Truths and myths about cancer

WHEN we hear the word ‘cancer’, most of us will instinctively conjure up an exaggerated Hollywood version of the disease in our minds where cancer patients almost never survive the disease because it’s more of a death sentence than a diagnosis.

We imagine the disease being extremely aggressive, rapidly spreading across its victims’ bodies while the harrowing radiotherapy and chemotherapy treatments suck the very life out of the victims as they attempt to stop the cancer in its tracks.

It’s far from a pretty scene but one most of us are used to seeing – thanks to the dramatisation of the disease in many popular films and drama series.

In reality, however, the disease is far from the scary death sentence we imagine it to be as statistics from the American Cancer Society (ACS) have indicated most cancers in their early stages are curable while five-year survival rates for some cancers such as breast, prostate, and thyroid now exceed over 90 per cent.

Overall, the five-year survival rate for all cancers combined is currently about 66 per cent in the US.

And treatment-wise, the scene of a frail sickly-looking patient is now a thing of the past as cancer treatments have come a very long way in recent years to help increase both survival rates and the quality of life for cancer patients.

In fact, there are an estimated 100,000 people in Malaysia at any given moment with cancer – meaning at least one of two of your healthy-looking Facebook friends are likely to be cancer patients.

This milder and more accurate depiction of cancer is not very widespread in our communities but healthcare professionals and associations around the country like the Malaysian Oncological Society (MOS) are determined to change this as they believe our unsubstantiated fear of cancer has given us a lot more grief than benefit.

It has done this by gripping many of us with such fear that we would rather live in denial about this potential disease – leading to increased rates of late diagnosis and even flat out treatment refusals as some fear the perceived side effects of treatment more than the disease itself.

There’s little doubt our society is cancer-phobic and to battle that phobia, Dr Winnie Ling, a medical oncologist at Normah Medical Specialist Centre and MOS member, will guide us through some of the common truths and myths about cancer.

According to Dr Ling, the most important step to battling cancer is to first understand what exactly it is because as Chinese strategist Sun Tze says, “If you know your enemies and know yourself, you will win a hundred battles; if you do not know your enemies nor yourself, you will be imperilled in every single battle.”

In essence, cancer is a large group of diseases characterised by an uncontrolled growth and spread of abnormal cells, which are called cancer cells.

“Normally, the cells in your body will slowly replace through cell division and they will stop dividing when enough cells have been replaced.

“Cancer cells are different because they do not know when to stop dividing, causing them to grow into masses of cells called tumours while also invading other tissues.

“They behave this way because of some changes in the DNA sequences of key genes, which are also known as cancer genes,” Dr Ling explained.

These changes or mutations in cancer genes can either be inherited through germline mutations which occur in sexual reproduction cells or caused by somatic mutations which can occur to any of our cells during our lifetime.

Germline mutations are heritable and can cause family cancer syndromes like the breast-ovarian cancer syndrome where individuals with the syndrome stand an increased chance of developing breast and ovarian cancer.

On the other hand, somatic mutations which are much more common for all types of cancers occur in non-germline tissues and cannot be inherited.

But what causes these mutations in our cancer genes to occur?

Dr Ling explained there are several factors believed to contribute to this, mainly an unbalanced diet, smoking and alcohol use, chronic infections and hormones.

“Individual risk of getting cancer increases with age but besides that, environmental factors like obesity and smoking and alcohol use have been also been found to be linked to higher rates of cancer. Some cancers are also associated with hormonal imbalances and chronic infections such as the Human Papillomavirus (HPV), Hepatitis B (HBV) and Hepatitis C (HCV).

“These are all important factors to be aware of as they are things we can do to help reduce our risk of cancer – such as avoiding smoking and alcohol use while maintaining a healthy lifestyle with balanced diet and regular exercise.”

And to further strengthen our defensive stance against cancer, Dr Ling suggested we should also be aware of some of the common cancer symptoms as well.

The common symptoms of cancer are: Any changes in bowel or bladder habits; unusual bleeding or discharge; growing lumps; sores that do not heal; obvious changes in warts and moles; digestion issues; persistent coughs or hoarseness; persistent bone aches and pain; and unexplained weight loss.

“Generally, if anything is out of the norm for an extended amount of time, I would recommend you visit a physician because even if it’s not cancer, it could be some other underlying illness,” Dr Ling advised.

Cancer in Sarawak

Looking towards the scenario of cancer in Sarawak, the top five types most commonly seen are breast, colorectal, lung, nasopharyngeal and cervical.

Overall, these mirror the top five cancers found in Malaysia and the radiotherapy and oncology unit (RTU) at the Sarawak General Hospital (SGH) has also seen steadily increasing new total cancer cases since 2003.

While increasing new cancer cases may seem concerning, Dr Ling explained that it could also be a good sign as it may indicate rising awareness of cancer and its symptoms in our local communities’ statewide – resulting in earlier presentation and increased cancer diagnosis.

But despite this, Dr Ling opined the current awareness levels of cancer are still insufficient as it is estimated that one third of all actual new cancer cases are still undocumented.

Dispelling cancer myths

Myth 1: Cancer is only for the old or those with a family history.

To help resolve the issue of low awareness levels, Dr Ling believes one of the most effective ways is to address some key cancer myths that are heavily perpetuated locally.

