Chapter 3 Medical Treatments

Back to Chapter 2.

There are two schools of thought on patient education. One is for the patient not to know, to care or to worry. Let the doctor or other health professional treat and cure you. The other is to explain every aspect of the disease and treatment so the patient can understand and become an active participant, not a recipient. Today, oncologists (doctors specially trained to treat cancer) are taught the latter method. It is believed the greatest resource to cure a patient is within the patient.

There is an old tale with a great moral called the "wheelbarrow story." An individual carted scrap metal from machines in a plant to the junk pile hour after hour, day after day. The turnover in this position had been high, and the current employee was very slow and lethargic. The plant manager came to him one day and explained the entire process of producing their product and what an important place this individual had in continuously moving the scrap from the machine to the junk pile. He was an integral and vital cog in the entire operation. From that moment on, he did an outstanding job.

Table of Contents
Chapter 1: Understanding Cancer
Chapter 2: Initial Approach
Chapter 3: Medical Treatments
Chapter 4: Quiz
Chapter 5: Mental Attitude
Chapter 6: Physician-Patient Exercise
Chapter 7: Self-Help Exercise
Chapter 8: Prayer
Chapter 9: Smoking
Chapter 10: Pain Relief
Chapter 11: Diet
Chapter 12: Conclusion
Chapter 13: 25 Most Frequently Asked ?s
Chapter 14: Checklist
I believe the same thing applies in the recovery from cancer. If we can understand the part that we are able to perform, we can help ourselves do an outstanding job in the successful treatment of our disease. It is for that reason that the following information on medical treatment is presented. It is so that you can understand what your options are, what your doctor is recommending, why it is being recommended, what it is intended to do and how it is supposed to do it. With this information, it is hoped that your mind and your body will help the treatments do their intended job.

This book could not serve you well without some discussion of alternative therapies. Even though you have cancer, you still have a good mind, and you are able to think and rationalize. You have gone through a traumatic experience being diagnosed with cancer, but that doesn't mean you have to rush into everything with blind faith and believe everything anyone says or everything you read. Use the common sense God gave you without trying to take the easy road out.

There are three types of treatments that you must consider in treating cancer. First are orthodox medical treatments (such as surgery, chemotherapy, and the other treatments described later in this chapter) of which I am completely in favor when prescribed by a qualified physician and concurred with by an independent qualified second opinion. Orthodox medical treatments always come first and foremost in treating cancer.

Second are termed supplemental (such as prayer, relaxation, imagery and diet), which means methods of treatment that are used in addition to orthodox medical treatments. I am completely in favor of any and all supplemental forms of treatment as long as your physician says they will not specifically harm you or interfere with whatever medical treatments you are taking.

Third are alternative therapies, methods of treatment used instead of orthodox medicine. I am totally and unequivocably opposed to any form of alternative treatments!

Sometimes you may hear a person describing a treatment as "unorthodox." In my opinion, that term should not be used. It merely indicates the person using it is unfamiliar with the treatment and trying to discourage its use even though it might be helpful to the particular patient.

Fifty years ago, anyone being cured from cancer could only have done so with surgery. Therefore, to relatively few surgeons, any methods of treatment other than surgery, such as radiation, chemotherapy, relaxation or prayer are unorthodox. Oncologists know that this position is totally foolish. A few doctors with tunnelvision will call any treatments other than straight medical treatments unorthodox. This is only because they feel that they are imbued with all the knowledge in the world, and since they weren't taught this, it can't be good. My advice is to ignore the negative connotation of the word unorthodox whenever used. The idea is to get well, and if unorthodox methods can help, then after you are well you can try to figure out whether it was the orthodox or unorthodox treatments that did the most good.

The critical thing to differentiate between is alternative and supplemental treatments. Use your head and you will have no problem figuring out which is which. Everything recommended in this book is supplemental. It is in addition to whatever your qualified physician recommends.

Some people don't like the prospect of taking an unpleasant medical treatment. Perhaps some doctor told them there was nothing medically that could be done, and they failed to seek a second opinion. A human being will not be denied hope. They get oversold on a supplemental therapy, and use it to the exclusion of medical treatments. Then this supplemental therapy becomes an alternative therapy. It goes from something wonderful, something that can help save your life to something terrible, something that can most certainly cost you your life.

