Myths in cancer management

Debunking myths surrounding cancer and its management.

THE diagnosis of cancer is one that fills people with dread. This dread has spawned a host of myths that further intensify fear and apprehension of the disease. It’s time to dispel some of these myths.

Myth 1

A needle biopsy can “disturb” cancer cells, causing them to spread to other parts of the body.

Fact: For most types of cancer, there’s no conclusive evidence that needle biopsy – a procedure used to diagnose many types of cancer – causes cancer cells to spread.

Increasingly, Tru Cut needle biopsy is being done for the diagnostic work-up of cancer as pathologists are getting better at working with small specimens (with the aid of immunohistochemistry). As no surgery is involved, patients recover faster and they can move on to any further treatment with no waiting time.

There are exceptions, though, of which doctors and surgeons are aware of. For instance, needle biopsy usually isn’t used in diagnosing testicular cancer. Instead, if a doctor suspects testicular cancer, the testicle is removed.

Myth 2

Regular checkups, blood tests for tumour markers, and advanced medical scans can detect all cancers early.

Fact: Although regular medical care can indeed increase the chances of detecting cancer early, it can’t guarantee it. Cancer is a complicated disease, and there’s no sure way to always spot it, especially at the early stage.

Tumour markers may be normal in the early stage of the disease and some cancers can arise within a period of three to four weeks, such as rapidly growing lymphoma or acute leukaemia.

However, routine screening has been linked to a decrease in deaths from cancers of the cervix, breast and colon. Hence, regular cancer screening is useful for certain types of cancer; it certainly cannot detect all cancers at early stage.

Myth 3

Upon diagnosis of cancer, let me take time off to build up my body first before chemotherapy or other forms of definitive treatment.

Fact: Cachexia is a condition of general ill health, malnutrition, undesired weight loss, and physical weakness often associated with cancer. Generally, the weight loss is unlikely to reverse unless the cancer is under control. Hence, delaying treatment will not get a cancer patient in any better shape. It is likely that the cancer will grow in size, or spread further, and compromise subsequent treatment results. In cancers like acute leukaemia, delay in treatment can result in bleeding and infective complications, which are potentially life-threatening.

Myth 4

If I don’t have the usual side effects of chemotherapy, then my chemotherapy is not working.

Fact: The severity of side effects linked to chemotherapy is not linked to the treatment outcome. Generally, the supportive care of cancer has improved a lot. Hence, fewer than 10% of patients suffer vomiting or nausea these days.

Different chemotherapy regimens differ drastically in the side effects profile. Cytotoxic drugs like fludarabine or bendamustine are relatively free of side effects like vomiting, hair loss, etc, while drugs such as antracyclines and cisplatin are harder to tolerate.

The frequency and duration of the chemotherapy regimen also affect the tolerability of the treatment. For instance, acute myeloid leukaemia treatment is notoriously tough going as the treatment is stretched to seven days on a single course, and results in prolonged low blood counts, leading to infection and increased risk of bleeding,

Myth 5

Everyone who has cancer has to have treatment.

Fact: There are situations whereby treatment of cancer is postponed or withheld, for instance, patients with very slow-growing tumours or cancers such as early stage chronic lymphocytic leukaemia (this need only be observed as early treatment does not confer any survival advantage).

Some frail elderly patients with cancer who are unlikely to do well with chemotherapy are instead started on a palliative programme to relieve their symptoms as definitive treatment may not be feasible as the side effects of treatment may outweigh the benefits that treatment can bring.

The concept that we can live with our enemy (cancer) is not new and has been tested with long term follow up results.

Myth 6

Some people are too old for cancer treatment.

Fact: There is no age limitation for cancer treatment, which can be just as helpful for older adults as for younger adults.

However, age is a point for deliberation, and generally, the biological age is more important than chronological age.

Patients who are old but have no concurrent illness like heart disease or diabetes do better than younger patients with many illnesses.

People with cancer should receive treatment that is best suited to their condition and general health.

Myth 7

Since chemotherapy kills my normal cells while knocking off cancer cells, I must try natural therapy like herbs, which will only kill cancer cells.

Fact: The conventional chemotherapy which kills off tumour cells by interfering with cell division does have significant side effects, including harming normal cells. However, newer targeted therapy using monoclonal antibodies and designer molecules such as imatinib seem to reduce the collateral damage to normal cells.

As for herbs, the claims that there can be no associated side effects as they are derived from plants cannot be further from the truth. Any treatment can have potential side effects, and we have to balance the benefits versus the risk equation all the time.

Myth 8

Cancer treatment is usually worse than the disease.

Fact: Although cancer treatments such as chemotherapy and radiation are known to have some side effects that can be unpleasant, and sometimes, dangerous, recent advances have resulted in many chemotherapy drugs and radiation treatments that are much better tolerated than past treatments. Symptoms like severe nausea and vomiting, hair loss, and tissue damage are much less common these days.

For each patient, haematologists/oncologists always try to balance the known risks and side effects of the treatment (with the expected benefits).

Myth 9

No sugar, meat and milk (SMM) – just don’t feed the cancer.

Fact: Sugar doesn’t make cancer grow faster. All cells, including cancer cells, depend on blood sugar (glucose) for energy. But giving more sugar to cancer cells doesn’t speed their growth. Likewise, depriving cancer cells of sugar doesn’t slow their growth.

Unfortunately, there are patients who are taken up by the no SMM talk, and usually the proponent of this theory will double up as a health supplement provider. Invariably, the health supplementary products are exorbitantly priced. The down side of this myth is patients tend to lose weight by refraining from SMM, and that makes tolerability of prescribed treatment a far more difficult task.

Myth 10

There are all sorts of treated water in the market – alkaline water, oxygenated water, ionised water, magnetised water, energised water, and so on. These come with claims that they are good for health and treating ailments, including cancer!

Fact: we just need plain clean water, and in Malaysia (no thanks to our leaky underground pipes), all tap water needs to be boiled before consumption. Some sort of simple filtration system would suffice to get rid of the sand and mud.

Human beings extract oxygen through the lungs from inhaled air. We would need gills to extract significant amounts of oxygen from water that we consume!

Myth 11

Since no cancer is demonstrated now, I can stop my treatment even though it has yet to be completed.

Fact: The treatment plan or protocols for any cancer are generally tested for many patients, and if the treatment intent is curative (to get rid of the disease all together), then it is important to follow through the plan.

Microscopic disease may not be detectable even with very sensitive scanning techniques such as PET scanning, and certainly, aborting treatment without discussion with the attending doctor is a very bad idea, as relapses of disease are likely to occur, and further treatment is usually more complicated and less successful.

Myth 12

People with cancer must remain confined to a hospital bed or at home.

Fact: Most people living with cancer are treated on an outpatient basis (with periodic appointments, rather than an overnight stay in a hospital).

The chemotherapy infusion sessions can be done in daycare centres.

However, some leukaemic patients, or patients undergoing bone marrow transplant, need prolonged hospitalisation.

Most patients, when discharged, can continue with some of their day-to-day activities, depending on the type of chemotherapy given, and underlying conditions.

In situations whereby the risk of infection is high due to low blood counts, it is prudent to stay away from crowded places, but taking strolls in open spaces and doing light exercises are recommended.

This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.

source: thestar