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by Aryadasa Ratnasinghe

According to the Ministry of Health, the disease cancer accounts for 11.5% of deaths in Sri Lanka, and it is said to be rising at an alarming rate. However, early detection and treatment have saved the lives of many unfortunate patients from carcinomatosis and, at the same time, increased every possible chance of recovery from the lethal disease by prophylactic treatment.

According to medical opinion, the effects of cancer are legion or widespread. It has been medically established that the organs of the body vulnerable to the disease are the breasts, womb, colon, prostrate glands, vulva, penis, face, mouth etc., which are the common sites for the development of the disease.

Excessive smoking also leads to cancer of the lips, oral cavity, the pharynx, the oesophagus, the pancreas, the larynx, the lungs, trachea and the bronchus, the bladder, the kidneys and other organs of the body susceptible to the disease. Habitual drinking, specially undiluted or meat, and the ingestion of certain chemicals into the body have also been signalled as positive causes leading to cancer.

Owing to the increasing number of patients suffering from cancer, in addition to the Cancer Hospital at Maharagma, which was the only hospital for cancer patients, other hospitals with the latest diagnostic equipment, have now been opened in Galle, Kandy, Jaffna and Anuradhapura, for the convenience of the patients who come from afar for treatment.

The word 'cancer' has been derived from the Greek etymon 'karkinos' (crab), because of the disorderly growth of epithetial cells, which invade adjacent tissue, have the appearance of a crab.

We know that cancer is the most agonising disease, and the acute pain and suffering the patients undergo calls for our sympathy. If any one were to make a visit to the Cancer Hospital at Maharagam, he can see to himself the condition of the unfortunate victims to the lethal disease, which had developed for reasons still unknown to the medical profession. Most of them suffer from psychosis because they are well aware of the threat to their lives.

Believe it or not, that there is no other disease so painful and irritating than cancer. There is hope that the disease can be cured in its initial stage by surgery. But the problem is that people rarely become aware that they carry the lethal disease, because in most cases, symptoms appear too late, requiring protracted treatment.

Other methods of treatment include X'ray therapy, the use of electron tubes for deep therapy and radioactive sources for surface therapy, the traditional radium being replaced by giant sources of radioactive cobalt (metallic element of atomic number 27) or caesium (an extensile alkaline metal of atomic number 55). In suitable cases, needles containing short-lived radon (a gaseous radioactive element of atomic number 86) are implanted or a cure may be sought by the use of chemicals.

Cancer being a disease involving certain vital parts of the body, it always requires complex and protracted therapy. The disease is so wide-spread and its dangers so feared and pervasive, despite the tremendous increase in effective therapies, that the diagnosis represents a crisis for the patients as well as their kith and kin. It is said that the disease usually has adverse effects on the body image. The effects of surgical, radio, chemo and immuno therapies have now proved a boon to patients who have become frustrated of life, aggravated by suffering and pain.

Untreated, the disease may result in acute pain, disfigurement and malfunction of the body, depending on its location and the presence of metastasis or removal from one place to another. Cancer of the reproductive system and urinary system may cause infertility, impotence or orgasmic dysfunction, and result in weakness, fatigue and chchexia that may result in decreased libido.

Surgical excision of malignancy provides sufficient opportunity for cure. But it is frequently anticipated with dread, even if the projected operation is nighter extensive nor mutilative. The patient is faced with two threats: the disease and the surgery, which often is the only definitive therapy. Both are said to produce special problems, one related to the loss or change in the function of the body part, and the other related to the psychosomatic disturbances.

Radiation therapy is utilised in the treatment or palliation of localised disease alone, or in combination with surgery, immuno-therapy or chemotherapy. It is said that "body-image changes may occur as a result of change in the appearance of the skin or erythema (reddening of the skin), or more acute reactions, such as desquamation, blisters that burst to form ulcers, loss of hair and radiation burn. Burns are rare but when they occur they are marked by deeper blisters and slough of entire skin areas."

The diagnosis of cancer precipitates an emotional crisis for the patient and the family. At most, cancer connotes death. At least, it connotes pain and unbearable suffering. Anxiety, depression, guilt, shame, dependency or regression, anger and altered body image may, in all probability, cause altered responsiveness in sexual partnership. Cancer and its therapies may lead to loss of health, beauty, youth, in and out activities and potentially life itself. Contrary to popular belief, it has now been found out that, although the fear of death from cancer is an established fact, patients have no disrupted feelings over death.

