Cancers are of several types. Carcinoma is a cancer of the
outer part of the body (such as skin, lip, breast, tongue) or of the innermost
part of the body (such as stomach or colon). Sarcoma is a cancer of in-between
tissues (such as muscles and bones). A teratoma is a mixture of these types. A
hamartoma is an overgrowth of cells in an organ which does not progress and is
now considered more a congenital abnormality than a tumor or cancer.
Because
cancer starts in a single organ rather than diffusely, there have been some
daring suggestions about primary prevention. Quite seriously, some
distinguished surgeons have discussed the possibility of prophylactically removing
organs that are common cancer sites. Why not, they suggest, remove the uterus
after child- bearing when it is no longer needed, Cancer of the breasts, or the
prostate? From a straight surgical viewpoint, the decision would rest on the
dangers and disability of operation versus the danger of the cancer. But surely
other considerations enter in. Removal of the breasts is a great emotional
shock for a woman.
The danger of operation, while small, cannot be overlooked.
And, too, this danger comes for a relatively young woman, for if prophylactic surgery is to be meaningful it would have to be performed when a woman is
entering the time of life when cancer becomes a possibility. Thus, at 40 years,
she may be exposed to the danger, discomfort, and psychological hazards of the
operation, whereas even if she is destined to get cancer, it may not strike
until she is 55 and she has a good chance of getting years of relief or even
complete cure from surgery performed at that time.
Prophylactic removal of the
uterus after the childbearing years might seem more desirable if it were not
for the Pap test, which makes it possible to detect precancerous lesions in the
uterus and thus institute surgery that will be curative. And for men, prostate
removal is a major operation with some risk of mortality and danger of impotence, which a younger man would not want to face. At present, then,
primary preventive surgery does not seem a practical answer.
There are more practical methods possible for primary
prevention of cancer even though we realize from the frequency of the disease
that these are far from sufficient. First, as we have noted earlier, cessationof smoking can save thousands of lives otherwise doomed to be lost from cancer.
And an appreciable additional number can be saved from cancers of lip, tongue,
larynx, and possibly stomach and urinary bladder. Then there are the
precancerous lesions which can be removed before they have a chance to become
malignant.
They include leukoplakia (white patches) on tongue and lips; senile
changes in the vagina; skin lesions such as moles which begin to enlarge;
certain polyps of the colon and rectum. These pre-cancers can be detected by
the type of regular checkup we have described earlier in this book. There are
cancers that follow heavy exposure of the skin to sun and wind -the so-called
sailor's and farmer's cancers-which can be prevented by covering the skin and
shading the face. Radiation can lead to cancer. There is much less danger from
diagnostic than from therapeutic x-ray or other irradiation. But every exposureto radiation should be entered in your medical record and shown to your doctor
and dentist whenever they suggest x-rays. Workers in the radiation industries
should know every safety precaution.
