Dave Kristula
Science: Independent Study
May 31, 2000
[page numbers are from the Word version]
This paper is a weave of scientific data, personal experience, and common knowledge. While it would technically be possible to produce a paper based fully on scientific data alone, I feel it would be biased in the wrong direction and have a terribly bland flavor. The life of a cancer patient is rarely black and white facts, therefore this paper consisting of research by just one survivor cannot be considered "purely scientific." Regardless, I think you will find this information useful. Please consult your physician for true medical jargon. This paper is intended for educational-entertainment purposes only.
The Author,
[signed]
Dave Kristula
The American Cancer Society estimates that in the year 2000 1.2 million people will be diagnosed with a new case of cancer. During the same year over 500,000 American lives are expected to be lost to the beast (Statistics).
Cancer is the second leading cause of death in the United States. Comparably, AIDS/HIV, an often-feared yet-preventable illness, is predicted to cause less than 20,000 fatalities in the United States in 2000 (HIV).
Cancer is classified as a group of over one hundred diseases in which cells inside the body grow abnormally without any sort of control. Most cancers form tumors. Not all tumors are cancerous though - benign tumors, as opposed to malignant tumors, can be removed from the body and rarely pose a health threat once removed.
Cancer has plagued modern humans since before the beginning of written history. Cancer has been recorded in descriptions in as early as 1600 BC in Egypt, where it was said to have "no treatment" (History).
Even for most of the twentieth century, cancer was thought to be a certain death sentence. Today, there are over eight million survivors in America alone (BCF), and hundreds of thousands more are added to the ranks each and every year.
In the year 2000 cancer is no longer a certain death sentence. Treatments options increase seemingly daily, and throughout every city, ever town, every country, and every soul sits a hope for the cure. Today's cures have been discovered in places from ranging from the rainforests, to chemistry labs, to the inside the human body itself.
The likelihood for a single cure from a toxic chemical compound is in my opinion probably slim to none. Although most of the hundred-plus cancers are mildly related, they each act in different manners, and react differently to most chemical compounds. Currently there is no real anti-cancer compound that is effective against all the types of disease, although an immunological cure (that is, a cure designed by having the body fight off the cancer itself) could be right around the corner.
CURRENT CONVENTIONAL TREATMENT OPTIONS
Today there are three main forms of conventional cancer treatment. Those treatments are surgery, radiation therapy, and chemotherapy. In surgery, the largest portion of the tumor, if not all of the tumor, is physically removed from the body in an operation. In radiation therapy, portions of atoms are sent by beam to the area of the body in which the tumor lies in hopes of destroying the molecular makeup of the cells within the tumor thereby making it impossible for the cells to multiple. In chemotherapy, toxic chemicals are placed in the body in an effort to destroy all cancerous cells. While all these forms of treatment can be successful, they do have their downsides. Surgery can leave scars and a possible deformation from a normal-looking body; radiation therapy can hurt normal cells and even cause other types of cancer; Chemotherapy can destroy veins, cause other cancers, and even prevent the immune system or other biological systems from functioning. Typically, chemotherapy and radiation therapies harm not only cancerous cells but also healthy. Both of these treatments can cause hair to fall out. They also reduce the amount of immune system cells available to the body for its own protection (although this reduction is usually only for a short period of time).
RECENT VICTORIES IN AID TO CANCER PATIENTS
Researchers are constantly working to find new treatments and also to find new products that aim to alleviate some of the problems and inconveniences of going through a cancer treatment. One of the more recent great inventions from a lab is Neupogen. Neupogen is a shot that when taken over a series of days after a treatment causes the immune system to speed up the production of the white blood cells that are necessary to fight off an infection that may appear. Another popular recent drug is Zofran which can reduce the feeling of nausea and the frequency vomiting while having chemotherapy by being administered intravenously before the treatment or taken by pill afterwards.
THE HISTORY OF AN ANTI-CANCER COMPOUND
Nitrogen mustard, which is often used as a chemotherapy agent in treating lymphomas, was discovered after scientists studied the often-fatal effect of mustard gas, a chemical warfare agent used during World War I. Scientists determined that mustard gas was harmful because it disrupted and sometimes even stopped the production of blood cells by the bone marrow. Although mustard gas was first used in 1917, it was not until 1946 that its cousin, nitrogen mustard, was first studied as an anti-cancer compound (Holland).
Not all anti-cancer compounds are byproducts of war. Many scientists and general population alike believe that the rainforests and dryforests of the world may hold some of our cures. They are not dreaming a fairytale - both vincristine and vinblastine from the rosy periwinkle are used in treating Hodgkin's Disease and some leukemias. Taxol, derived from the bark of the pacific yew, is used in treating ovarian and breast cancer. Both the rosy periwinkle and the pacific yew grow in the forests of the world (Nuland).
