CANCER ITS CAUSES AND CURE

Wanganui Chronicle, Volume LXXXIII, Issue 19784, 7 March 1927, Page 11

CANCER ITS CAUSES AND CURE

THE SURGEON’S SUCCESS NEED FOR KNOWLEDGE AMONG PUBLIC. “Cancer and how to fight it” was tho subject of a lecture delivered in London recently by Sir Berkeley Moynihan, president of tho Boyal College of Sdrgoons of England. Cases of cancer (said Sir Berkeley) may conveniently and for purposes of brief description be divided into two groups:—First, those in which the growth is lying either on or near the surface of the body, or is attacking organs, or parts of organs, which can with no great difficulty or danger be removed. Secondly, those in which the growth is relatively inaccessible, lies out of right, cannot be felt, and only reveals its presence by symptoms, or after examination by X-rays. In these cases an operation may be difficult, impracticable, or even impossible. How, then, can we expect to conquer or control this disease? It is obvious that two methods of attack must be followed. Making Surgery Safe.

In the first place we must so instruct the public ami educate ouraolvas that those cases of cancer in which complete eradication of the disease is surgically possible shall be roeognisod and treated at the earliest moment. Wo know that operations performed in the earliest stages of the disease are safer than those in tho latest stages, when tho patient’s health is seriously undermined by tho disease, which may have spread insidiously beyond the farthest reach of the surgeon. We can make I surgery safe and even more successful, I not by strengthening the arm of the surgeon but by enlisting the help of the patient; by encouraging him with the knowledge that accessible growths are capable of complete removal, with small risk and with permanent freedom from recurrence, if only they can be reached in time. And, in the second place, we must carry out all manner of research to disclose the secret, the most baffling and elusive secret, of the cause and the prevention of cancer, so that inaccessible cancer shall also be treated with success, or even prevented. We may even dare to hope that we are not far distant from the day. when these mysteries will at last be revealed; when what is perhaps the heaviest burden ever laid upon mankind shall at last be lifted. Those of us who have been responsible for the Yorkshire branch of the British Empire Cancer Campaign have realised the necessity of the education of the public. If surgery has almost reached the limit of its powers in removing disease, and if it is true that the earlier the disease the more effective is the operation in eradicating it, it is obvious that the recognition of an early stage of the disease cannot be made, and action takerf, until two consecutive events are secured —the awakening in the patient’s mind of a need to consult tho doctor, and action by the doctor, who in' turn seeks aid from the surgeon. Unless, therefore, a patient knows something of the antecedent conditions of cancer, of its early manifestations, of the importance of early treatment, how is ho to realise that a medical man should be consulted without the delay of one single day? In Yorkshire I have “tho happiness to command a hand of brothers.” The Medical and Scientific Committee of the Yorkshire Council has appointed a Propaganda Sub-committee under the chairmanship of Dr. Hillman. This sub-com-mittee will endeavour to instruct the public in such matters as it is essential for them to know if they are to help us, and will teach them to realise that the only hope of amelioration or of cure in cases of accessible cancerrests upon early diagnosis and skilled surgical treatment.

What the Public Should Know. What are the lessons we can teach the public in 'connection, with this disease? The following are some of tho truths it is important for thorn to know: —Cancer is always at first a local disease. For many years (and even today in tho popular mind at least) tho belief that cancer is a “blood disease” having local outbreaks is firmly held. It is often supposed that the blood is contaminated, and that the local evidence of this is the nodule or the ulcer, recognised as cancerous. All knowledge we possess refutes this view. Cancer begins locally; it remains local for periods that vary in length according to circumstances; it may even prove fatal while still local, and therefore, if accessible, still removable. Cancer chooses to attack a diseased rather than a healthy organ. It has been said that cancer never attacks a healthy organ, but that is to set the standard of health rather high. It is, however, quite certain that any organ, or the skin when affected by some chronic disorder, is more apt to be attacked by cancer. This involves tho necessity for us all, patients and doctors alike, to pay attention to health, and to do all we can to keep fit. The occurrence of cancer is influenced by antecedent conditions. The corollary to this is that cancer in certain instances may be regarded as a preventable disease. Sir Jonathan Hutchinson many years ago described what he called “precancerous conditions” —conditions which though not yet cancerous would become cancerous, or tend to become cancerous if neglected. Chronic irritation is a definite precursor of cancer. This is seen especially upon exposed surfaces. Mule-spinner’s cancer appears upon the lower parts of the abdominal wall in consequence of the protracted irritation of lubricating oil, and of repeated small injuries by the loom. Tho occurrence of cancer, so far as wo know, is uninfluenced by certain factors, sometimes regarded as “causes.” There does not appear to bo any hereditary predisposition to cancer. Tho fact that one person in seven ovor the ago of 30 dies from cancer must in this connection be re-

