The conquest of cancer

by H. W. S. Wright

We pass on another few years, and our friend reappears. This time his sore has a more permanent appearance about it. It is hard, and somehow looks as if it goes deep, and has a tendency to bleed. We look at it and tell him that he ought to let us cut out that small sore, but as a rule he won’t allow this procedure; he wants medicine to take for it, an ointment to put on it. If we were again to have a microscopical section at our disposal we should see a very different state of things. Those epithelial cells which before were just thickened, and a little angry looking, have at last wakened up and begun to grow. They have branched out and grown deeper into the lip; there is nothing to check them since they have thrown aside all the restraints imposed by the necessity of keeping to their original form, and have, so to speak, got out of the control of the usual mechanisms which the body possesses for keeping cells in their proper place. The only thing we can do for the patient is either to find some means to kill them—an end which has not yet been achieved, as what will kill them will also kill the patient—or to cut away the tissue in which they have grown, leaving a wide margin around the farthest palpable edge of the ulcer. If this is done, the patient can be assured of a permanent cure. But if he will not believe you, as he often will not, possibly because you are not willing to stake your reputation on the ulcer being malignant, or the certainty of its cure by surgery, he will go away for another year or so. One day he appears again because his ulcer has been showing a tendency to bleed and has got a bit bigger lately; also he has noticed, while shaving, a small hard lump in his neck which he feels as the razor goes over it. He still has no pain and no discomfort whatever. We look at this and tell him that he has to undergo an operation, both on his lip and on his neck, and that he has got cancer. We remove the ulcer and every gland that we can find in a large area around, but we can only assure him that he has a one in five or three chance of a permanent cure whereas, if he had taken our previous advice, we could have promised him a permanent cure in between ninety and one hundred per cent. of chances, according to the age of the disease.

If we now use our microscope, we see that the undisciplined epithelial cells have penetrated the lymphatic capillaries which are present in all our tissues, and have followed them until they reach their destination, the nearest glands. What will happen next depends on time. The growth may spread to more glands, or even outside the glands, and the only course we have open to us is to remove the primary growth, again with a wide margin, irrespective of what disfigurement may result, together with its corresponding lymphatic glands, trusting to radium or X-rays to kill any stray cells that may be set free or missed during the operation. The chances of cure simply depend on whether it is possible to remove the disease completely or not.

The figures I have given are taken from a recent analysis of more than five hundred cases of cancer of the lip carefully followed up. Of cases in which there were no glands involved, ninety-one per cent. were cured: of those with glands only eighteen per cent. were cured. Now here is the point I want to emphasize. The average duration of all these cases was two and a half years before operation. It is impossible to devise any more radical operation, with a much lower death-rate than we at present obtain, and there is no other method which as yet produces better results than I have just quoted, but it is possible to do away with that two and a half years of waiting and medicine. There is no reason for it but ignorance, neglect, stupidity, self-deception and fear.

The example which I have just quoted is not an unusual one, nor, as I hope to show you later on, do the figures materially differ for cancer arising in other parts of the body. Cancer of the lip merely happens to be a convenient, and easily understood, peg upon which to hang my text.

Cancer is practically always preceded by chronic irritation of some kind or other. There may be, and in fact are, other factors which enter into the problem, but there can be no doubt that in nearly all cases there is what may be called a precancerous stage, which, if adequately dealt with, will often prevent cancer appearing at all. It is moreover a longstanding chronic condition which, as a rule, gives rise to very little inconvenience on the part of the patient.

After this precancerous stage there appears what may be called early cancer, often indistinguishable to the naked eye from the original precancerous lesion, but giving rise to great suspicion in the eyes of the initiated on account of its hardness, and tendency to be fixed, and its resistance to treatment. Cancer in this stage can be cured, with results which will compare favourably with the cure of any other known disease (i.e., in about ninety per cent. of all cases) its cure simply depending on early diagnosis. This is a fact neither known nor appreciated by the general public, and until it is known by everybody, and these early stages are radically dealt with, we shall still be spending our time and money looking for new and miraculous cures for a condition which, in its very nature, is unlikely to be susceptible to any method of cure when its late stages are reached.

The third stage is that in which the neighbouring lymph glands are involved. In this stage about thirty per cent. are incurable, but these figures are not of much help or comfort to any particular sufferer as they depend on the degree of involvement and the rapidity of growth. There is, in the vast majority of cases, no reason why it should ever reach this stage other than those causes which are within the control of the patient and his doctor.

Lastly we get to a stage in which the disease is frankly inoperable, and generally speaking, only capable of relief by one palliative measure or other. About forty to fifty per cent. of all cases which reach the surgeon have already arrived at this stage, and it is to this fact that the generally hopeless attitude of everybody is to be attributed. It is only when this stage is reached that the patient has pain and symptoms which “wake him up,” and that he realises the calamity which has befallen him.

The early signs of cancer may now be summed up as those of a lesion of some kind, extending over a number of years, giving rise to very little trouble or inconvenience, and followed by a small hard lump or ulcer. If the latter is present, it is often characterised by bleeding. Again, practically no symptoms. To find it we must look and see; often an operation involving practically no suffering and a very small mortality is necessary. But the penalties of failure to do this at the proper time are that ten per cent. of the population die of cancer.

There are certain popular misconceptions about cancer which require correction. The first is that cancer is necessarily painful. This is responsible for much of the late diagnosis, operative mortality and the bad results. Only late cancer, and it would not be far wrong to say only incurable cancer, gives rise to pain. If only pain were an early sign of cancer the whole aspect of the cancer problem would be changed.