Ignore the word unorthodox, as it has no meaning other than to demean a particular treatment because it is not familiar. Stay far, far away from alternative therapies because they can kill you by denying you access to the treatments that thousands of scientists have developed and perfected over the years. Believe in and use every supplemental therapy that your physician says cannot hurt you. It is your life, and if you don't do everything possible to help yourself, no one else will.

There are numerous commonly used treatments for cancer, many of which could be successful if used individually, but often are proved more successful when used in combination. I personally had radiation therapy, chemotherapy, surgery, immunization therapy and a year of adjuvant chemotherapy in addition to psychotherapy. The cure rate for patients with advanced Hodgkin's disease was increased from 54% to 84% by giving alternating treatments with two four-drug combinations demonstrating the complexities within a single type of therapy. We shall discuss several of the more common medical treatments.

We have all heard war stories about various treatments for cancer and how horrible they are. I had 5 of the more common treatments. Prior to that, I was told I was terminal, that nothing could be done and that there was no hope. I lived for 5 days without hope. I want to go on record as stating that any single minute without hope is worse than all the treatments I went through!

These horror stories were probably true in your parents' or grandparents' time. Today, these treatments, when administered by qualified professionals, are scientific, not guess work. They know exactly how much of anything can be given to you safely to do exactly what is supposed to be done and probably what the side effects or residual effects will be.

By far, the greatest progress in cancer treatments has been made in recent years. Over half of all cancers that a young doctor graduating from medical school only 10 years ago was taught were untreatable are today curable to some degree. At the annual review meeting of the National Cancer Advisory Board in December, 1985, Dr. Alan Rabson, director of the Division of Cancer Biology and Diagnosis, referring to scientific highlights and discoveries, stated, "It has been one of the most exciting years during my lifetime." Dr. Lloyd Old of Memorial Sloan-Kettering, one of the most respected cancer specialists in the U.S., recently said there had been more progress made in the cancer field in the last several months than in the previous 25 years he has been in research. Dr. Vincent T. DeVita, Jr., director of the National Cancer Institute, states, "The pace at which science is moving is so exciting that the fear is not being able to keep up between the laboratory and the clinic."

People were burned with radiation therapy years ago. Today, there is no excuse for this. Sure, some people were poisoned with drugs. My recollection is that in an article a few years ago in the Washington Post, the reporter was able to locate some 6 drug-related deaths nationally. They showed a picture of an infant superimposed over her death certificate stating this child was killed by drugs. What dramatic journalism! These 6 deaths were out of some 200,000 people who received chemotherapy that year. If you compare the risk to the reward, there is no comparison. In my opinion, that article, by frightening people away from the proper treatment, killed more people than drugs would for many, many years.

Some 15 years ago a radical mastectomy was the treatment of choice for breast cancer. Now it is rarely an option. Relatively no one should die from testicular cancer today. Many say the greatest advances have been made in childhood cancers.

Be grateful that dedicated doctors and scientists discovered the treatments and perfected them so you are able to receive the benefits of them. Only a few years ago this was not possible. Because many people died previously, maybe you have a chance of beating cancer. Do everything your qualified doctor recommends to help save your life.

SURGERY: In 1984, at a meeting at the National Cancer Institute, we were told that today surgery is given credit for 60% of those cured from cancer. Radiation therapy is credited for 25% and chemotherapy 15%. As you can see from these statistics, if you have a tumor that is surgically removable, your case has an optimistic outlook.

But don't get the wrong impression. First of all, not too many years ago surgery was the only possible treatment for cancer. Therefore, surgery's current cure rate of 60% is a reduction from 100% a short time ago.

Secondly, don't confuse inoperable with incurable. Maybe they sound somewhat alike, but they don't mean anything similar. I was inoperable and here I am writing this book. Inoperable means that at the moment, in the opinion of the doctor who is examining you, it cannot be operated on. It does not mean that you cannot be successfully treated without surgery. Also, it does not mean that other treatments could not make you operable. In my case, radiation and chemotherapy reduced the size of the tumor to make it operable. In addition, it does not necessarily mean that another surgeon with more experience or skills could not successfully perform the surgery.

Surgery, other than for taking a biopsy or debulking a tumor, is generally used in cancer treatment only when it can cure a patient or solve a particular problem, such as a stopped-up colon or uretor. Therefore, if surgery cannot be expected to completely cure a patient, it would not be considered the treatment of choice, and other options should be examined. There is no reason to debilitate the patient, postponing possibly curative treatments, for the sake of performing surgery.

