We saw that fully 50 per cent of all cases of cancer were quite inoperable when first seen by competent surgeons, while the average end result, or cure, in the cases operated on, for all kinds together, good and bad, slight and severe, did not total as much as 25 per cent; this makes but 12.5 of the entire number who applied for surgical relief. We quite naturally asked, therefore, if some form of medical treatment, including diet and hygiene, could not afford a better prospect of arresting this fearful mortality. It is especially in regard to the large number of inoperable and recurrent cases, comprising over 60 per cent of the whole, that this inquiry is particularly important. We will briefly consider these latter sad conditions.
Looked at from its broadest aspect, in connection with what I have tried to show here and on former occasions, all cancer will be inoperable, or rather, not needing operations, when the principles I have tried to develop are fully elaborated by the wide experience of others, and when they are firmly established, and correctly carried out. For when it is universally realized that it is the errors of life, determined and accentuated by advanced civilization, so-called, which lead up to and cause cancer, and when public education has been advanced along correct lines, the tendency to cancer will diminish and there will be fewer cases, either operable or inoperable. The former will melt away under correct internal and external measures, and the latter will be helped by, or slowly yield to the same, unless the malignant process has already progressed beyond the possibility of retrogressive metabolism. But, of course, it is too much to expect that such longed for results will be fully attained within a generation or two.
Inoperable cancer is truly a most distressing condition, especially after it has become so after one or more surgical operations. The hopelessness and despair of the patient when told that no operation is possible is bad enough. But when with recurrence, time and again after repeated operations, it is decided that no further relief by the knife is possible, the despondency is indeed pitiful—especially as ordinarily one can only look forward to a sure and most painful death, at a not very distant day. It is very difficult to convince many of these patients that medical treatment, including diet, can do any good, so firmly fixed is the idea that an operation is the only possible remedy; many, therefore, get weary of the restraint necessary when immediate results are not seen. And yet in my previous lectures I gave several such cases to show that much can be done medically along these lines, even in these distressing cases, and later shall hope to narrate other instances, similar to those reported in my lectures two years ago.
It is undoubtedly true that some of these cases which are inoperable when first seen could have been operated on at a much earlier period, with as much success as follows in those in which this is tried. But we have already seen in the last lecture how small a proportion of these selected cases survive a long time; for we have yet to find statistics regarding those who have been traced even as long as ten years. In my previous lectures I reported concerning two patients with undoubted cancer of the breast who had been watched for sixteen years, with no trace of the trouble remaining, and two others who had been seen each for nine years; these latter have been watched since, and have been seen recently, eleven years after beginning treatment, with the same results, all without operation. These cases had all been diagnosed as undoubted cancer by competent surgeons, some eminent, and had refused operation, which had been urged. Later I shall hope to relate other similar instances of early cancer.
Inoperable cancer, comprising at least 50 per cent of all cases applying to the surgeon, presents many features of interest and worthy of consideration. The reasons for inoperability may be grouped as follows:
1. Those occurring in regions quite inaccessible, as in the brain, esophagus, liver, pancreas, etc.
2. Those otherwise accessible, but which have advanced too far before seeking surgical relief, occurring in many locations.
3. Those in accessible regions where experience has shown that recurrence is pretty sure to take place, such as advanced cases in the oral cavity, bladder, prostate, etc.
4. Those which have recurred after repeated operations, with extensive spreading of the disease, as in many cases of the breast, uterus, etc.
5. Those with already very great metastatic involvement, in many regions, presenting a true carcinosis.