CANCER basics & CHEMOTHERAPY- 3pgs -- 11/23/13  http://healthfully.org/rc/id16.html & id4

It is essential to understand the inroads made upon medical science by corporate medicine.   Corporate medicine is market driven; medical science evidence driven.    These two approaches result in different explanations concerning cancer. The goal here is to understand the general basic biology of cancer and its treatment options based quality scientific evidence—without market considerations. What follows is based upon sound science with sources.  Marketing science is driven by profits, & thus promotes aggressive treatments.   Pharma’s marketing ploys confirms Harvard Prof. Dr. Marcia Angell’s  observation that we have “the worst system we could imagine.”  To learn more read Marketing Science and its links.  The goals of the tobacco companies are the same for pharma, maximization of profits, rising stock prices, and rewards for top management. 

“A benign tumor is a mass of cells (tumor) that lacks the ability to invade neighboring tissues or metastasize. These characteristics are required for a tumor to be defined as cancerous and therefore benign tumors are non-cancerous.  Also, benign tumors generally have a slower growth rate than malignant tumors and the tumor cells are usually more differentiated (cells have normal features).  Benign tumors are typically surrounded by an outer surface (fibrous sheath of connective tissue) or remain with the epithelium.  Common examples of benign tumors include moles, colon polyps,[1] and uterine fibroids.   Although benign tumors will not metastasize or locally invade tissues, some types may still produce negative health effects…. [Some types of] benign tumors can become malignant….  invade adjacent tissues or spread to distant sites by metastasizing.  For this reason, benign tumors are not classed as cancer” Wiki.  This is the first area where business has blurred the distinction between benign and malignant by calling them “carcinoma”, then aggressively treat with surgery and chemotherapy.  Critics point out in journal articles the negative consequences of treating benign (small local) tumors of the breast prostate, thyroid cancers, and others tissues with adjunct chemotherapy following excision; moreover, removing some types of benign tumors are not advisable.  Benign breast tumors, called “cancer”, when treated with chemotherapy shorten life over 4.6 years[2] (mostly from the blocking of estrogen as part of therapy).   

“Cancer (malignant neoplasm) is a broad spectrum of diseases involving improperly regulated cell growth.  For that cell growth to become life-threatening it must be capable of sufficient reproduction so as to disrupt essential bodily processes.  Over 80% of fatal cancers spread to more distant part of the body through the lymphatic or blood systems—some such as cerebral cancer often don’t.  With the exception of blood and lymphatic cancers, they form hard tumors.  One of the most important factors in classifying a tumor as benign or malignant is its invasive potential” Wiki.   A microscopic examination of a biopsy by itself is insufficient to prove that the tissue is malignant, for it doesn’t reveal the properties of being invasive and metastatic.  Lab reports often numerical grade the tissue based on shape of differentiation of tissue and this which yields a probability rating.  Lab write ups very often use terms meaning cancerous, which is misleading.  Cancerous can only be definitively determined with additional imagining, such as MRI.  Depending on lab findings,  removal often is the best choice, and but subsequent chemotherapy often isn’t necessary.

Oncogenesis (carcinogenesis): is literally the creation of cancer. It is a process by which normal cells are transformed into cancer cells. It is characterized by a progression of changes at the cellular genetic and epigenetic [regulate the expression of other genes] that ultimately reprogram a cell to undergo uncontrolled cell division, thus forming a malignant mass.  Over 98% of potential mutations and epimutations will have no bearing on cancer” Wiki  For most tissues 7 or more mutations are required to create a malignant tumor.   Less than 10% of all cancers involve inherited mutations, the remainder is a result of environmental factors and bad luck.  Over half the cancers are attributable to carcinogens.  Excluding skin cancer, only about half of all cancers prove fatal.     

