at the end of their treatment.

These days many many people are cured of their cancers. So if your doctors have given you the ‘all clear’, although there is no absolute way of proving they are right and guaranteeing you are cured, they obviously think your chances of success are excellent and you should look forward to the future with confidence.

Despite the advances that have been made in the treatment of cancer there are still many tumours that cannot be cured. In these situations it often possible for different treatments to stop the growth and spread of the cancer, or even to shrink  it for a period of time.

Depending on the type of cancer and treatment which has been given this period of time when the tumour is no longer growing may last from a few weeks to a number of years.During this time the tumour is said to be  under control or ‘stable’. 

Other phrases which are sometimes used to describe this situation are ‘static disease’ and ‘ISQ’ (in status quo). If the cancer has shrunk  by at least 50% before the period of ‘stabilisation’ this may be referred to as a ‘partial remission’ or ‘partial regression’ or ‘partial response’ (all three terms mean the same thing).

Small changes in tumour size, either recorded by direct measurement or by looking at images on x-rays or scans are difficult to assess precisely. Therefore there is general agreement among cancer specialists that in order for a cancer to show signs of progression, or a relapse, there must be a greater than 25% change in the measurements that have been used to assess it. So provided that any change is less then this level, and assuming there has been no other evidence to suggest the disease is becoming active again), then the condition will still recorded as being ‘stable’.

In the early days of radiotherapy treatment, skin burns during treatment and sometimes permanent damage or scarring of the skin, was common.

This changed during the late 1950s and 1960s as two new types of machine were introduced to give the radiotherapy treatment. These are called Linear Accelerators and Cobalt Units. These machines produce irradiating rays of a much greater energy than the previous machines. This higher energy of the rays give the treatments greater accuracy and greater penetration of the tissues (allowing treatment of cancers deep inside the body and also reduce skin damage. This is because the high energy rays pass through the first centimetre or two of the first tissue they meet, before they actually begin to give out any radiation.
 
Skin problems are uncommon with modern radiotherapy treatment. Occasionally skin problems can occur because of the location of the cancer and the area of the body treated. Usually this will cause no more than some temporary pinkness or redness of the skin for a week or two after treatment. If any soreness does develop it will only last a short time and can usually be eased with creams or lotions, which you will be given at the hospital. Severe or permanent skin damage is  rare indeed.

The fact that skin damage was common forty or fifty years ago means that people can remember friends or relatives who had bad experiences with their radiotherapy treatments which  probably account for the stories you have heard. Nowadays the situation is very different and things have improved enormously.

Radiotherapy is almost always a local treatment, limited to a particular part of the body. Only the skin in that area will be irradiated and the skin elsewhere will not be affected.

The doses of radiotherapy used can vary but even with quite high doses modern radiotherapy machines usually cause a little skin irritation. Even so this does mean that the skin which has been irradiated will be more sensitive to sunlight than your normal skin.

The degree of sensitivity will vary from person to person. The increased sensitivity also reduces gradually with time but probably never disappears completely.

Having had radiotherapy does not mean you must avoid the sun completely but you should take care over exposing the treated skin. It is very important to cover the treated area for at least the first year after radiotherapy. Wear clothing made of cotton or natural fibres which have a closer weave and offer more protection against the sun. Even after this time the area treated will be more delicate, so extra care should be given. You should also use a high factor sunscreen (of at least factor 15). Remember, too much sunbathing does carry the risk of leading to skin cancer and should be avoided.

Very occasionally radiotherapy is given to the whole body. In this situation the doses are normally quite low but you should still take precautions in exposure to strong sunlight. Seek advice  from your doctors if you are having this type of treatment.

For a long time it has been known that some cancers occur more commonly in some families than others. There are at least two possible reasons for this. It could be due to some shared environmental factor (something in the diet or something else to do with a lifestyle common to a number of family members). Or it could be due to abnormalities in the genes, which are passed from one generation to another.

In recent years research has shown that a small minority of three common forms of cancer, breast cancer, cancer of the ovary and cancer of the bowel are due to abnormal genes. There are other, rarer cancers associated with these commons cancers: there seems to be a higher risk of skin, prostate and pancreatic cancer in families with many breast and ovarian cancers. Families who have a bowel cancer gene also can have cases of endometrial, ovarian, pancreatic, stomach and kidney cancer. These genes can be passed from one generation to the next and so do account for some, but not all, of those families where these cancers are commoner than usual.

The abnormal genes do not themselves cause the cancer but they do mean that someone who has the faulty gene is more likely to develop cancer than someone who does not. So what is inherited is a greater risk of developing cancer and not the certainty that a cancer will develop. The degree of risk varies with different genes, with some it is quite small whilst with others it is very high indeed. Families that are affected by a faulty gene normally have a number of the same cases of cancer in the family, and people tend to develop the cancer earlier than usual (under 60 years).

It is true to say, however, that for the great majority of cancers, including most breast, ovary and bowel cancers, that there is no obvious family tendency and no evidence that they can be inherited. If you have two or more cases of the same cancer on the same side of your close family, you might want to talk to your GP.

Categories: BILE DUCT, BONE CANCER

There is a widespread public belief that stress can lead to cancer.

Over the last twenty years there have been many scientific studies looking at whether there really is a relationship between stress and cancer. These studies have used a number of different methods. Some have looked at women with benign and malignant (cancerous) breast lumps and compared the number of major stressful events in the five years or so before their condition was diagnosed, to see if the women with cancers had suffered more stress. Others have followed the lives of people who have been bereaved, or who were prisoners of war, to see if these stresses led to a greater chance of cancer developing in the future when compared to the normal population.

When the results of all these studies are analysed there is absolutely no evidence that stress does cause cancer.

At the end of the day stressful life events – bereavement, divorce, redundancy, moving house and so on are very very common and inevitably many people who do develop cancer will have experienced one or more of these in the few years before their tumour was discovered. Doctors often don’t know the cause of any particular cancer and people are distressed to find that there is no definite explanation as to why they developed cancer. They find it very plausible to believe that their cancer was caused by stress but there is no scientific evidence to suggest that these events are any commoner for cancer patients than for the population at large.

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.

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