Sometimes, acute depression, with suicidal tendencies may occur in persons who have become frustrated of life given to pain and suffering, or those who have found life almost miserable. Some view cancer as punishment for past indiscretions, when regression and increased dependency on others, especially the spouses, may develop. One wife once said: " Now I am treating my husband like a child, make him feel like a child and that he is loved and wanted."

Once of the most prevalent reactions described by cancer patients is a sense of isolation, of being cut off from those persons who are indispensable to them. Perhaps, the most profound isolation is the inability to relate to and derive comfort from others. Tragically, myths and misconceptions about the nature of cancer, its causes and its therapies may result in social and sexual isolation of persons with cancer.

It has long been known that workmen in certain occupations are unduly liable to develop cancer. Study has shown that the disease is caused by prolonged exposure to some substances used in particular occupation, and that the type of tumour produced is specific for that occupation. Compared with cancer of unknown origin, occupational cancer is a relatively rare condition, but it is nevertheless, interesting and important in the study of cancer.

Cancer is a general term to denote all forms of malignant tumour. Tumours occur when the cells of a tissue or organ multiply in an uncontrolled fashion unrelated to the biological requirements of the body, and not to meet the needs or repair or of normals placement. In contrast to beaning tumorous, which enlarge in a specific place and cause damage by pressure on the adjacent tissues, malgnat tumorous invade, destroy and spread and enlarge (metastases). Cancer kills by destroying vital tissues by interfering with the performance of their functions through ulceration, bleeding and infection.

Although the cause of cancer is still unknown, it appears to depend upon an interplay between factors in the environment and the genetic component of body cells. Only a small number of cancers are determined solely by inherited factors. The great majority are related to exposure to one or more environmental factors which predisposes to cancer.

These factors are known as 'Carcinogenic' (producing cancer). Sarcoma is a malignant tumour in connective tissue, bone or muscle. Sarcomas are much less common than carcinomas, which arise from the lining tissues of the skin and internal organs. The branch of medicine concerned with the nature and origin of tumours, including the study of their natural history and response to treatment by drugs, surgery or ionizing radiation (radioactive substances or X'rays) is known as oncology and is connected with cancer.

Historically, the study of occupational cancer was begun by Percivall Pott in 1775, when he drew attention to soot as a cause of scrotal cancer in chimney sweeps. The site sin the body commonly affected by occupational cancer are the skin, the lungs and the bladder. In addition, tar and pitch may also cause dermatitis and conjunctivitis. Sir Ernest Kennaway became the inspired leader of a team which studied chemical carcinogenesis, and in 1924, discovered the first cancer-producing hydrocarbons Dibenzanthracene and Benzpyrene from pitch.

Workers employed in the manufacture of synthetic dyes are liable to papillomata (an epithelial tumour or a wart) and cancer of the bladder. In curative treatment, workers exposed to risk should know the danger of developing cancer, if they prove to be negligent. Routine examination and centrifugation of the urine should be carried out for red blood cells and exfoliated bladder epithelium.

The powder of arsenical compounds which settles on the skin of the industrial worker may give rise to warts on the nostrils, eyelids, lips, ears and wrinkles of the neck, and since these compounds of arsenic are carcinogenic, the warts may become malignant. The face, abdomen, scrotum, buttocks, clavicle and chest may also be affected.

Reproductive organs may also be adversely affected due to radiotherapy. Radiation sickness, a generalised illness, may cause nausea, fatigue, malaise, and weakness, and may also decrease interest in sexual activity. It is further said that depending on the size of the area and the amount of bone marrow irritated, patients may develop decrease in white blood cells and platelet count, predisposing them to infection and haemorrhage.

The commonest malignant turmour in women, spreading within the breast tissue and to the skin which may ulcerate is known as breast cancer. Treatment depends on many factors, but includes surgical removal of the tumour or breast (mastectomy) and a combination of hormonal and anti-cancer drugs. Once the breast is removed, most women feel that their best image is lost, but overcome the situation by wearing an artificial breast.

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