Role of Stem cells:  “they are undifferentiated biological cells, that can differentiate into specialized cells and can divide through mitosis to produce more stem cells, which are found in various tissues.  In adult organisms, stem cells and progenitor cells act as a repair system for the body, replenishing adult tissues. Stem cells maintain the normal turnover of regenerative organs, such as blood, skin, or intestinal tissues.  Stem cells possess two properties:  self-renewal (to maintain through cell division the undifferentiated state) and potency (to give rise to any mature cell type).  Induced pluripotent, these are not adult stem cells, but rather adult cells (e.g. epithelial cells) reprogrammed to give rise to pluripotent capabilities of forming more than one type of tissue.  A progenitor cell is a biological cell that, like a stem cell, has a tendency to differentiate into a specific type of cell, but is already more specific than a stem cell and is pushed to differentiate into its "target" cell… and can divide only a limited number of times” Wiki.  The finding of stem cells in malignant tumors, and the heterogeneity of cells in most malignant tumors demonstrates their role.  Unfortunately given there are over 100 tissue types that can become malignant and the variation in properties between different cancers of the same tissue type, there can be no one model for the role of stem cells, pluripotent cells, and progenitor cells in the various cancers.  In most if not nearly all cases, these types of cells pay a central into turning a benign tumor, malignant; and an indolent cancer aggressive.  In most lethal cancers stem and progenitor cells play an essential role.        

The following discussion on treatment and prognosis is about the typical, common cancers, lung, colorectal, breast, & prostate.  There are a few cancers which can successfully be treated with chemotherapy, these are not typical.   These 4 cancers account for about 80% of all cancers (excluding the very common skin cancer, for which only the rare melanoma is very often lethal).

FOUR KEY FACTORS AFFECTING PROGNOSIS:    One factor is the stage I-IV, which is based upon the degree of invasiveness of the cell line and size.  How fast the cancer is invading adjacent tissue and spreading through the tissue of origin can only be determined by successive examinations months apart.   Tumor size and location give a poor approximation.  For an example with a breast cancer of > 5 cm 45% lethal and < 2 cm 96% survival, and similar results for location.  Second is the primary tissue in which it evolved.  Each tissue has its own prognosis.  Pancreas has 3 primary tissues; however, all tissues produce a high percentage of aggressive malignancies (the 5-year survival rate is 2%).  The third factor affecting prognosis is the rate of mutations; the higher the rate the greater the chance that the cancer can metastasize or will develop these abilities. This is roughly correlated with the variety of cells, and percentage of grossly abnormal cells in the tissue.  Fourth factor is the genetic mutations that created the cancer of which there are at least 7 (less for leukemia).  Most consist of a substitution of letter in a codon[3] forming a gene that makes that gene an oncogene.  Since most mutation affected only 1 codon and there are of dozens of codons on the gene, and that mutated codon could specify one of several amino acids in the protein to be formed, the biological consequences of that mutation will be different from the hundreds of other possible mutations of that gene.  The properties of the chromosomal mutations affects prognosis.  Given this complexity, the success of treatments is based on a rough statistically observational probability.     

KEY PROBLEM WITH CHEMOTHERAPY:  Ideally it should function to make long-term dormant or destroy bodily cells that are malignant without also poisoning or making dormant normal bodily cells in an essential organ or tissue type.   The difficulty arises because cancerous cells are nearly identical to normal cells.  Often the difference is inside the cell when a set of genes are turned on to produce semen, milk, etc.  A chemical which could damage cells that produces milk would have to penetrate the breast cells and be capable of disrupting an essential function of that cell in a way to make dormant or destroy it.  Such a chemical would very likely have similar effect on many other types of cells.  Most chemical are not selective and effect many tissue types.  They disrupt cell division, production of capillaries, and other functions which can only be switched off temporarily.  “Thus chemotherapy also harms normal cells that divide rapidly in the bone marrow, digestive tract, and hair follicles, and to a lesser extent slow dividing cells.  This results in the most common side-effects of chemotherapy:  myelo-suppression (decreased production of blood cells, hence also immuno-suppression),  mucositis (inflammation of the lining of the digestive tract), and  alopecia (hair loss).  Virtually all chemotherapeutic regimens can cause depression of the immune system, often by paralysing the bone marrow and leading to a decrease of white blood cells, red blood cells, and platelets” Wiki.   Indolent cancers tend to respond less to chemotherapy.  Causing damage to many tissues is why most chemotherapies are given short term and thus prolongs life on average 3 months. 

SHOULD CHEMOTHERAPY BE GIVEN TO A STAGE I, II, OR III CANCER?  Typical survival rates (5 years of being free of metastatic cancer) for the common cancers are 90 for stage I, 80% for stage II, and 65 for stage III.  Higher survival for stage 1 entail treating benign tumors mislabeled malignant.  If chemotherapy is given to those who will remain cancer free, it is life shortening and affects quality of life.  This negative effect is very significant in cancers of the prostate and breast because of hormone blocking (castrating) drugs are included in the chemotherapy.  Without estrogen, total morality was double at 10 years. Using the above stats for stage III, 65% of patients must endure chemotherapy when they don’t need it.  And for the 35% who will die of cancer, they are gaining 3 months of life.  Rather than treat every one, it would be better to treat only those who have progressed to stage IV (metastatic) cancer—better for the patient but not for the oncologist, clinic, and pharma.   And given the small benefit of chemotherapy, why prolong the illness with costly treatment that lowers very significantly the quality of life?   

