CANCER - Full extract 

Although cancer can occur in all age-groups, it is far more common with increasing age. Excluding minor skin cancers, there are about 60,000 new cases in Australia each year. Cancer also causes about 29,000 deaths each year, second only to heart disease. Men have about a one in three chance of developing cancer at some stage in their lives, women one chance in four. It can occur in virtually any organ. However, the most common types are lung, breast, bowel, prostate and bladder cancer and melanoma. 

Cancer is not a single condition but a number of different conditions with similar characteristics. The main feature is that the cells grow in an uncontrolled way. Usually, cancer is meant to describe a malignant tumour that can invade and replace normal tissues or spread to distant organs as secondary deposits. In contrast, a benign tumour can enlarge locally and press on other structures but does not have the capacity to invade or spread. 

The precise cause of cancer is not clear. Each person has a certain family history and genetic make-up and continually interacts with a range of things in the environment...diet, tobacco smoke, chemical substances, ultraviolet radiation, and even viral infections. In some people the interaction triggers the development of a cancer. It is likely that a number of factors are responsible.

 There is no doubt that the earlier the diagnosis of cancer the better the prognosis. Warning signs like abnormal bleeding, new or altered skin spots, change in bowel habit, finding a lump, persistent cough, and loss of weight all need prompt assessment by the doctor. Regular self-examination of the breasts in women can lead to earlier diagnosis of breast cancer. Likewise, self-examination of the testicles in men is also important. 

A major emphasis these days is to detect cancer even earlier, before there have been any symptoms. This is the whole basis of cancer screening. 

Mammograms  are a very valuable test and can pick up early, curable breast cancers. However, there are limitations. Any breast lump that persists should be evaluated by a specialist, and in most cases excised for pathology. Mammograms have the highest yield of positive results in women between 50 and 75 years of age. They should be done every two years and are now available free for all women in this age group. Women with a family history of breast cancer should ask their doctor whether they should commence regular screening earlier.

Pap smears  are another important screening test. They should be performed at least every two years in all women who have ever been sexually active. If other symptoms like pain or bleeding should occur, more detailed investigations are required. As with any other screening test, Pap smears are not infallible. However, each year about 800 Australian women have cancer of the cervix diagnosed early, and have curative treatment as a result of the test. 

Bowel cancer  has a tendency to run in families. For this reason it is very important for people with a family history to discuss regular screening tests with their doctor. Annual testing of the stools for blood and a special internal examination of the bowel every few years may be advised. A colonoscopy allows the full length of the large bowel to be inspected. A simpler but more limited bowel examination, called a flexible sigmoidoscopy, is also being increasingly used.

Prostate cancer  screening is a very contentious issue these days. Although there are varying opinions it would seem a good idea for men from 50 - 75 years of age to have a regular rectal examination ... preferably as part of an annual medical check-up. Sometimes a PSA (prostate specific antigen) may also be advised. Any symptoms of prostate enlargement, like difficulty starting to pass urine, dribbling and a sense of urgency all require careful assessment. In some cases referral to a urologist may be suggested. A family history of cancer of the prostate should be kept in mind; the condition does have a tendency to run in families. 

It is possible that specific screening tests for other cancers such as breast and ovarian cancer will also be generally available in the near future. Genetic research may soon make it possible to identify people at risk of developing specific types of cancer before the conditions have even occurred.

On a positive note, the treatment of most types of cancer has improved considerably in recent years, with several types of cancer now regarded as fully curable. And there are a number of measures that we can take to reduce the risk of developing cancer... 

Smoking  is the number one cause of preventable disease in our community, and it is the main preventable cause of cancer. Smoking is known to cause cancer of the lung, throat, tongue, bladder and several other organs. Not smoking is easily the most positive step anyone can take to lower the risk of getting cancer. 

Dietary factors.  There does seem to be a definite link between diets rich in fat and cancer of the bowel and breast. Natural diets with an emphasis on fruit, vegetables, and natural fibre offer protection against several types of cancer. 

Avoiding excessive ultraviolet radiation  reduces the risk of developing all skin cancers, including melanoma. 

Having a healthy lifestyle and avoiding unnecessary stress may also lower the risk of developing cancer. 

Health Tip:
* We should be proactive in our approach to cancer. There are things we can do to detect cancer at an early stage. And there are things we can do to prevent it from occurring in the first place.

Dr. Andrew Pattison: Common Consultations
North East Valley Division General Practice, Melbourne, Australia.   Disclaimer
  - Last modified: August 18, 2001