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| Question for GeorgeK | |
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| Tweet Topic Started: Aug 7 2008, 06:17 AM (265 Views) | |
| jon-nyc | Aug 7 2008, 06:17 AM Post #1 |
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Cheers
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Question for you about the history of cancer treatments. When did effective chemotherapies and radiation treatments become available? When I say effective I mean treatments that could essentially cure certain types of cancer. The reason I ask is I'm reading Elizabeth Kubler-Ross' On Death and Dying, published in 1969, and it seems to imply that cancer was pretty much always a terminal diagnosis. She doesn't say that explicitly, but strongly implies it. It got me wondering if she wrote this before effective treatments for many cancers were available. |
| In my defense, I was left unsupervised. | |
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| Klaus | Aug 7 2008, 06:44 AM Post #2 |
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HOLY CARP!!!
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I'm not GeorgeK but I hope you don't mind if I add my 1.2936 Euro-Cents. From what I understand from my wife (who is an expert in oncology - she is a radiooncologist) it that the rule of thumb is that you are doomed once the cancer has metastasized, more or less regardless of the original type of cancer. It also depends tremendously on the kind of cancer. For example, a glioblastoma means an almost certain quick death, and there is nothing you can do about it. A prostate cancer, on the other hand, may not cause trouble for decades. I don't think you can point out one "breakthrough" year in history. The treatments get better every year, but there's still a lot they can't do. |
| Trifonov Fleisher Klaus Sokolov Zimmerman | |
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| apple | Aug 7 2008, 06:53 AM Post #3 |
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one of the angels
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my sister in law has had stage 4 breast, bone and lung cancer for 4 years - she was first diagnosed with stage 1 breast cancer 14 years ago. she still travels.. just having come back from Thailand and now in El Paso. she has been lucky to have been married to Bill, an insurance salesman who has been instrumental in getting her the best treatment, paid for ... much of it experimental the last 4 years. i think patients really benefit from an advocate. i have a friend who was denied treatment for a lump and now just had double masectomy.. she faces months and months of further treatment... probably not necessary if she had been treated immediately. |
| it behooves me to behold | |
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| jon-nyc | Aug 7 2008, 06:59 AM Post #4 |
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Cheers
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My question isn't about the current state of treatment - its about the history of treatment. When did effective chemotherapies and radiation treatments become available? When I say effective I mean treatments that could essentially cure certain types of cancer. In other words, now we treat many cancers and stop them (when they're caught early). Before these treatments were available it was just a matter of time before the cancer spread and destroyed vital organs and hence the person. But when was that? |
| In my defense, I was left unsupervised. | |
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| Klaus | Aug 7 2008, 07:09 AM Post #5 |
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HOLY CARP!!!
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I think you have a misunderstanding of cancer treatments. The majority of cancers cannot be cured - they can only be delayed. The success is not measured in terms of "cured" or "uncured" but in terms of: What is the percentage of patients surviving X years. From what I understand, chemotherapy and radiation therapy can very very seldomly cure a cancer. A complete cure is usually only possible if you can make an operation (and augment it with chemo and radiation therapy), and even then the cancer often shows up again after years. Regarding history: I think radiation therapy has been around since the discovery of x-rays, and something was improved every decade and year. Again, I don't think there was a "breakthrough". |
| Trifonov Fleisher Klaus Sokolov Zimmerman | |
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| jon-nyc | Aug 7 2008, 07:13 AM Post #6 |
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Cheers
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Right, I used the phrase 'essentially cured' meaning the 10 year survival rate is very high. At any rate, there was a time before which even that wasn't true. Thats the nugget of information I'm after. |
| In my defense, I was left unsupervised. | |
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| QuirtEvans | Aug 7 2008, 07:28 AM Post #7 |
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I Owe It All To John D'Oh
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I may be way off base here, but I thought that, for many types of cancer, if you are clean at your five-year checkup, you are viewed as ... well, not cured, but that the recurrence rate approaches the same rate as for initial occurrence in the general population. It varies by type of cancer, of course. |
| It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010. | |
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| blondie | Aug 7 2008, 07:34 AM Post #8 |
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Bull-Carp