Although it is uncertain what causes most types of cancer, researchers do have some ideas. For example, smoking is known to cause a certain type of lung cancer. Excessive exposure and damage to the skin by the sun or by artificial lighting such as tanning beds is known to cause certain types of skin cancer. Some other things that are thought to cause cancer are genetics, diet, and a polluted environment. Many people think that some cancers are often caused not by a single factor but a variety of factors. An example of this type of case would be someone that has a certain gene developing cancer after being exposed to a toxin in his or her environment.
Many times cancer will go unnoticed for months or even years in a patient who is not thought to be in a risk group. Many times a person will go to a doctor with a normal seeming problem like swollen lymph glands or a prolonged flu-like feeling and end up being diagnosed with cancer (although the diagnosis may not be immediate).
A typical diagnosis involves first preliminary tests such as blood or urine tests and may be followed by small x-rays of the area where a possible tumor may be located. If these tests are able to confirm a suspicion of cancer a CT scan or MRI scan may follow. If confirmed yet again, a biopsy is usually scheduled so that the doctor can be positive about the diagnosis. During a biopsy a piece of a tumor is removed, usually by surgery or a long needle, and then studied under a microscope by a pathologist. The pathologist will be able to determine the difference between similar-looking cancers such as the related Hodgkin's Disease and Non-Hodgkin's Lymphoma.
Once diagnosed with cancer, a patient will usually be referred to an oncologist (a doctor who specializes in cancer treatment) who will be able to discuss possible treatment options with the patient. Most patients will be offered surgery, chemotherapy, and radiation therapy. The doctor will make their recommendation but will leave the choice to the patient.
In the late (highly progressed) stages of cancer a more radical procedure such as the bone marrow transplant may be proposed as an immediate option. A bone marrow transplant typically costs many multiples the cost of a regular conventional cancer treatment and is usually not given as an option unless there are no other options that show a direct promise of remission.
Doctors may also refer a patient to a clinical trial in which they will be part of a group who are receiving a new drug or a new combination of old or new drugs together. Clinical trials are often provided at no cost to the patient. An unfortunate downside to a clinical trial is that travel expenses will not always be covered to and from the treatment center, which often may be many hours or days drive away from a patient's home.
Treatment itself is pretty straightforward. In surgery, a date is scheduled after an explanation of the procedure is given to the patient. The patient arrives on the date, checks in, and is given a bed. Once in the operating room, the patient is usually given an anesthetic, and then the surgery begins. A surgeon makes incisions in necessary places in an attempt to remove all or most of the tumor. An infected organ may be removed if it is not necessary for the body's life functions (example, spleen). Once the surgery is done, the patient is wheeled to recovery. Depending on the type of surgery, the patient may be allowed to leave the hospital the same day.
Chemotherapy is a lot more complicated than surgery. First, the explanation is given, and a date is set for the first treatment. Chemotherapy treatments are typically given twice a month, and in most cancers two treatments make up a "complete cycle". The typical number of cycles necessary usually ranges from four (eight treatments) to ten (twenty treatments). Doctors often monitor the regression of the cancer to decide the necessary amount of cycles after treatment begins.
If a chemotherapy drug is known to have a significant chance of allergy, it is first tested in a small dose administered to the patient. Once the necessary drugs are checked for possible allergies, the treatment can begin. A chemotherapy nurse places an intravenous line into a patient's vein. A bag of anti-nausea medication will hang from a hook on the ceiling and be administered over a given period of time. At this time extra saline fluids may be administered if necessary. Once the anti-nausea medication has had time to have an effect on the patient, the first of the drugs are administered through the IV. Depending on the type of drug, it may be injected directly into the IV from a syringe with dilution, or hung on the hook and allowed to drip slowly. Many times, multiple drugs are administered. Drugs are often rotated from treatment one to treatment two on the cycle depending on the exact mix of drugs for the particular cancer-this mix is called a protocol or regimen.
Once chemotherapy treatment is finished, the patient is free to leave but usually has a direct emergency line to contact the doctors and nurses should a problem arise. Patients are advised to report any side effects. Most patients are given Zofran (anti-nausea medication) in pill form if they or their insurance can cover it. Also, many patients are given Neupogen (an immune system booster) that they can administer themselves subcutaneously (under-the-skin) into a fatty or muscular area of the arm or leg by a small syringe with a tiny needle. If necessary, a patient may have a nurse or relative administer the Neupogen. Nurses are prepared to train the patient or relative to properly administer this drug. Other than mild to moderate bone pain Neupogen usually has no side effects.
