DEFINITIONS OF SOME EXPRESSIONS YOUR DOCTOR MAY USE – TACKLING THE CAUSE OF PAIN DIRECTLY (INTRODUCTION)

Let’s start at the beginning. Let’s say that the cause has been checked and your pain is due to your cancer. It may be possible to tackle this cause directly, but this would not necessarily be the best approach. You will have to weigh up the costs and benefits, just as for any other treatment.

In general, radiation is the form of anti-cancer treatment most likely to control cancer pain, especially that due to secondary cancer in the bones. This may entail only a few treatments and very little side effects. Pain due to cancer in other parts of the body, especially if the growth is large, generally requires longer treatment and higher doses and, even then, radiation is less likely to result ill good pain control. Ask your doctor just What your proposed treatment would involve and how likely it is to work.

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LETTING THE EXPERTS DECIDE? (PRACTITIONER’S POWER)

Some practitioners are simply unable to tell their patients that control of their cancer is beyond the practitioner’s power. To advise not having, or stopping, anti-cancer treatment would be to admit that this is so. Thus these practitioners keep on recommending highly potent and unpleasant treatments when they are either known to be extremely unlikely to do any good or are experimental. Or course, these practitioners justify their actions to themselves, their colleagues and the patient’s relatives. When questioned they say: ‘I can’t tell that patient that I can do nothing because that would be cruel — it would take all hope away.’ This sort of statement actually confirms my claim that these practitioners are solely concerned with fighting cancer, not with treating whole people. When there is no effective anti-cancer treatment available, they say they can do nothing. When there is no hope of curing the cancer they say that stopping treatment would take all hope away. Practitioners who care for whole people would never think or say that they can do nothing. They know that treating symptoms, giving time, care, reassurance and a sympathetic ear are all doing something! Practitioners who care for whole people know that cure of their cancer is not the only thing that patients hope for. They recognise and try to fulfill other hopes—hopes for relief of pain, for time to spend at home with family and loved ones, for realistic information that will allow time for goodbyes and grieving.

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CANCER: PROTECTING THE PROSTATE

Prostate cancer is to men roughly what breast cancer is to women. Each is far and away the most prevalent cancer for its respective sex, and each is a solid second (behind lung cancer) in deaths caused. And just as its breast-based relative was for women, prostate cancer has become the emblem of middle-age male health angst. It seems like that plum-size gland is going to get you, sooner or later.

But doctors have noticed that men are taking another tip from women. They’re fighting back. Proof? Well, how often did you hear prostate cancer or the prostate itself even mentioned 15 years ago?

“Prostate cancer has come out of the closet,” Dr. Catalona says. “Everybody knows what a breast is, and everybody knows what a lung is. But until very recently a lot of men didn’t know what a prostate was, or where it was.”

For the record, your prostate gland surrounds the urethra at the base of your penis and helps produce the semen you’re so fond of giving away. It seems to be built to go partially wrong. It often starts to enlarge (benignly) in your forties, and from 30 percent to 50 percent of men in their forties and fifties have precancerous lesions on its surface. Not all develop into cancer, but those that do are, on average, diagnosed at age 72. But with new methods of detection, the age at diagnosis is decreasing.

You don’t have to die from prostate cancer. “The disease is definitely treatable,” says “warren Heston, Ph.D., director of the George M. O’Brien Urology Research Center at the Memorial Sloan-Kettering Cancer Center in New York City.” Early detection is very much a big key.”

But your best weapon against prostate cancer is not getting it in the first place. And, hey, most guys don’t. “About one in five men are diagnosed with prostate cancer in their lifetime,” Dr. Catalona estimates. “So the chances are 80 percent that you won’t be.”

Not the worst of odds. And you can make them better by adding the following prostate-specific weapons to your anti-cancer arsenal.

Whip up some spaghetti. Vegetables, in general, fight cancer. But it’s tomatoes that go right after prostate cancer, according to Dr. Giovannucci, who worked on the Harvard study that came up with this happy I news. Tomatoes are rich in the antioxidant lycopene, which may lower risk

of prostate cancer. “For prostate cancer, it’s important to include tomatoes in your diet-tomato sauce, in particular,” Dr. Giovannucci says. He suggests two one-cup servings a week.

