The word ‘cancer’ is horrific. And, to hear it from a family or general physician that “You have a cancer” or “Your loved one has a cancer”, is like a bullet piercing your heart. You feel as if a bolt of lightning has hit you to the ground and the darkness has fallen all around you. With your body shaking like a leaf, you nervously inundate the physician with questions in a quivering voice, “What type of cancer is it? Where in the body it is located? Could it be treated or cured? Is it going to cut short the victim’s life? and on and on.” The physician may not be able to answer all questions to your satisfaction and so, may advise you to further consult an oncologist for the treatment of cancer.

There are more than 100 types of cancer, each with its unique issues and treatments. The most popular are breast cancer for women, prostate cancer for men, and back, lungs, colon, and brain cancer for both men and women. Like each cancer is unique, so are its victim’s (i.e., a person diagnosed with cancer) physical, immunological, and genetic characteristics. In other words, there is quite a diversity among cancer victims ranging from the nature, type, and location of cancer to their personal physical and non-physical attributes – all affecting the duration of survival after this dire diagnosis.

Unfortunately, the main conventional treatments to cure cancer (i.e., to stop or slow its growth or spread over other organs of a victim’s body) are not that diverse but are just restricted to three – not only in Canada but the world over. These are the surgery, radiation, and chemotherapy (not necessarily in any order of merit). This article briefly touches on these three conventional treatments, even though oncologists occasionally use other treatments including immune cell therapy, and stem cell transplants, to treat some special types of cancer.

How advanced or at what stage a cancer is and its complexity is usually determined by examining microscopically a sample of body tissue with or around the growing tumour, or a biopsy test (in medical terms). The biopsy test determines, first, if the tumour is benign (i.e., non-cancerous), or malignant (i.e., cancerous), and second, the stage it is at.

Five stages of cancer can be detected: early detection (stage 0), its early formation on a body part (stage I), its early advancement on the infected part (stage II), its late advancement on the infected part (stage III), and its widespread not only over the infected part but also on other parts of the body (stage IV). The cancer detected at stage IV usually is in a very advanced stage and most likely has metastasized, i.e., has invaded other organs of a victim’s body. A cancer victim at this stage has very little chance of recovery by any of the conventional cancer treatments. A victim’s life span is cut short as his/her death is imminent over a limited duration of time. An oncologist can easily predict an estimated time of a cancer victim’s survival, based on research and clinical studies.

Knowing fully well that a person with cancer at stage IV has almost no chance of recovery, oncologists in Canada and elsewhere still treat their cancer patients with conventional procedures including surgery, radiation, and chemotherapy. The latter two can be given at separate intervals or at the same time as the clinical studies have shown that radiation and chemo procedures given together are more effective to cure a cancer than given one procedure at a time. The surgical procedure may be applied before or after the other two treatments.

Surgery

This is the quickest way to treat a cancer. If it is at a stage from I to IV, visible and accessible, the surgical procedure can fully or partly remove the cancerous tumour and give the victim an extended life almost free of cancer. For instance, a woman with cancer in one or both of her breasts can lead a cancer-free life after having her breast(s) surgically removed (i.e., mastectomies), or a cancer in the toe or foot or lower leg can be surgically removed for highly diabetic men and women. On the other hand, if cancer is in an inner part of a victim’s body, like the head or brain, a surgeon can scrape it, if unable to fully remove it, to enhance a victim’s length and quality of life.

Unfortunately, the surgical procedure carries several risks including a post-surgical infection, bleeding, pain, disability, or disfigurement after removal of any body part. And, if a scrapping of say, a brain tumour is done, then there is a risk a victim could suffer paralysis, stroke, loss of memory, speech, comprehension, etc., if a surgeon scrapped not only the tumour but also other healthy tissues of the normally functioning brain. A surgical procedure in this case of over-scrapping of a brain tumour would destroy a victim’s quality of life, making him/her physically dependent on others. A victim still lives with a left-over tumour, which in turn, would likely grow over time.

A surgeon can, however, avoid hurting a patient by such an over-scrapping of tissues if he/she could use more sensitive and technical instruments that would identify cancerous and healthy tissues. As of now, a surgeon simply uses MRI images to conduct brain surgery including scrapping. And, since these images don’t mark a separation between cancerous and healthy tissues, the surgeon is most likely to err and scrape the healthy tissues, thus damaging the quality of life of a patient.

The bottom line is that surgical procedure carries very serious side effects. There is no guarantee that it would cure a victim’s cancer (except for removable body parts); it may even cause a victim more serious physical injury and damage, with a part of the tumour still present.

Radiation

The radiation procedure is meant to cure or shrink the size of the tumour by applying intense heat from outside the body over many short sessions – a number that is estimated by an oncologist, given a victim’s type of cancer, the stage it’s at, its rate of progressivity, age, sex, weight, and any other morbidities present. Even though this intense heat is pinpointed on or close to the location of the tumour, the chances are that the heat would also burn or damage the body’s healthier tissues around the tumour being burned.