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Where's George, ... or Bach? I understand what you're asking Jon. Yes, I'm wondering now too. If I've some time later I'll start googling. I believe there are some cancers, e.g. specific leukemias of childhood, non-hodgkins lymphomas, that are highly treatable, to the extent they could be considered curable. Where's George, or Bach? There also must be a written history of chemotherapies and radiotherapies associated with these conditions ... in the same way the history & success of insulin has been documented. |
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| Mikhailoh | Aug 7 2008, 07:47 AM Post #9 |
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If you want trouble, find yourself a redhead
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John, althought there were apparently attempts at chemo in the 40s, the real first breakthroughs came in the 1960's. his Wiki might answer some of your questions: http://en.wikipedia.org/wiki/History_of_cancer_chemotherapy |
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Once in his life, every man is entitled to fall madly in love with a gorgeous redhead - Lucille Ball | |
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| George K | Aug 7 2008, 09:45 AM Post #10 |
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Finally
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Hi...just arrived North of the CC* Klaus speaks correctly, and I'm sure that his wife and bach know a lot more about cancer than I do. But someone knowing more thani do my won't stop me from giving my opinion. Cancer isn't a disease. It's a constellation of diseases, and survival for each of them is different based upon many factors, including the nature of the cancer (more than 50% of men over the age of 80 have prostate cancer - its slow indolent course lets these men die of heart attacks and strokes), the location of the cancer (a glioblasoma mulitiforme - Kennedy's tumor) won't kill you by spreading to other tissues - it'll kill you by expanding so that your brain is squeezed and you die of the "closed box syndrome), and it's propensity to spread to other tissues causing local damage there (imagine a tumor growing around your aorta. Eventually, it'll grow into the aorta, and you bleed to deaty). Cancers also can have a vague distant effect, sapping you of your nutrition, causing wasting away. AFAIK, there's no explanation for that, but others may know more than I on that front. I was in school in the 1970's, and at that time, the goal was to eliminate as much of the cancer as you could, either with radiation directed at the tumor, or by giving toxic drugs that affect all rapidly growing cells - hopefully killing more cancer cells than bone marrow, intestinal lining etc cells. The specificity of drugs for cancers has improved greatly in the last 20 years, and we find some chemotherapeutic agents are much better for some tumors than for others. At that time, the goal was "cure." I think that that goal has shifted in the last 15 years. Now, it seems to me to be "contain," rather than cure. We see many patients coming to us for treatment of localized metastases in liver or lung (via high-energy microwave radiation administered via a needle). The same is done for some brain tumors - zap it locally to relieve symptoms - to let the patient live with the tumor with a minimum of toxicity to other tissues. Cancer is becoming a condition that you live with - like diabetes, hypertension and heart failure. I don't know if that really answers your question, Jon, but I hope that it gives some insight as to what the current thinking is. I would say that the changes started in the early 80's. My former med-school dorm-mate is the director of the cancer institute at a local university. One time, I asked him why he decided to go into oncology. "Don't all your patients die?" I asked. "Of course they do, George." Everybody's patients eventually die. But, I have the ability to make a real difference in people's lives. I can take them from death which is imminent and give them one, five, ten, perhaps fifteen years that they would otherwise not have had. They are grateful for that time, and I have a sense that I've done some real good." His comments gave me pause, and a perception that I never had. Oncologists don't deal with death. The push life longer, making it better for the patient. I have a lot of respect for him. On a personal note, my wife's 74 year old mother was diagnosed with stage III ovarian cancer in 1985. She had about a gallon of cancerous fluid in her abdomen, and at surgery, everything was covered with little tumors. Everything. They took out as much as they could, and started a regimen which consisted of 10 courses of chemo, a month apart. After the 7th course, she fell and broke her hip. Considering her debilitated state, there was a lot of talk about how aggressive to be - poor nutrition, metastatic ovarian cancer, horrible blood counts. Well, they fixed the hip, and she got pneumonia postop. Spent about 4 days in ICU, got better and was sent home. She was told that she was done with chemo - too taxing on her. She became a widow in 1991, and moved in with us. She lived in the attic (bedroom, full bath, kitchen, living room), and insisted on having a job - she did the laundry and baby sat. She stayed in good health until 1993, when they found a recurrence - a lymph node. Mild chemo was given for the next year, and she remained fine, until February of 1994, when the cancer came back with a vengance. She died in June. She got 9 years out of a terminal disease and died at the age of 83. Pretty good, if you ask me. [size=1]*Cheddar Curtain[/size] |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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| Klaus | Aug 7 2008, 10:10 AM Post #11 |
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HOLY CARP!!!
