The truths you need to know about cancer

David Bowie's death from liver cancer reminded the world that it remains an underlying threat to anyone and everyone.
DYLAN MARTINEZ/REUTERS

David Bowie's death from liver cancer reminded the world that it remains an underlying threat to anyone and everyone.

This month has seen the sad loss of two of Britain's brightest stars – music legend David Bowie and the hugely talented, versatile actor Alan Rickman. They both suffered from cancer.

I am often surprised by the questions patients ask about cancer. Some people are afraid to even mention the "C word", and will skirt around the topic, out of fear perhaps that somehow saying it out loud may make it a reality. Others have carried with them for years misunderstandings that can create a lot of unnecessary fear and worry. So here are some truths and myths about cancer:

What is cancer?

Cancer is a name given to a collection of related diseases. In cancer, some of the body's cells start dividing, but don't stop as they normally would – creating an abnormal "growth" or tumour. Cancers can start just about anywhere in the body. They are always malignant. This means that  if left untreated they will spread. This ability to spread differentiates cancerous tumours from benign tumours, which don't invade or spread into surrounding tissues.

How do cancers spread?

Cancers can spread locally, by simply growing into nearby tissues. However, some cancers can also spread to distant parts of the body, and this is known as metastasis. Breast cancer, for example, can spread to the liver, lungs, brain and bones. This type of spread happens either via the blood vessels or via the lymphatic system. Some cancers can metastasise very early, but others won't spread for many years. Once there are metastases, then the cancer is more advanced – this usually means it is more difficult to treat. The earlier the cancer is detected the better the outlook or prognosis.

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Is cancer a death sentence?

No, not necessarily any more. Historically, there were no treatments available for cancer, so the outlook was poor. However, over recent decades huge advances have been made in cancer treatments – including chemotherapy (drugs) and radiotherapy (radiation treatment). Survival rates are now much greater, but this does depend on the type of cancer you have. There are still many cancers which can't be "cured", but in most cases there is treatment available that can help extend your life. Doctors talk about "5 year survival rates" – this means how likely it is you will survive for 5 years after your cancer diagnosis. For breast, prostate and thyroid cancers for example, the 5 year survival rate is now over 90 per cent. However, life expectancy depends on many factors – your underlying state of health, how advanced the cancer is at diagnosis, what sub-group of cancer it is, and what effective treatments are available.

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Is cancer inherited?

This is probably the question I am asked most often. Some cancers are definitely linked to the genes we inherit – this means that if a close family member (e.g. a parent or sibling) has that type of cancer, then you may have an increased risk of developing it also. Cancers that fall into this category include breast, bowel, ovarian, prostate, melanoma, kidney, retinoblastoma (cancer of the back of the eye), womb or uterine cancer, and thyroid. However, there are many cancers that can't be "passed on" – for example, you cannot develop certain types of lung cancer unless you have been a cigarette smoker, regardless of how many family members might have been affected. If you are worried about your family risk, I would suggest you talk to your GP who will be able to outline where there are any real risks to you or your children. If you do have an increased chance of developing cancer, there is often screening available that can help detect it early and improve your chance of successful treatment.

Is cancer always painful?

Not always. Some cancers never cause pain, especially in the early stages. This means they can be hard to detect and may present in quite subtle ways. However, if cancer is quite advanced it does usually start to cause pain, especially if it has spread to bones or other parts of the body. Cancer and hospice specialists are expert in managing pain control, and this is often one of the most important parts of treatment to get right.

Can I avoid getting cancer?

In all honesty, the answer for this would have to be no. You can certainly minimise your chances by modifying all the risk factors you can – don't smoke, limit alcohol and unhealthy foods especially processed foods, exercise regularly, avoid too much stress. However, the biggest risk factor for cancer is actually age – as our cells get older, their ability to "self-regulate" and switch off diminishes. This means that these cells become more and more likely to turn cancerous with time. As our population ages, the risk of developing cancer is greater and there isn't much we can do about that. However, regular screening checks for cancers certainly help, and seeking medical advice early if you have any unusual symptoms is the best way to detect any cancer early, giving you a better chance of a good prognosis.

For more information visit the Cancer Society's fantastic website on cancernz.org.nz

 - Stuff

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