Tuesday, February 20, 2007
Beating The Spread
If I could actually accomplish something with this blog, I'd like to put one notion forever to rest (I'm reminded of it by a commenter on a recent post.) There's an all-too-common conception out there; pernicious and pervasive, untrue as it can be, it's scared many prospective surgery patients nearly to death. In some cases, in believing it, it has quite literally done so. I've written the occasional humorous post: about this I'm deadly serious, so I'll say it very clearly:
Surgery does NOT cause curable cancer to spread.
I've heard the thought expressed a million times, and I have no doubt that every other surgeon has as well. "Doctor," they'll say, earnestly, fearfully, directly. "I heard that surgery makes cancer spread. Soon as they open your belly, when the air gets to it, it goes all over the place, and you die. I'm really scared to have an operation." Who wouldn't be, having heard such a thing? I think I know where it comes from: as with, I'd suppose, some other superstitions, there's a kernel of truth.
I've been there: operating with the intention of doing a curative (or at least durably palliative) cancer operation, only to find, entirely unexpected, that the cancer is widely spread throughout the abdomen. Sometimes the only option is to close up, accomplishing nothing. And surgery which doesn't do good is, by definition, bad. The effects of anesthesia, the demands of healing are, by themselves, adverse. So it's reasonable to think that the angle of decline could be made steeper by an operation that produces nothing positive, in the context of already far-advanced cancer. But it's not that surgery spread the cancer; nor that exposing it to air had an adverse effect. It's that it was too far gone at the time of the operation. Sadly, it happens. Even when palliation is attempted, it's not always as long-lasting as we'd have hoped. The stories, I think, are born of this.
When asked the question -- which I was, frequently -- I pointed out that everyone who's ever been cured of cancer -- and there are millions of them -- began with an operation. No cancer is treated without first being diagnosed in a laboratory, and that means, at minimum, getting a surgical sample for analysis. In most cases, it means an operation to extirpate the tumor. So clearly, surgery doesn't cause cancer to spread like wildfire: were that the case, there'd never have been a cure. Ever. Because virtually every cancer patient has had some sort of operation, often a major one, right at the start.
In approaching cancer, we are as far from the ideal as one can imagine. The day will come -- I'm certain of it -- when treatments will be devised based on a specific tumor -- quite possibly each individual one -- and which will attack only the cancer cells, leaving everything else undamaged. Radiation and chemo, if they exist at all, will be highly targeted and specific. The inklings are here already. Surgery, when needed, will be much more minimal than now; what we do currently will be considered, in a few decades, barbaric. But it does work. We all know people who've been cured, brutal as it may have been. I know lots of them, intimately.
Take it from me, who has been fortunate to have done many hundreds of curative cancer operations: when the timing is right, surgery works. If it happens to you, get yourself a surgeon and oncologist you trust, find out everything you need to know to get comfortable, and go for it. I want you around, so you can keep reading my blog.