Meditations of an oncology geek

Does cancer treatment vary by stage of diagnosis?

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16 May 2011

This week’s article was inspired by Barbara Burton from La Jolla, California:

Dear Ryon,

By the time a person has been diagnosed with cancer, say in Stage II or III, and treatment initiated, where in the stage above does that treatment occur and what is the treatment designed to do?

Thanks for your response,?
Barbara B.

Different cancers have different clinical grades, but most are rated via the I-IV grading system. Stage III for most is locally invasive, and usually confined to the tissue of origin. Stage IV usually denotes spread to distant tissues, or metastatic cancer. Most people are diagnosed in Stage IV.

Right: Early stage cancers are often curable via surgery. This is because they have not yet seeded the entire garden.

Early stage cancer is often curable via surgery in non-vital organs. If a tumor can be thought of as a weed, one has a much greater chance of preventing the spread of that weed in your garden if you remove the weed before it matures and sends its seeds flying in the wind. The same goes with cancer. Late stage tumors dump millions of tumor cells into the lymphatic system and bloodstream daily. Early stage tumors generally do not, and it is because of this that you can remove the weed before it disrupts the rest of the garden.

Once those seeds have spread, surgery is made much more difficult. You would need to dig up half the garden to get rid of all of the weeds! In a previous article, I discussed why late-stage cancer is often deemed terminal. For more advanced cancers that have begun to spread, oncologists will often employ surgery to remove the largest tumors, then use chemotherapy (think: herbicides) to try to eradicate the rest of the tumor seeds throughout the body.

Right: Late-stage cancer often requires a broader approach, and currently the best treatments involve systemic poisons.

Until recently, doctors would remove the sentinel lymph node of breast cancer patients (usually in the armpit region) believing that it would enhance survival by blocking the way for cancer cell migration. It turns out that this is actually not the case, and the practice is under open criticism now (1).

So, why not simply apply herbicides all the time to prevent the growth of weeds? Well, conventional chemotherapies are essentially glorified poisons, but poisons that hurt quickly growing tumor cells more than most other tissues. There are extremely serious side effects to chemotherapy, one of which being the frequent loss of hair which is so often associated with cancer patients. To most, it would seem absurd to try to prevent cancer in this manner.

The best treatment for cancer is prevention. Active prevention is not completely feasible for everyone, as even the healthiest and most vigilant person has a high chance of developing cancer with age, but early detection is the next best thing. A good relationship with your doctor and regular check-ups are very effective preventive treatments. New detection methods will continue to enable much earlier and more accurate (not to mention less invasive) detection of cancer in the coming decades as well.

So there you have it. Cancer is like a weed in an esteemed garden. Catching weeds early is paramount to effective treatment, and for those weeds that get out of control, the eradication methods closely mirror the strategies used by modern oncologists.

Ryon

References:
1) http://www.nytimes.com/2011/02/09/health/research/09breast.html?_r=1

Written by Ryon

May 14th, 2011 at 4:37 pm

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