Side effects of the chemotherapy itself are numerous. They include tingling fingers or toes or other tingling body parts, nausea, vomiting, hair loss, blurred vision, weight loss, weight gain, sterility, hallucinations, and euphoria among hundreds of other things. Different bodies often react differently to chemotherapy in terms of side effects. Chemotherapy typical takes a huge toll on blood counts and the immune system. Patients are often encouraged to avoid large crowds and small children during the months of treatment. If blood counts go too low a patient may have to spend a week more in isolation at a hospital.
Radiation therapy is another possible form of treatment. It involves the beaming of electrons through the body in a specific area where a tumor is present in an effect to destroy the DNA of the cancer cells to the point where it can no longer reproduce. Radiation therapy is given five days a week for three to eight or more weeks. Typical radiation side effects include nausea and "sunburned" skin.
Depending on the patient's situation, they make be given the option to have more than one of the three treatments mentioned. All of the treatments have risks. Chemotherapy and radiation therapy are even known to cause other diseases and even other cancers.
ALTERNATIVE AND COMPLIMENTARY THERAPIES
An alternative therapy is a form of treatment given in replacement of a standard conventional medical treatment. A complimentary therapy is a form of treatment given in addition to a conventional medical treatment. Usually both a complimentary therapy and conventional therapy are used concurrently if a patient chooses to have both.
Most alternative and complimentary therapies involve vitamins, herbs, and sometimes even chemical compounds. Doctors tend to shy away from alternative treatment because overall there hasn't been a single one that has been proven more effective than a convention treatment available today. Most doctors today will encourage the use of multi-vitamins and herbs like Echinacea while a patient undergoes conventional treatment.
Alternative medicine doctors and alternative manufacturers often make many claims of "cures" which have yet to be proven by conventional testing methods. Conspiracy seekers argue that the only reason they aren't used are because drug manufacturers can't "patent" a herb or vitamin and make money off it. But in Questionable Cancer Therapies, doctors argue that hydrazine sulfate, 714X, shark cartilage, and high dose vitamin C are on the list of "quackeries", or false cure promises. (Barrett).
While the quackery list gets longer ever year, so do the list of true promising treatments. Vaccines and monoclonal antibodies are on the top of the list of possibilities. Vaccines and monoclonal antibodies usually contain proteins that aid the immune system in recognizing the difference between healthy cells and cancer cells. These treatments are typically are injected into a patient at a certain interval over the course of months until a remission is achieved. While much research has yet to be done in these treatments, they show a lot of promise.
Professor Karol Sikora, a researcher from London, believes the future of cancer treatment may lie in "long term chronic treatment, perhaps by tablets" (qtd. in TFoCR). In essence this has already occurred for Hodgkin's Disease, although it is done by injection and not by pill. It is rumored that a drug derived from the rosy periwinkle administered every two weeks is effective for years in keeping a patient in remission once they have failed all other treatment options.
MY FEELINGS ON THE FUTURE OF TREATMENT
While I cannot say I believe one day all cancers will be preventable, I do think given time, energy, and money many more advances in their treatment will be made. We've come so far in such a short time. Recall from page four that in "1600 BC in Egypt [cancer was thought] to have 'no treatment'." Millions of survivors, including myself, are proof that time and endurance can provide cures. Every day we move a step closer to them.
PERSONAL EXPERIENCE -- DIAGNOSIS
I remember the first time I told my classmates at school about my cancer diagnosis. I walked into geometry class with a biopsy incision scar visible on my neck. I gave a note to the teacher informing him of my diagnosis. I then proceeded to tell my friends. "You're kidding, right?" was one response. I still don't think I had a full grasp on the concept yet. I didn't fully accept that I had cancer -- I looked to my illness more like a really bad cold that would last for months that I'd just have to get over.
Most of my friends were pretty supportive. Over the three years following my initial diagnosis I've met a number of people who had the same disease. Now as a senior in high school a lot of people here don't know who I am. But few have forgotten me, so it doesn't really bother me too much.
When someone is diagnosed with cancer they may often, after the initial shock, start to wonder how people will treat them. Some questions they may ask themselves could include:
A lot of questions certainly do arise. Few of them can be addressed immediately. I had a pretty easy time compared to most people. I didn't have many close friends, so I didn't have that many to lose. I had no co-workers or boss so the work issue wasn't really relevant to me. My school, with a few exceptions, was supportive and understanding throughout my treatment.
All of these listed questions (and the dozens of others not addressed here) are valid concerns. Difficulties can and do come about. Things can get worse. Things rarely get better quickly.
I had a few friends who would listen to me regardless of what I had to say. But it's often tough talking to someone who doesn't understand exactly where I am. I quickly turned to the Internet after I was diagnosed to find people like me -- people with my disease. I found a large number of personalities and a wealth of information on the Internet. I believe that being able to converse with others in similar situations helped me a great deal throughout my treatment.