Hopes Hypothesis:  Chemotherapy in clinical trials rarely has a placebo group.  It is given to terminal patients, thus avoiding long-term following with its side effects.  Remission is measure instead by imaging observations of the tumors size.  Typically the tumor stops growing or shrinks for 3 months.  Suppose the average death occurs in 12 months, some patients will die in 3 months; others will live 2 years or more.  That does not prove that a few patients had an atypical positive response to the drugs.  But rather a few patients had indolent metastatic cancer and would have lived that long, minus 3 months, without the chemotherapy.   

Recommendations: Given the bias in practice of medicine and journal and textbooks, the place to start is with a search of the critical journal articles concerning the treatment and diagnosis.  For the situation of where a suspect tumor is found in a tissue go to a teach hospital for treatment, the standards are better.   Assuming that there is a significant risk the benign tumor will become malignant, have a biopsy taken.  Read carefully the results concerning the abnormality of the tissue. The term cancer, malignant, and carcinoma can only properly be applied it the tumors have spread outside the tissue of origin.  The greater the abnormality of the cells, the greater the risk,[4] and the more likely it will be called malignant though it is benign.  If the risk is substantial that the tumor will evolve into cancer, have it removed.   If cancerous cells are also found in adjacent lymph nodes the risk of it being aggressive and/or metastatic increases.  Remember that time increases risk of an indolent cancer becoming aggressive, and only time will reveal if the removed cancer was metastatic .  If chemotherapy is recommended, submit to it only when major benefits are clearly documented and deduct for bias, which is the norm.  Don’t rely upon treatment guidelines, they are based upon marketing science, so too is the advice of the oncologist whose continuing education is given by pharma.  Published articles have an average bias of 32%.  Only for a few cancers does chemotherapy save lives.  If it is one of those cancers, then see if an in vitro chemo-sensitivity testing[5] is available.  In the majority of cases aspirin is the best prophylactic and treatment because it activates necrosis factor NF-B.  Read Aspirin. Take 975 mg of aspirin daily; and for reducing risk of cancer take 325 or 650 mg daily.  JK has taken aspirin since 1992, an average of 650 mg, and this has reduced his risk over 50%.  Testosterone and natural estrogen moderately reduce risk of certain cancers .         

Aspirin:  It is more of a miracle than penicillin; what has changed is the control pharma exerts. Its major unexpected health benefits were discovered  in the 60s through 90s.  It has the highest cure rate of all chemotherapies for stage I, II, and III,  and is also best at preventing cancer.  Aspirin promotes the apoptosis (death) of abnormal cells through stimulation of various necrosis factors and inhibition of JNK which “regulates several important cellular functions including cell growth, differentiation, survival and apoptosis”  Wiki.   A large collection of journal articles are pasted at http://healthfully.org/aspirin/ & http://healthfully.org/nsaids/.  The past below is from an article prepared by JK at  http://healthfully.org/rc/id3.html; its section on cancer:

BREAST CANCER SURVIVAL UP 66% by stimulating necrosis factor TNF—above. Colon cancer survival increased 74%, others.  Mechanism: COX-2 which is associated with increased prostaglandin biosynthesis which correlates to metastasis and carcinogenesis, and aspirin blocks COX-2, thereby reducing risk, plus promotes death of abnormal cells (below).     

CANCERS VARIOUS TISSUES RISK: reduction of “63% colon, 39% breast, 36% lung, and 39% prostate cancer. Significant risk reductions were also observed for esophageal 73%, stomach 62%, and ovarian cancer 47%” also.  Epidemiologic studies of malignant melanoma, Hodgkin's disease, and adult leukemia also found that NSAIDs are protective; melanoma 55%.  Other studies have shown that aspirin promotes the death of abnormal cells through the natural mechanism of apoptosis by stimulating tumor necrosis factor NF-B, by p38 & JNK.  Long term, but low dose is insufficient. 

The increased survival of breast cancer can be extended to the other glandular, blood, & epithelial cancers.

CANCER,  GENERAL  OVERVIEW:

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