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Anil Mitra, December 2023 Contents Lung cancer (including bronchus) Most aggressive common cancers Diagnosis to treatment: when to begin? My attitude toward western medicine Cancer PurposeI wanted to clear my head about my choices. There’s nothing perfect about them or this document—it’s just a stab. The most common cancersBreast cancerEstimated yearly new cases: Female: 268,600 Male: 2,670 Estimated yearly deaths: Female: 41,760 Male: 500 5-year survival rate: Female: 90 percent (2008–2014) Lung cancer (including bronchus)Estimated yearly new cases: 228,150 Estimated yearly deaths: 142,670 5-year survival rate: 23 percent (2008–2014) Prostate cancerTypically slow growing, prostate cancer is the most common cancer and second leading cause of cancer death among American men. Estimated yearly new cases: 164,690 Estimated yearly deaths: 29,430 5-year survival rate: 98 percent (2008–2014) Colon and rectal cancerColorectal cancer refers to cancers found in the colon or rectum. Together they make up the large intestine. Estimated yearly new cases: 145,600 Estimated yearly deaths: 51,020 5-year survival rate: 64 percent (2008–2014) Melanoma (skin)Melanoma is cancer that begins in specialized cells that make up the pigment that gives skin its color (melanin). While more common on the skin, melanomas can also form on the eye and in other pigmented tissues. Estimated yearly new cases: 96,480 Estimated yearly deaths: 7,230 5-year survival rate: 92 percent (2008–2014) Bladder cancerBladder cancer usually affects older adults and occurs more frequently in men than it does in women. Estimated yearly new cases: 80,470 Estimated yearly deaths: 17,670 5-year survival rate: 77 percent (2008–2014) Non-hodgkin’s lymphomaNon-hodgkin’s lymphoma is cancer that begins in the lymphatic system. It’s characterized by tumors developing from a type of white blood cell known as a lymphocytes. Estimated yearly new cases: 74,200 Estimated yearly deaths: 19,970 5-year survival rate: 71 percent (2008–2014) Most aggressive common cancersLung cancer Colorectal cancer Breast cancer Pancreatic cancer Prostate cancer Palliative care vs treatmentTreatments—radiation, ultrasound, surgery, and chemotherapy, individually or in combinations, may be recommended. Whether treated or (due to other conditions, untreatability or aggressive nature of the cancer, or old age), there is most likely to be discomfort and pain, often severe. Therefore palliative care—symptom management and reduction; and psychological and physical support—is often recommended as an alternative or adjunct to treatment. Palliative care may improve treatment outcomes. Palliative chemotherapy has significant benefits—pancreatic, small cell-lung, and breast cancers, and is commonly routine. Watchful waitingSome cancers are slow to grow. Therefore, ‘watchful waiting’ may be recommended. Many prostate cancers are of this type. Diagnosis to treatment: when to begin?If at all, early. However, unless the cancer is aggressive or is impacting function, e.g., by pressing on other organs, waiting a few weeks generally will not hurt. RiskThough I reflect on society, I write for myself. PhilosophyThere are benefits to early detection and treatment and risks to avoidance (though there are economic incentives to pushing detection and treatment, this does not invalidate the fact of the benefits). However, the choice is individual, the role of experts is to provide information. Too much emphasis on medicine, whatever that means in fact, can detract from living well vs living long. What I select to do is partly based on subjective and incompletely articulated factors. Regret?I’m aware that I might regret my choice. My attitude toward western medicineThe purpose of the comment that follows is to defuse the thoughts that I think I’m rational or that I have a negative opinion of western medicine. I’m impressed by its power, science, and accomplishments. I wouldn’t be alive if it weren’t for it. And in no way am I implying it is deficient or that I know or could even dream of knowing more or better. |