Furthermore, in my personal opinion, while surgery is properly given credit for 60% of those cured from cancer, I believe that failure to give additional treatments prior to or following surgery is responsible for many of the deaths from cancer. That is why I urge every patient to receive a multidisciplinary opinion prior to any treatment or to confirm with a board certified oncologist the surgeon's statement that no further treatments are necessary.

Since surgery is the treatment of choice in many cancers, the National Cancer Institute is proposing to direct a major expenditure for improving the use of surgery in cancer cases. At the beginning of a presentation on improving surgery, we were given a note of caution in the form of a quotation from an eminent surgeon: "There must be a final limit to the development of manipulative surgery. The knife cannot always have fresh fields for conquest and although methods of practice may be modified and varied, and even improved to some extent, it must be within a certain limit, that this limit has nearly if not quite been reached. It will appear evident if we reflect on the great achievements of modern operative surgery; very little remains for the boldest to devise or the most dextrous to perform." This quote is from Sir John Erickson and was published in "Lancet", a leading British medical publication on June 15, 1863!

CHEMOTHERAPY: Once the black sheep of cancer treatments, chemotherapy has become the leading weapon for increasing the number of patients who can be cured of cancer. At the same time, researchers are reducing the debilitating side effects that chemotherapy patients have typically had to endure.

"When chemotherapy was developed in the 1950's, cancer statistics were pretty much static," observed Dr. Bruce Chabner, head of the National Cancer Institute's Division of Cancer Treatment. "Surgery had gone as far as it could go in curing local disease, and the radiation therapy of the 1960's and 1970's only improved the cure of local and regional disease.

"Unfortunately at the time of diagnosis, about half of cancer patients already have spread of their disease beyond their original site, and the only therapy that has made inroads against these cancers is chemotherapy."

Now an additional 50,000 patients with cancer who cannot be cured by surgery or radiation are being saved each year by drug treatments. Five years ago, chemotherapy cured just a few thousand patients annually. The future promise of chemotherapy is very bright. Recent discoveries of ways to improve the effectiveness of drugs and overcome resistance to them, as well as better understanding of how cancer cells spread to other parts of the body, are beginning to produce new treatment tactics that should further increase drug cures and extend chemotherapy to common cancers not currently vulnerable to its effect.

"The prognosis for patients with disseminated malignancy has improved considerably," Dr. Chabner said. Especially notable is the increase in long-term disease-free survival time for patients with testicular cancer from 10% in 1973 to 70% in 1983. Similarly, the response rate for patients with ovarian cancer has risen from 30% in 1973 to 90% in 1983. Further improvements in the efficacy of chemotherapy are expected to be attained with the refinement of high-dose chemotherapy, regional chemotherapy, bone marrow transplantation, the use of colony-forming assays to predict response, the use of combinations of noncross-resistant drugs, and the development of analogs of currently used agents.

The new chemotherapy approaches are increasing the damage done to cancer cells and diminishing effects on normal tissue. Chemotherapists are also better able to control the occasional side effects of nausea and vomiting. Currently, one patient in four who receive chemotherapy is cured!

The importance of drugs is universally acknowledged now that cancer specialists realize that the disease is often systemic, or bodywide, not confined to one site or tissue. In such cases, only treatments like drugs that can reach the nooks and crannies of the body wherever cancer cells may be hiding can be successful.

Cancer cells lose their ability to control their own growth. Normal cells know when to stop growing. If half of your liver is removed in an operation, for example, your liver will grow back. Once local repair is complete, growth stops.

Something happens to cancer cells so that they lose their ability to respond to the body's signal to stop growing. They become wild, erratic cells that keep multiplying.

By themselves, cancer cells are not usually destructive, but they keep proliferating in the body so that they eventually crowd out the normal tissue of organs. That's what kills the patient. If the cancer is in the lungs, for example, the eventual replacement of healthy tissues by malignant cells interferes with breathing.

Many of the new drugs and biological agents now being tested are aimed at controlling the growth of cancer cells rather than destroying them. In a sense, we want to give cancer cells the correct signal to stop growing and behave like normal cells.

