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Medical Forum / General / General / June 2005Cancer myth or not
Here's a quote from http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=8905102 "NEW YORK (Reuters Health) - When US adults were polled about certain erroneous cancer 'myths', the most widely believed misconception was that surgical removal of a cancer can cause it to spread throughout the body." If you cut into a bunch of cancerous cells when removing a tumor, which is unavoidable sometimes because of a hard to detect "halo" of them around some tumors, which I just read about, don't you think there's a possibility of some being released into the bloodstream? Look at the Google results for "tumor seeding during surgery" at http://www.google.com/search?hl=en&lr=&safe=off&rls=GGLG%2CGGLG%3A2005-21%2CGGLG %3Aen&biw=995&q=%22tumor+seeding+during+surgery%22 . I'm not a medical expert, and I don't want to make it sound like a cancerous tumor shouldn't be removed when a doctor says it should, but those Google results sure make it sound like removing a tumor could accidentally spread cancer in some cases. Maybe the survey should have asked if people think an attempt at surgical removal of cancer is likely to cause the cancer to spread, creating a more dangerous health risk. > Here's a quote from > http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=8905102 [quoted text clipped - 19 lines] > surgical removal of cancer is likely to cause the cancer to spread, > creating a more dangerous health risk. The technique of removing a discrete cancerous tumor involves (optimally) excising it "en bloc". The tumor is examined microscopically to evaluate adequate margins of non-involved surrounding tissue, and depending on those findings, adjuvant local treatment (radiation) is used. In some types of cancer, the tumor behavior dictates that adjuvant radiation be used anyway. However, there are some situations where cutting across or into a cancer is unavoidable, and in those cases it's possible that some tumor seeding could occur. Additionally, cancers are not necessarily always discrete enough that it's possible to identify their gross margins, meaning that the surgeon can cut across a cancer and not know it until the path report comes back. So, yes...in some cases local tumor seeding can occur. Given the use appropriate surgical techniques and adjuvant radiation (when appropriate), it unlikely that it has much, if any, ultimate effect on the five year survival. Certainly we know that removing a cancer will vastly improve the chances of a "cure" compared to leaving it in place. HMc > > Here's a quote from > > http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=8905102 [quoted text clipped - 41 lines] > > HMc I understand what you're saying here, but like the original poster, I take exception to the claim that believing that surgery spreads cancer is equivalent to believing a myth and indicative of the person's ignorance about cancer. I can't find the actual citation right now but a couple of years ago there was a study published showing that a mastectomy for a certain type of breast cancer should be done as soon as the original biopsy (used to be frozen quick section) comes back positive since even a few days delay following cutting into the tumor did tend to increase the risk of recurrance and future metastases. I remember reading this and thinking that the old fashioned way of getting a consent for mastectomy if the QS came back positive was maybe not such a stupid old-fashioned notion after all. > I understand what you're saying here, but like the original poster, I > take exception to the claim that believing that surgery spreads cancer [quoted text clipped - 8 lines] > getting a consent for mastectomy if the QS came back positive was maybe > not such a stupid old-fashioned notion after all. The problem comes when a patient comes in with erroneous internet research, or a vague recollection of a citation that they "can't remember right now" that convinces them thay they know more about appropriate treatment for cancer than the surgeon or oncologist that they're seeing. I'm curious...are you a doctor? Some other kind of health care professional? If so, your post would seem to me to be particularly irresponsible. The paper you vaguely quote from your two-year-old impression, without specific attribution or even a clear memory of, is the worst sort of internet statement to make. Not only does it run at odds with current standards of care relative to the treatment of breast cancer, your extension of this "vague recollection" to treatment of other cancers does not even necessarily have the slightest bearing. You should provide a reference if you're going to promote a concept that counters current clinical studies, especially if you're not a doctor with specific experience in the area. Otherwise, you should just sit down and be quiet. This kind of thing is the reason that internet medical advice is so dangerous. I can envision a breast cancer patient telling their surgeon "It has to come out RIGHT NOW, doctor...I read it on the internet...". HMc Since I have good reason to respect your opinion, Dr McCollister, I have removed my post and will not re-post it until I have the citation. > The problem comes when a patient comes in with erroneous internet research, > or a vague recollection of a citation that they "can't remember right now" [quoted text clipped - 18 lines] > > HMc Dr. McCollister, I have found the citation in question. Needle biopsy linked to breast cancer spread Last Updated: 2004-06-24 13:59:52 -0400 (Reuters Health) NEW YORK (Reuters Health) - Having breast cancer tissue sampled with a needle seems to increase the odds that disease will also be found in an armpit lymph node called the sentinel node, new research suggests. The spread of breast cancer to the sentinel node adversely affects a woman's survival and influences the treatment received. As reported in the Archives of Surgery, Dr. Nora M. Hansen of the John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California hypothesized that the method used to obtain specimens from the breast tumor might influence the spread of cancer to the sentinel node. To investigate, the researchers studied 663 women with proven breast cancer. Of the cancers, about half were biopsied with a needle, while the remainder involved actual removal of the tumor. Woman who had a needle biopsy were about 50 percent more likely to have cancer in the sentinel node than women who underwent tumor removal. The researchers suggest that the increased risk of sentinel node disease may be "due in part to the mechanical disruption of the tumor by the needle," and they call for further studies to confirm these findings. SOURCE: Archives of Surgery, June 2004. I'm sure that you have access to the journal in question and so to the full text article. Would you care to comment on it? > Dr. McCollister, I have found the citation in question. > [quoted text clipped - 31 lines] > I'm sure that you have access to the journal in question and so to the > full text article. Would you care to comment on it? Very interesting. Thanks for the reference. I will download it look it over. I remember the article, but I'm not sure it has any relevance to the ability to cure the cancer. What would be more interesting is to know the results of the formal axillary dissection that took place after the positive sentinal node was found. I'm impressed that you were able to dig up the article and I appreciate the effort. HMc I just want to bring up a couple of things that might or might not need to be pointed out to the experts here. Any point along the perimeter that's cut when removing the cancer would contain fewer, if any, cancer cells than the area that's biopsied, but total perimeter being cut could vary greatly, so biopsy studies might not help so much in calculating the risk of removing the cancer. Also, small differences in "mechanical disruption" seem to matter, according to the section Does Surgery Cause Cancer to Spread at http://www.cancer.org/docroot/ETO/content/ETO_1_2X_Surgery.asp#C7 which says "In the past, larger needles were used for biopsies, and the chance of spread was more significant." -------------------- http://www.polisource.com
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