PERSONAL PHILOSPHY - TREATMENT
Experiencing cancer is not exactly one the easiest things in the world. Repetitive treatments, daily bloodtests, monthly scans and x-rays -- it's not all fun and games, or even close to it. The only benefit I found immediately about having cancer was that I got some time away from school, which was something I really needed at that point in my life.
Chemotherapy and radiation therapy include almost daily trips to and from a hospital treatment center. In addition to the hassle, there is plenty of nausea, vomiting, and hair loss involved in these treatments. Then there's the migraines, memory impairment, loss of energy, and an increase in the amount of time needed daily to rest to feel comfortable for the rest of the day.
Continuing an education during treatment is not an easy task. A considerably large amount of class time is lost in order to have treatments, and even more class time is lost in the recovery periods that follow them. It is extremely difficult to keep up with everything. I personally remember very little of what I was taught during the years of my treatment (in school at least, outside of school is another story). But I don't really see myself at much of a disadvantage from the normal (average) student.
I do firmly believe that a student undergoing cancer treatment should be given an opportunity to continue their education. Perhaps they might not continue at a full scale, or even at a half scale immediately. I don't think a student should be forced to continue their conventional education during treatment. I think a better option may be the tutor method I was given during the second half of my treatment. It was much more effective in my case, and it eliminated the major threat of catching a serious illness like a cold or influenza which may have forced me into the hospital for a week stay or longer.
Unfortunately not everyone is given the opportunity for time off. Someone who lives alone or is the major income earner in a family might not be able to take leave under their circumstances. The problem is not easily addressed, but with the newer chemotherapies and reduced radiation therapies it is becoming easier to continue work or school if it is absolutely necessary during cancer treatment.
It is much easier for me to relate to other people who are different now. It's easy because I am very different myself. I don't think it's a negative quality at all, either.
As a cancer survivor, I feel there is more of a need for a union of people who believe we can accomplish if we put our minds and energies to the task. These days many people just think things are too hard to accomplish. I believe that if we ask each other for help, and learn from one another, we'll be able to accomplish anything we would like to accomplish.
There is no doubt in my mind that the cancer experience changes the life outlook of many survivors. I suffered a double-change: I was a teenager when I was diagnosed so I still felt invincible, and at the same time I had to accept that my life may even be cut shorter than that of the average person.
According to literature I will be considered "cured" after five years of complete remission -- around April of 2003. I feel that I am cured in other ways right now.
It's easy to be caught up in the immediate future -- "...How am I going to pay for an apartment? ...Where do I want to live? ...What am I going to be doing Friday?"-- but as a survivor I don't worry about these little things as much. Most of the things in my life seem to fall into place with the appropriate effort applied, and if things don't fall into place I still have my family and friends to lend me a helping hand.
While I am not able to tell you not to drink or not to smoke excessively, I am able to tell you the possible horrors you may be in for should you develop liver disease or lung cancer. I'm amazed at how many people can still say to themselves, "It can't happen to me!" after seeing my ordeal. The truth is it can happen to anyone. That's one of the greatest lessons I've learned.
Barrett, Stephen M.D. and Victor Herbert, M.D., J.D. "Questionable Cancer Therapies." Quackwatch. April 21, 2000. April 29, 2000. <http://www.quackwatch.com/ 01QuackeryRelatedTopics/cancer>.
"Basic Cancer Facts." 2000 Facts and Figures. February 7 2000. American Cancer Society. March 7, 2000. <http://www.cancer.org/statistics/cff2000/basicfacts.html>.
"The future of cancer treatment." March 27, 2000. BBC News. May 2, 2000. <http://news.bbc.co.uk/hi/english/health/medical_notes/c-/newsid_590000/590699.stm>.
"History of Cancer." Cancer Resource Center. March 24, 1999. American Cancer Society. March 7, 2000. <http://www3.cancer.org/cancerinfo/ load_cont.asp?ct=1&doc=3&Language=English>.
"HIV/AIDS Statistics." December 1999. National Institute of Allergy and Infectious Diseases, National Institutes of Health. April 15 2000. <http://www.niaid.nih.gov/ factsheets/aidsstat.htm>.
Holland, Rebecca. "Mustard Gas." Molecule of the Month. Bristol University. April 15, 2000.
Nuland, Sherwin B. "The Plant Hunter." Heroes of Medicine. Time Magazine Online. April 29 2000. <http://www.time.com/time/reports/heroes/plant2.html>.
Please do not copy this research paper for use as a term paper. You may cite it but not copy it. Thank you.
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