The drugs fall into four main categories:

Alkylating agents. The genetic material, or DNA, of a cell is made up of molecules, called bases, that must be duplicated and precisely paired when the cell divides. Alkylating agents interfere with the orderly pairing process and prevent successful division. Some of the prominent drugs in this family: Cytoxan and L-PAM.

Antimetabolites. These compounds chemically resemble vitamins or other nutrients and are therefore absorbed by the cell. But once inside, they disrupt the cell's metabolic machinery. Such agents include methotrexate, 5-FU and 6-mercaptopurine (6-MP). 5-FU, for example, resembles uracil, a substance the cell needs to make DNA. It is not, however, a proper substitute and effectively blocks DNA synthesis.

Antibiotics. Some of these were discovered in research for new drugs to fight infections. They disrupt the synthesis of RNA, a substance the cell needs to make essential proteins. Two leading antibiotics in cancer therapy: bleomycin and Adriamycin.

Steroids. It isn't precisely known how these hormones, which include prednisone and estrogen, work against cancer. They are believed to prevent the production of proteins or other key enzymes.

Some of the anti-cancer drugs don't fall into general categories. Vinblastine and vincristine, derived from the periwinkle plant, prevent the cell from doubling. The drug L-Alparaginase is an enzyme that destroys asparagine, an amino acid that some cancer cells can't make for themselves and must draw from the bloodstream. Normal cells, which synthesize the asparagine they need, are apparently unaffected by the drug.

Among the new developments are these:

The growing use of drugs to treat possible hidden cancer immediately after the obvious tumor has been removed by surgery or destroyed by radiation. This approach is called adjuvant chemotherapy. The drugs are believed to kill off the seeds of spreading cancer, or metastasis.

The realization that chemotherapists have been "too timid" and that more intensive drug regimens given for shorter periods of time are likely to result in a greater number of lasting remissions, which are considered tantamount to cure. Dr. Chabner said, "We get the best results when patients are given full doses of the drugs as fast as possible immediately after surgery or radiation." Traditionally, when toxic effects of drugs got too severe, therapists reduced or stopped treatment. Now they know more about how to help patients survive the treatment, both physically and emotionally.

The use of drug treatments to shrink tumors before they are treated with surgery or radiation, a technique that converts some inoperable cancers into ones that can now be removed or destroyed. At the same time, this technique can improve the cosmetic effects of cancer treatment, permitting less radical surgery or less extensive radiation. Tumors are often most responsive to chemotherapy when first discovered, before they are treated with surgery or radiation.

The development of analogues of established drugs that retain their cancer fighting properties but have fewer toxic effects.

The linking of toxic chemicals to immunological weapons like monoclonal antibodies that are capable of recognizing and attacking specific cells. This technique allows the linked chemotherapy agents to attack just the cancer cells and not normal cells.

The administration of drugs to a limited area of the body, such as the bladder, colon or abdominal cavity, to destroy cancerous tissue with minimal damage to normal tissue. This technique, called regional perfusion, can improve the drug response, reduce the risk of recurrence and minimize the side effects in some patients.

The discovery of new drugs that can overcome the resistance cancer cells often develop to established drugs. Drug resistance has been the major roadblock to the successful use of chemotherapy in patients with widespread metastatic disease.

Of the 10,000 new compounds that are now tested annually, approximately 8 are brought to clinical trials each year. From 1971 through 1985, 25 of the 91 compounds that reached clinical trials have shown significant antitumor activity.

Does Cancer Chemotherapy Work?

Dioscorides (50-79 A.D.) used an extract of Colchicum autumnale leaves soaked in wine to "dissolve tumors and growth."

Pliny (23-79 A.D.) and ibn Sina (980-1037) A.D.) thought the extract worked, but Galen (129-210 A.D.) did not.

Abu Mansar (circa 977 A.D.) and Hildegaard (1098-1178 A.D.) thought it was more a poison than a medicine, because it caused nausea, vomiting, hair loss, and loss of appetite.

Today it is known that colchicine, its analogs, and
the related vinca alkaloids are highly effective against certain hematologic malignancies.

Out of 1,000 laboratory-engineered chemical relatives of cis-platinum, the most potent of the recently developed chemotherapy agents, 2 have been found to retain their potency but have less severe side effects.

Many people expect worse side effects from chemotherapy than actually occur. Your doctor must, and rightfully so, warn you of all the possible side effects that have happened to anyone taking that particular drug. Many patients are able to work and perform most or all of their normal activities while receiving chemotherapy.