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Thanks, George, this fits exactly to what I hear from my wife as well. When I ask her why she is working on oncology, she says that the conversations with the patients are much deeper and more rewarding than on an ordinary (say, internist) station where people complain all the time about "frills and furbelows" (I hope this is the correct metaphor). |
| Trifonov Fleisher Klaus Sokolov Zimmerman | |
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| jon-nyc | Aug 7 2008, 11:51 AM Post #12 |
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Cheers
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I would have guessed 70s or 80s. In this book Kubler-Ross practically uses 'malignant tumor' and 'terminally ill' interchangeably. It sounds strange to a reader 40 years later. A very interesting book, by the way. |
| In my defense, I was left unsupervised. | |
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| Red Rice | Aug 7 2008, 12:09 PM Post #13 |
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HOLY CARP!!!
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A real revolution in chemotherapy occured in the 1970's with advances in the treatment of lymphoproliferative disorders. Diseases that were once considered terminal, like Hodgkin's disease, were now instead experiencing high cure rates. While chemotherapy has had less spectacular success with other types of cancers like adenocarcinomas, and even less with squamous cell carcinomas, survival and morbidity have been improving steadily over time with the introduction of new drugs and regimens. Radiation therapy has advanced along with imaging technology, most particularly during the 1980's with the widespread use of CT and MRI scans allowing stereotactic radiotherapy, which concentrates radiation at the site of the cancer in three dimensions while sparing surrounding tissues. For many cancers of the head and neck, for example, radiation therapy is now the preferred method of treatment over surgery, as it allows for comparable cure rates but significantly less morbidity. |
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Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool. I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss! - Cecil Lewis | |
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| jon-nyc | Aug 7 2008, 12:15 PM Post #14 |
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Cheers
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Interesting, RR. Do you work in health care? |
| In my defense, I was left unsupervised. | |
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| QuirtEvans | Aug 7 2008, 12:16 PM Post #15 |
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I Owe It All To John D'Oh
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I shall now call you Red Rice-ipedia. |
| It would be unwise to underestimate what large groups of ill-informed people acting together can achieve. -- John D'Oh, January 14, 2010. | |
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| blondie | Aug 7 2008, 12:18 PM Post #16 |
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Bull-Carp
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The book you're reading jon is a classic, is used still today in nursing schools. |
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| Red Rice | Aug 7 2008, 12:23 PM Post #17 |
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HOLY CARP!!!
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I work for Abbott Labs. |
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Civilisation, I vaguely realized then - and subsequent observation has confirmed the view - could not progress that way. It must have a greater guiding principle to survive. To treat it as a carcase off which each man tears as much as he can for himself, is to stand convicted a brute, fit for nothing better than a jungle existence, which is a death-struggle, leading nowhither. I did not believe that was the human destiny, for Man individually was sane and reasonable, only collectively a fool. I hope the gunner of that Hun two-seater shot him clean, bullet to heart, and that his plane, on fire, fell like a meteor through the sky he loved. Since he had to end, I hope he ended so. But, oh, the waste! The loss! - Cecil Lewis | |
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| George K | Aug 7 2008, 12:47 PM Post #18 |
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Finally
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Just to amplify what Red Rice said: I had a patient on Monday who has metastatic colon cancer. He was diagnosed and had a colon resection in 2003. 4 years later, it returned - with a single metastasis in the liver - about the size of a plum. He had it treated by the interventional radiology guys. With CT guidance, the stuck a needle into the lesion in his liver, hooked the needles up to a microwave generator, and "cooked" the lesion. He was tumor free until this year when the lesion recurred. About the same size. He got it cooked again - took about 2 1/2 hours. Pain in the ass anesthetic to give, but he did well. He's done until another followup. 10 years ago, he would have died of the liver met. He got at least 5 years with two interventions. Both as an outpatient, both with no surgery, and little pain. We're becoming specific in our treatment of cancer. The next step is to treat inaccessible tumors by marking them with an antibody that can be microwaved. |
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A guide to GKSR: Click "Now look here, you Baltic gas passer... " - Mik, 6/14/08 Nothing is as effective as homeopathy. I'd rather listen to an hour of Abba than an hour of The Beatles. - Klaus, 4/29/18 | |
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