Oncologists try to minimize this problem of damaging healthy tissues by providing a victim with a customized protective shield to cover the area(s) around the tumour to be burned. Unfortunately, such a shield is not 100% effective. The risk of damaging healthy tissue(s) around the tumour by the intense heat remains.

Other major side effects of radiation include nausea, vomiting, and tiredness. Even though an oncologist prescribes a victim an anti-nausea and vomit-control medicine like Gravol before the radiation procedure, a victim is still likely to vomit and have dizzy spells, besides other effects, depending on a victim’s physical and non-physical characteristics, besides the size and location of the tumour.

Chemotherapy

Unlike the surgical and radiation procedures, which focus on the location of a tumour, the chemotherapy procedure to treat cancer affects the entire bloodstream of a victim. Under this procedure, an oncologist prescribes a victim one or some combination of toxic medicines either in the form of pills or capsules to be taken by mouth or injections over a recommended length of time like five or twenty-eight consecutive days, as deemed necessary by an oncologist. The dose and daily intake of medicine(s) are again determined by an oncologist, depending on the nature and complexity of a victim’s tumour.

This is the worst of the three conventional procedures as the intake of toxic medicines makes the victim’s bloodstream highly toxic, which in turn, may deaccelerate the growth of a tumour or shrink its size. This procedure generating toxicity, however, is also likely to damage the functioning of other vital organs of the victim’s body, namely, the liver, kidneys, lungs, and heart’s arteries. Once the toxicity affects one or more of these key organs, a victim becomes more bedridden as he/she feels completely worn out – too tired to walk, sit, or remain fully awake. A victim also loses control of body muscles that control peeing or passing of stool.

The longer a victim is on chemotherapy, the more likely he/she is going to live a fully dependent life on caregivers, and eventually live like a breathing-dead. The toxicity caused by chemo drugs may kill some cancer cells or slow the growth of a tumour, but the reality is that it may cause a slow death to a cancer victim. A victim with stage IV cancer already has limited odds of long-term survival. Too much toxicity caused by the ingestion of chemo drugs further shortens a victim’s remaining life span.

Besides making the bloodstream toxic, the chemotherapy has other side effects as well. These include fatigue, loss of appetite, nausea, vomiting, and loss of hair – to name a few. The major risk of ingesting a chemo drug is that it can be fatal if it turns out to be incompatible with any of the DNA cells of a victim. A victim can die right after ingesting the first dose of the drug. Even though the health professionals do check the compatibility between the prescribed chemo drug and the key cells of a victim’s DNA before letting a victim take it, it’s unfortunate that incompatibility with any of the non-pre-tested DNA cells would result in a fatality.

Consent for a procedure

In Canada, healthcare professionals, including doctors, surgeons, and oncologists, can only recommend, encourage, or persuade a patient, including a victim with stage IV cancer, to undergo a given treatment or procedure if it carries any risk or adverse effect for a patient. A patient must voluntarily sign a consent form before having any such procedure with a clear understanding that he/she fully understands the risks and side effects of the proposed procedure as explained by a health professional. A patient must provide a signed consent form for each recommended procedure. Doctors and oncologists also need the patient’s consent to save their skin so that they are not to be blamed or legally sued if the patient were to suffer a post-procedure physical or brain injury, including paralysis, stroke, or death.

Indeed, when surgeons and oncologists are faced with a victim of stage IV cancer and have the victim’s written consent, they would apply the procedure even if they knew in their hearts that the chances of treating and curing cancer at this advanced stage were remote. They would proceed as they are supposed to on purely professional and ethical grounds.

On the other hand, a victim with advanced cancer still has the option to accept or refuse the proposed treatment procedure. Very rarely one would find a cancer victim refusing to undergo any of the treatment procedures because almost all cancer victims would strongly wish to have an extended life – the underlying reason for voluntarily consenting to undergo the recommended procedure.

It’s saddening that victims don’t know the reality of what their treatment providers do. What usually happens under these circumstances is that the providers of treatment would keep rhyming periodically to both their patient and his/her family members that the procedures have been ineffective, i.e., not working to cure the growth of cancer – something very disheartening and heart-wrenching for family members to keep hearing. Such post-treatment conclusion is generally reached after periodic examinations of a victim’s MRI images.

Conclusion

I would conclude that doctors, surgeons, and oncologists should refrain from treating a patient with stage IV cancer with conventional treatment procedures like radiation and chemo. Surgery (including scrapping), on the other hand, is not a panacea either, it can, however, still be used to treat stage IV cancer and help extend marginally a victim’s life span. Canadian oncologists must find a better alternative to treat a victim of stage IV cancer, like a customized treatment procedure, be it a stem cell transplant, immuno-cell replacement, or else. Such customized treatments may be costly but are worth every penny to save thousands of human lives.

Keywords: Cancer   Surgery   Craniotomy   Radiation   Chemotherapy   Stem Cell  Immune Cell