RADIATION THERAPY: As a result of technical advances and training programs, radiation oncology has developed into a highly refined specialty. Now, with superb accuracy, a radiation beam can be focused on the tumor without damaging surrounding normal tissue. Linear accelerators, which hit tumors with up to 40 million electron volts, many times the dose of earlier machines, provide deeper penetration and a more precise beam that does less damage to healthy cells. By itself, as well as in combination with other therapies, radiation therapy is an increasingly potent tool.

Radiation therapy, in contrast to what many people imagine, does not destroy or dissolve cancer cells like a laser beam would. Possibly, if the dose were multiplied many, many times, it would. However, it is given in such small doses that its prime mission is to damage the DNA of a malignant cell. The cell does not die instantly, but when it tries to divide, it is unable to and dies at that time. Therefore, radiation treatments continue to be effective on the tumor after the treatments are completed, often for 90 days and more. Sometimes, tumors shrink primarily after the therapy is finished.

Radiation treatments are normally given 5 days a week, not because the doctors don't like to work on the weekends or have a strong union, but because during the other two days, normal healthy cells will repair the damage done to their DNA. Cancerous cells are unable to repair this damage.

Because scar tissue will continue to build up, changes could be noticed in follow up X-rays even though the tumor is gone. Also, no changes may be noticed in a bone scan for some time even though the radiation did its job because the bone mending itself after radiation will give the same image as a tumor on a scan.

IMMUNIZATION THERAPY: Some of the most exciting possibilities are offered by drugs that work in entirely different ways from the conventional ones. One such approach is immunotherapy, using drugs that cause the body's immune system to attack cancer just as it fights off infections. The concept is based on two theories. First, cancer cells can be perceived by the immune system as "foreign" and, with proper help, rejected. The second is that cancer victims have lost their natural powers of rejection because of their debilitating disease.

The widely publicized drug, interferon, stemmed from immunological research. Discovered in the 1950's, it is a protein produced by body cells to help fight off viral infections. In cancer, researchers think it fastens onto cells and causes the release of enzymes that inhibit growth. And, because it is a natural substance, experts hope the side effects will be limited. So far, this is mostly theory; until recently, large scale testing of interferon hasn't been possible because it could be extracted only in minute quantities and at great cost from donated white blood cells. The emergence of recombinant DNA technology, in which common bacteria can be programmed genetically to manufacture quantities of proteins, has only recently made it possible to obtain enough interferon for cancer research.

On December 5, 1985, the New England Journal of Medicine carried a story on Dr. Steve Rosenberg's treatment of Interleukin II combined with LAK cells. That started a torrent of publicity throughout the winter of 1985-1986. Simply stated, this treatment took the natural killer cells from a patient's blood, treated them with IL II, and reinjected them and more IL II back into the patient. These IL II armed white cells, called LAK or lymphokine-activated "killer cells", destroy tumors for months after administration in some cases, until the patient is clear of detectable cancer. Only patients who had failed all other treatments were accepted for this protocol. The success in reducing tumor burden by 50% or more was striking in several types of advanced cancer. In February, 1986, we received a report that Dr. Rosenberg had been successful in 100% (6 out of 6) of the cases of renal cell cancer and 50% (5 out of 10) of the cases of advanced malignant melanoma. Both of these types of cancers were relatively untreatable using other methods of treatment if surgery failed. Steps are underway to confirm and extend these results in other centers.

The most exciting aspect of this treatment, to me, is that IL II is not intended to harm the malignant cells. It is solely to stimulate the patient's own immune system which in turn destroys the cancer. Surgery, radiation or chemotherapy, the methods of treatment most physicians are used to discussing in fighting cancer, are each designed to damage malignant cells in their own way. The mere concept of IL II, as well as the success of the treatments, emphasizes the importance of the patient's immune system. it throws wide open a new and separate field in fighting cancer.

It seems that there are a number of substances that occur naturally in the body to maintain normal growth and development which may be utilized to stimulate the body's natural defenses against cancer. The National Cancer Institute has established a special research program to explore intensively the therapeutic applications of these naturally ocurring substances called "Biological Response Modifiers." In addition to IL II and interferon, this group includes thymosin, bombesin and tumor necrosis factor (TNF).

