The conquest of cancer

by H. W. S. Wright

So far we have spoken in detail of cancer of the breast but, when we come to deal with cancer of the uterus, we shall find that the facts are almost exactly analogous, only that the results of indecision and delay are even more deplorable. We find that, by the time they come for treatment, about half the cases are quite incurable, and those which are operable are as a rule a great deal further advanced than those of cancer of the breast. In spite of this we find that out of two hundred consecutive cases no less than forty per cent. were cured; that is to say, had no recurrence within seven years. All the cases which were operated on had had quite definite symptoms for six months. In other words, the patient herself should have come for examination six months before she did, and if she had been examined in the course of a proper routine, the disease could have been discovered far earlier than was the case.

Quite recently, a report of a series of cases has been published by Professor Faure, a distinguished French gynæcologist, which so exactly illustrates my views that perhaps I may be forgiven for making use of it. Faure cut ninety-six cases of cancer of the uterus and has divided them into good cases, mediocre cases and bad cases. It is significant that there were only twenty-one “good” cases, thirty-five “mediocre” cases and forty “bad” cases. The good cases are what I have called early cases, the mediocre cases correspond to moderately advanced cancer, and the bad cases to those which are on the border line between operability and non-operability. His total results approximate very nearly to most other published lists but their analysis is very significant. Of the good cases there was one operative death; of the remainder seventy-five per cent. were cured and twenty-five per cent. recurred.

Of the mediocre cases there was an operative mortality of 8.57%. Of those surviving the operation 62.5% were cured and 37.5% recurred. In the bad cases there was a post-operative mortality of 22.5%: only six were cured and twenty-five recurred. That is to say, respectively, 19.35% were cured and 80.65% recurred. These figures tell their own tale.

With this hopeless condition of affairs it is no use saying that the results of surgery are bad. They are; but it is not the fault of doctors, or the methods at their disposal; it is the misfortune of the patient that her lack of proper education must bear the blame.

Cancer of the uterus is in many cases preceded by precancerous lesions, all amenable to various kinds of treatment. Again, the only way to deal with it is not to wait and see whether a woman has got cancer but to look and see that she has not. Until this is our attitude, the results are not likely to be much better, whatever the means at our disposal for its cure.

Finally, turning to another great group of cancers which make up thirty per cent. of all in men (and in women too, if we exclude the two previously mentioned types), we find exactly the same condition of affairs.

In two out of every three cases of cancer of the stomach there is evidence that it has arisen in an old ulcer, and Dr Mayo has suggested that eating hot food may account for the remaining third. It is moreover the experience of all surgeons who systematically submit all gastric ulcers upon which they operate to microscopic examination, that about twenty per cent. of them all are malignant.

We have before us the plain fact that from ten to twenty per cent. of all chronic ulcers which have come for surgical treatment are already malignant and can only be cured by a complete removal. Another fact also requires taking into the most serious consideration, and this is, that it is the considered opinion of by far the large majority of experienced surgeons that exploration and some form of operation is the best treatment for every case of chronic gastric ulcer which has recurred once, or at least twice, after a thorough course of medical treatment. (The term “chronic gastric ulcer” is here used in its strictest scientific sense, and by it is meant an ulcer whose diameter in any one direction is more than a centimeter, and whose edges are hard and thickened). In spite of this, a distinguished surgeon recently put on record that every case of gastric ulcer upon which he operated had on an average been “cured” nine times. Why is this? The reason is clear. In nearly every case the symptoms of gastric ulcer (and, remember! twenty per cent. are already cancerous) can be relieved for a time by palliative treatment, when once again the deluded patient thinks he is cured.

There is no need for me to point the lesson from this. I have put forward the facts, and every one can draw his own conclusions. There is only one gleam of hope that I can see on the horizon, and that is, in dealing with the disease in an early stage by radical measures, and, in twenty per cent. of the cases, thus combining prevention with cure.

Again, we must alter our attitude. We must look and see, not merely “dope” and see! Once symptoms of this disease have recurred after efficient treatment, there is only one good reason for not looking and making certain, and that is when the risks of looking exceed those of the lesion being malignant—that is to say, somewhere between ten and twenty per cent. At present, the risks of looking are about one in a thousand, and the risks of removal of a cancer about three per cent., taking all cases, most of which are at an advanced stage. The operative risks of earlier cases are less than this, and to this must be added about a two per cent. risk of a further operation being necessary—in all, not exceeding five per cent.