membered. It implies that within the limits of slight variation from this normal the incidence of any family may appear to be unduly heavy. Probably few families of ordinary size escape cancer in throe consecutive generations. Striking instances of the frequency of cancer in one or two generations of a family, and equally remarkable examples of its absence, come under observation from time to time. Cancer, so far as we know, is not caused by any special food or foods, nor by any absence of special foods. It is true that excessive indulgence in food when liti tle or no exercise is taken will steadily and insidiously depreciate the general health; and that in such circumstances of lessened resistance a person may more easily fall a victim to cancer as to other diseases. Various articles of diet have been impugned, but there is no evidence that would satisfy a scientific mind that these or any other articles of diet, in excess or in abstinence, play any specific part in causing this disease. There is at present no sufficient proof that “cancer houses” or “cancer districts” exist, though here again striking examples of individual exceptions to this statement may be observed. Further inquiry may well be conducted to resolve this question, and wo are proposing to undertake a new e survcy of this matter in Yorkshire.

Disease Not Infectious. Tho disease is neither infectious nor contagious. Very few surgeons have ever seen any case in which transmission of tho disease by contact could conceivably explain tho development or localisation of tho disease. The disease spreads from the spot originally affected by direct extension; by the invasion of lymphatic vessels, which then convoy cancer cells to neighbouring glands and thence to distant parts; and rarely by invasion of the blood vessels and the transmission of cancer cells in the blood stream. The reverse procedure never occurs. That is to say, the disease never begins as a generalised systemic disease—as a “blood disease” having, in a later stage, a local manifestation. In the early stages cancer rarely causes pain. This is a truth which it seems very difficult for a patient to realise. One of the commonest incidents of practice is to hear a patient protest that a growth cannot be of a serious nature because no pain results from it. In tumours of the breast no pain, as a rule, is caused until the skin is involved; the lump is discovered by accident, and little regard is paid to it because it causes no inconvenience or discomfort. The truth that in women over 35 years of age a lump in the breast is malignant in three cases out of four needs all the repetition and emphasis that can be given to it. The silence of some forms of growth in the stomach and the rectum is notorious. In the ailmentary canal it is often obstruction rather than discomfort that first attracts attention.

While the disease is local and when tho growth is accessible cancer is curable. This is a necessary and logical extension of tho truth that cancer is invariably local in origin, and that it spreads from the point first attacked. While the disease is local the complete eradication, not only of the parts immediately involved, but of all the adjacent parts which arc most likely to be first implicated in its extension, would also cure the disease. It is true that the patient might then live long enough to develop another type of cancer elsewhere; but the instances in which this has occurred are so rare as to be surgical curiosities, and of no importance in stating the truths of a general problem. There arc, however, a large number of cases of carcinoma where the growths are not accessible to tho surgeQn, or lend themselves only to tho most dangerous and least successful forms of attack.

It is perhaps hardly too much to say that the conquest of cancer is a question of money. Research, ceaseless research, by trained skilful workers, research of the widest kind into all aspects and relationships of the disease, will surely capture the most elusive secret of its causation. In Yorkshire our appeals to the public for help have resulted in the collection of nearly £150,000 in twelve months. A research institute has been opened, and happily is associated with the University, so that all tho scientific knowledge of the day is accessible to our research workers. During the next decade I should like to see the most active and the most populous department of any research institute devoted to the study of the subject of cancer. Research in connection with other diseases has within the last half-century saved millions of lives, released mankind from terrible sufferings, added immensely to human happiness and comfort, and helped to prolong the span of human life.