HYPERTHERMIA: This is the process of heating a tumor approximately 10 degrees fahrenheit. It is generally done with a microwave type mechanism. This in and of itself is capable of killing certain types of cancers. But that is not where the great promise lies. It has been found that hyperthermia can magnify the benefits of chemotherapy or radiation therapy several fold without much downside risk. A critical matter is monitoring the exact temperature of the tumor and the surrounding tissue. For this reason, it had previously been done on lesions relatively near the surface. However, great advances are being made, and it is being tried with many types of cancers. The moderate increase in temperature is not damaging to ordinary cells and not dramatically uncomfortable to the patient. In many applications, hyperthermia is considered experimental today with tremendous potential.

HORMONAL MANIPULATION: The art of treating certain cancers by denying needed hormones, hormonal manipulation is normally one of the more pleasant treatments as it is non-toxic and has very minimal side effects. The possibility of its use is tested for regularly in breast cancer. If applicable, it is certainly a treatment of choice and can be used along with other forms of therapy. A pathologist described it in a fascinating way. A malignant cell is examined and found to be estrogen or progesteron positive, meaning it is dependent on those substances for survival. There is a door on the side of each malignant cell that opens to allow those substances to enter. By giving a certain pill, those doors are sealed shut and the malignant cells are deprived of this hormone they need to survive and divide and are killed.

LASER: Also known as photodynamic therapy, it was developed at Roswell Park Memorial Institute in Buffalo, New York in the early 1970's. A non-toxic drug, Hpd, is injected and is absorbed only by malignant cells. It sensitizes these malignant cells to light. About three days later, an intense laser light is shined on the tumor for 8 to 10 minutes, producing high-powered singlet oxygen inside the cell so reactive that it burns up everything in sight, destroying the cancerous growth. Since the light can only penetrate 5 to 10 millimeters, it does not work well on treating thick or deep-seated tumors. It appears to work best on early to middle-stage cancers of the lung, bronchi and bladder. The use of die laser is increasing dramatically in many major cities, but it is still generally considered an experimental therapy.

MONOCLONAL ANTIBODIES: These are stirring great interest among researchers. The surfaces of viruses, bacteria and even normal cells contain specific molecules that are called antigens. When they enter the body, these molecules trigger certain blood cells to produce antibodies, proteins that lock onto the antigens and render them harmless. All vaccines are made from antigens that induce the formation of antibodies in advance to ward off infectious diseases.

First, researchers inject a mouse with an antigen for example, a human cancer cell. The mouse then makes antibodies to different components of the cancer cell, including abnormal proteins associated with cancer itself. The investigator removes the mouse's spleen, where much of the antibody production occurs, and extracts its cells. They then fuse these cells with cancer cells from another mouse with myeloma. These tumor cells are used because they are immortal: they will continue to divide ad infinitum and make the fused hybrid do the same. Finally, the scientists select the hybrid cells that are producing the particular antibodies they want and encourage them to reproduce, or clone, in separate tissue cultures. All of this is done in the laboratory. The products are called monoclonal antibodies because each comes from a single line, or clone, of cells.

If special antigens can be found on cancer cells that are not present on normal cells, the lab-produced antibodies would home in on tumors like heat-seeking missiles while ignoring normal tissue. These antibodies could be tagged with radioactive substances or chemicals to carry lethal doses directly to cancer cells while bypassing normal cells. One application currently being tried for pancreas cancer is arming these monoclonal antibodies with the patient's own white blood cells to kill the malignant cells. The entire treatment is done in one day with usually no side effects for this normally fatal disease.

Also, they have the potential of causing a revolution in diagnosis. Doctors can tag these antibodies with radioisotopes and scan the whole body for individual clusters of cancer cells that cannot be detected with current methods. While today they have been developed for only a few of the many types of cancer, and what has been developed is in extremely short supply compared to the demand, the entire concept of monoclonal antibodies is mind boggling and the potential is enormous.

Cyto-differentiators: A new class of nontoxic drugs that render malignant cancer cells benign instead of killing them. In recent years, researchers discovered that normal cells, when very young, are much like cancer cells. They divide and spread rapidly and are undifferentiated that is, without specific functions like skin or blood cells. If the young cell is disrupted, perhaps by a carcinogen, as it is growing toward the more mature, differentiated stage, it can become stuck in its immature phase, proliferating randomly and eventually forming a tumor.