“To start with, there are a lot of misconceptions regarding who can develop cancer. Many people think that cancer happens only to the old but that is not true as the young do get it as well.

“Whilst the biggest risk factor for cancer is age, the disease is not restricted to any age group,” she said.

And besides age, she stressed it’s important to not discount the possibility of cancer as the disease could potentially develop in anyone – even those who may not have any family history of cancer.

“Most cancers are not inherited – only around 10 per cent are hereditary while 85 to 90 per cent of cancer patients have been found not to have a family history of cancer.

“So just because you may not have a family history of cancer does not mean you will not get cancer.

“At the same time this also means not everyone with a family history of cancer and cancer genes will develop cancer – so please don’t panic.”

Additionally, Dr Ling also assured that cancer is not a contagious disease.

“While some viruses like HPV, HBV and HCV can increase the risk of certain cancers, cancer itself is non-contagious. So one should not worry about contracting cancer from a loved one diagnosed with it.”

Myth 2: Chemotherapy and radiotherapy are worse than cancer itself

As mentioned earlier, our society is cancer-phobic and a significant portion of that fear stems from a lot of misconceptions regarding cancer treatments.

Many of us imagine cancer patients being too weak to continue with their daily lives due to the side effects of their treatments but Dr Ling pointed out this is a gross misconception.

“Most people living with cancer are treated on an outpatient basis and many are able to continue with some or all of their day-to-day activities. They can work part-time, full-time, care for their children and attend social activities while they are having cancer treatment.

“And this is thanks to all the advances we have made in every area of cancer treatment in the last 30 to 40 years.”

Dr Ling said these advances have not only increased our survival rates for most cancers but also allowed for personalised cancer treatment plans for patients depending on what type, subset and stage of cancer they may have, while maintaining their quality of life during treatments.

“So many times, I’ve heard patients tell me ‘It’s not as bad as I thought’ and that’s what we are aiming to achieve with this awareness campaign.

“We hope we can dispel some of these fears people have about cancer and its treatments so they can get the proper treatment they need and get on with their lives.”

And not forgetting the elderly, Dr Ling also encouraged the elderly, diagnosed with cancer, to seek treatment.

“While elderly cancer patients may have concomitant chronic illnesses which may limit their treatment options, age per se is not a contraindication for treatment.

“We encourage them to come and seek proper medical attention so we can better advise them regarding their options and care plan accordingly.”

Myth 3: There are ‘miracle’ cures for cancer.

For our final myth, Dr Ling lamented that one of the most harmful yet prevalent cancer myths in our community is the belief that cancer can be cured through miracle foods, supplements or even objects.

These ideas are widely advertised in online articles or videos where people share their personal anecdotes of how the ‘miracle’ cures have helped them beat cancer.

However, there is little evidence to back up these grand claims, and the sad fact is that proper treatment is often delayed and cure evaded by these misleading claims which often also cost patients and their families thousands of dollars and ultimately their lives.

One example of these so-called miracle cures is the belief that restriction of sugar will help prevent or stop cancer.

“All our cells, cancerous or not, will use glucose for energy and because cancer cells are usually growing at an accelerated rate compared to healthy cells, there are claims that sugar feeds cancer cells.

“However, there is no scientific evidence to suggest sugar enhances or causes cancer growth. Too much sugar can lead to obesity which does increase cancer risk but that’s a far cry from saying sugary foods specifically feed cancer cells.

“It is instead recommended that a balanced healthy diet and regular exercise should be focused on to reduce the risk of cancer,” she said.

Trust in proven data

And with that said, Dr Ling is hopeful the public will place more trust in healthcare professionals over Internet articles as she argued that it’s extremely important for people to only trust published data from peer-reviewed, scientifically rigorous lab-based clinical trials as it enables researchers to prove that a prospective cancer treatment is safe and effective.

“It also allows doctors around the world to judge for themselves and use it for the benefit of their patients,” she added.

Awareness

While this article has only presented a general overview of cancer in Sarawak and how it develops, Dr Ling is hopeful it can act as a gateway to helping Sarawakians have a better understanding of cancer.

“Awareness of cancer is key because early detection, diagnosis and timely appropriate treatments all improve the chance of cancer survival,” she stressed.

About Dr Ling

After finishing her housemanship in Adelaide, South Australia, Dr Ling returned home to Malaysia where her very first posting as a medical officer was at the RTU at SGH.

Thrown into a new environment, which was severely understaffed at the time, Dr Ling recalled that she was initially overwhelmed by the whole experience and felt totally inadequate.

However, not giving up on her new found responsibilities, she soldiered on and by the end of her posting, she found herself so deeply moved by her experience at the RTU that she decided to spend the next decade of her life getting trained and equipped as an oncologist.

An advocate for a more holistic approach to medicine, Dr Ling believes that the field of oncology is not just about treating cancer and is instead about treating and supporting patients with cancer and also their families.

“I think it is a tremendous privilege for us oncologists to journey with our patients and their families through what is understandably a challenging time in their lives.”

In 2013, a year after completing her medical oncology training in Singapore, Dr Ling returned to the RTU where she first started. And since then, she has continued to serve as an oncologist in Sarawak.