Grab some soy, boy. Soy products are rich in genistein, a weak estrogen with antioxidant properties that, studies have shown, will slow the progression of prostate cancer. That may explain the fact that Japanese men eat a lot of soy and seldom get prostate cancer, while American men eat almost no soy and get lots of prostate cancer.

Get enough vitamin E. Dr. Heston points to a Finnish study that found that those who took 50 milligrams of vitamin E “actually had a 30 percent reduction in the development of full prostate cancer.” Dr. Heston suggests that getting your Daily Value of 30 international units, or about 20 milligrams, would be beneficial.

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BREAST CANCER: DIAGNOSTIC INVESTIGATIONS CARRIED OUT

Ultrasonography

Ultrasonography – also known as ultrasound – is another imaging technique which, rather than using X-rays, involves passing high-frequency sound waves into the breast. It is the same process as that used for fetal scanning in pregnant women. When the sound waves meet a solid object within the breast, they are reflected back like an echo. The waves are processed by a computer, and a picture can be built up which is displayed on a screen and interpreted by someone trained in ultrasonography. The picture will show the normal glandular tissue and fat quite clearly, as well as any prominent ducts, cysts and tumours. Ultrasound is particularly useful in differentiating between fluid-filled cysts and solid lumps, and ideally should be used with mammography and fine needle aspiration to distinguish clearly between the two. It is the imaging investigation of choice when breast lumps are suspected in women below the age of 30. However, its use is not routine as it is a time-consuming process, is not able to detect calcium deposits, and its results are operator dependent.

Biopsy

Diagnosis of a breast lump often used to involve the surgical removal of a small piece of tissue. Although this is occasionally still necessary, there are now other techniques which can normally be used instead, which do not require a general anesthetic, and which can often be done by a surgeon at an out-patients’ clinic.

Fine needle aspiration biopsy

Fine needle aspiration is a cytological examination (i.e. one which involves the examination of cells) which is often helpful in confirming the diagnosis of a non-malignant tumour or cyst. However, although it can confirm that a suspicious lump is a cancer – and when a cancer is present it is rare for it to be missed using this technique – a negative result does not necessarily mean that it is not: the needle may have been inserted into normal tissue around a malignant tumour. Further tests may therefore be done to confirm a negative result.

The skin is usually wiped with an alcohol wipe prior to inserting a fine needle – about the same size as one that would be used to take blood from the arm – through the skin of the breast. The needle is repeatedly pushed into the lump, which the surgeon holds firmly between the fingers. Suction is applied to a syringe behind the needle and a few cells from the lump are sucked up through the needle and into the syringe. This sample of a small number of cells is then spread on a glass slide which is sent to the laboratory for examination under a microscope by a cytologist. Malignant and pre-malignant cells can be identified, as well as those from a benign lump or from normal breast tissue. Fluid aspirated from a cyst will also be sent to the laboratory in a bottle if it is at all suspicious.

You will be asked to press on the area once the needle has been withdrawn. This is simply to try to prevent serious bruising – which usually occurs despite this precaution and may last for several days or more. Therefore, as needle biopsies may cause swelling and bruising of the breast which may make palpation difficult and a mammogram unclear, they are better not done by a GP before a clinic visit.

Although a small minority of women does find the procedure painful, it is usually only uncomfortable. Local anesthetic is not used as it would destroy the cells the cytologist needs to make a diagnosis.

A non-palpable breast lump, i.e. one which cannot be felt, can be localized by ultrasound or by mammography using a special mammographic attachment which can guide the needle into the lump.

Tru-Cut biopsy

This is a histological examination which involves taking a slightly larger sample of solid tissue rather than cells. It is sometimes done when a fine needle aspiration biopsy of a palpable lump has proved unhelpful. It is used less commonly today than in the past, although some surgeons routinely perform Tru-Cut biopsies for all suspicious breast lumps.

The needle is of a wider bore than that used for fine needle aspiration, and it has another needle within it. Local anesthetic is usually used for this procedure, a small amount being placed into the skin over the site of the suspicious breast lump before the Tru-Cut needle is inserted. A long, very thin core of tissue is then removed as the needle is withdrawn, and is sent to the laboratory to be examined under a microscope.

Although a Tru-Cut biopsy is quite an accurate process, the tissue sample can only be taken from one site, and it is therefore possible for the needle to miss the appropriate part of the lump when it is inserted. This biopsy is more traumatic to the breast than a fine needle aspiration, and it is gradually being replaced by this cytological test.

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