Although researchers have shown that a drug known as HMBA can normalize malignant cells in a wide range of animal cancers, it is only recently that they have learned how the substance works. Each HMBA molecule is highly charged like a battery, with negative and positive forces at opposite ends. Once the HMBA enters the cancer cell, the drug's electrical charge sets off a series of biochemical events that ultimately deactivate the genes commanding the cell to replicate endlessly. With this process shut down, the cell reverts to its normal functioning, ages and dies.

Dr. Paul Marks, president of Memorial Sloan-Kettering Cancer Center in New York, who helped discover the drug 10 years ago, made the announcement at the annual science writer's seminar in 1986, that his institution, University Hospital in Baltimore and Yale University School of Medicine are starting tests on humans with bladder cancer and a type of leukemia. If results of preliminary laboratory experiments can be duplicated with cancer patients, the chemicals could prove less toxic and possibly more effective than existing anti-cancer drugs. It is believed that these will be most effective when used in conjunction with conventional chemotherapy.

I would like to tell a story for the sake of the cancer patient looking for proper help. They say a picture is worth 10,000 words, and this brief story is a graphic picture. A friend was unexpectedly diagnosed with a very serious cancer of the sinuses at an outstanding institution. The surgeon who had done the biopsy and removed all the tumor mass possible originally, upon learning the cell pathology, stated that the only hope was for extremely radical surgery with pre-op or post-op radiation. The patient went to a second institution for a second opinion from a noted surgeon. There, he was told that radiation would not help and much more radical surgery than he had been led to expect would be necessary, nearly obliterating his face, if there was any hope of saving his life.

Being totally unnerved, he went back to the first institution for a consultation with the radiation therapist. Here, he was told that the surgery was far too dangerous and his only hope was in radiation therapy, which could be very damaging. Then, he went to a third institution where a medical oncologist, radiation therapist and surgeon sat down together with the patient after numerous additonal tests were performed. Jointly, they worked out the possibility that a very low dose radiation could be given over 5 weeks fairly safely compared to the high dose that had been proposed, followed by surgery from the top of the head causing minimal appearance damage. However, the head and neck surgeon wanted a neurosurgeon present for that part of the operation.

I know none of this first hand. It has all been told to me by the patient and his wife directly. Maybe none of it is what he was told. That doesn't make any difference. It is definitely what he understood. Obviously, he chose the latter institution. He chose the physicians who did not feel they knew more about other methods of treatments than the specialists in those methods. He wanted doctors who were open to the suggestions of others and who sought and wanted the assistance of specialists in fields other than their own. All this gave him hope which helped his mental attitude and gave him a strong desire to fight and live. The result of his search and the subsequent teamwork shrank the tumor with radiation to a point where it could be removed with adequate margins and no facial disfigurement.

Articles in local publications or media announcing gigantic breakthroughs in cancer should be viewed with skepticism and not allowed to raise false hopes or doubts. Generally, these can be checked out easily by calling 1-800-4-CANCER, the Cancer Information Service at the National Cancer Institute. Major break-throughs, if publicly announced, would be important enough to make all the major wire services. You would hear about them on all the radio and TV news programs as well as in newspapers and magazines. An example would be Dr. Robert Gallo's discovery of HTLVIII as the cause of AIDS.

The following is from an article in "Good Housekeeping, by Dr. Alan E. Nourse about what you can do to avoid being taken in by cancer quackery.

"First, I think it is important to recognize what really is being done by modern medical science, slow as the progress may appear. Researchers are piecing together an immensely complicated puzzle, and progress is slow precisely because the puzzle is so intricate. To discover why a normal cell goes wrong and how to stop the process, we have to understand some of the most basic processes of life itself. But bit by bit the answers are coming in.

"Second, we should bear in mind that even though a magic bullet against cancer may not be found, more and more kinds of cancer are being cured, and the list of known, effective treatments is lengthening.

"Third, knowing what we do about the dedication and integrity of most medical scientists, we should be suspicious of anyone who claims that researchers are deliberately hiding valid cancer cures from the public.

"But most important of all, we should use some plain good judgment. When you hear about a new cancer remedy that sounds simple and easy and that you can handle largely by yourself, recognize it for what it is. If is sounds too good to be true, it almost certainly isn't true."

Chapter 4