Prevention, early detection and treatment of cancer mean that fewer Australians
can expect to die of the disease.
One in three men and one in four women will be directly affected by cancer before
the age of 75. However, improved prevention, detection and treatment have made cancer
a less threatening disease.
Cancer is a condition characterised by uncontrolled multiplication of abnormal tissue
cells. These cells can invade nearby organs, or spread (metastasise) to distant
parts of the body. Depending on the cancer, some treatments can cure, while others
may temporarily stop the cancer.
What causes cancer
Medical scientists don't yet have all the answers about how or why cancer develops.
What they do know is that there are chemical, physical and biological agents that
can trigger the cell mutations that cause cancer. These are called carcinogens and
include tobacco, ultraviolet radiation and asbestos. Certain genes can also make
cancer more likely. Even some diseases can increase the risk of cancer later on.
According to Professor Alan Coates, Chief Executive Officer of The Cancer Council
Australia, a number of cancers also share risk factors. One in eight cancers and
one in five cancer deaths are because of smoking and about 3% of cancers and 3%
of cancer deaths are related to alcohol consumption.
Many cancers occur as a direct result of dietary or lifestyle influences, such as
a poor diet, lack of exercise or excessive exposure to ultraviolet radiation. There
is also a genetic factor in some cancers, including some bowel and breast cancers.
However, the overall message is that a healthy lifestyle i.e. maintaining a healthy
weight, eating a diet containing plenty of vegetables and fruit, taking regular
exercise and avoiding carcinogens such as tobacco, excessive alcohol and excessive
sun, are all factors that can help reduce your risk of developing cancer.
In fact, with its current knowledge, The Cancer Council Australia believes at least
half of all cancers can be prevented.
At the same time, because of earlier detection and improved treatments, the survival
rate for many common cancers has increased by more than 30% in the past two decades.
Early detection general guidelines
Check your skin for suspicious spots and see your GP if you find anything of concern.
Women:
- aged 18 - 70 who have ever been sexually active should have a Pap test every two
years
- should become familiar with the normal look and feel of their breasts and see a
GP if they notice any unusual changes
- over 50-years-old should have a mammogram every two years.
Men:
- be aware of the signs of bowel cancer: bleeding from the back passage, blood in
a bowel motion, a persistent change in bowel patterns, unexplained tiredness, or
lower abdominal pain
- discuss testing for blood in the bowel motion with their GP
- if a close (blood) relative has had bowel cancer, talk to their doctor about a colonoscopy
- if they notice any changes in the testicles (example: a small, hard lump, swelling
or dull ache) see their GP
- over 50, have their doctor check for prostate enlargement.
Skin cancer
By far the most common form of cancer in Australia is nonmelanoma skin cancer, with
approximately 374,000 cases annually. More than half of all Australians will develop
at least one of these cancers. The vast majority of these are successfully treated.
However, they can occasionally be fatal.
Melanoma, the most dangerous type of skin
cancer, is much less common but causes almost a thousand deaths in Australia each
year.
Who's at Risk?
Everyone who has had major sunburn, particularly in childhood and teenage years,
is at risk, especially those who burn easily. But those who need to be particularly
alert are:
- People with fair skin, fair hair and light coloured eyes
- People with a close relative who has had skin cancer, especially melanoma
- Those in the older age bracket.
Types of Skin Cancer
There are different types of skin cancer. To check skin properly, people should
be aware of each type of cancer.
- Basal Cell Cancer (BCC): The most common type of skin cancer is, thankfully, the
least dangerous. BCC often starts as a little pimple that grows very slowly. After
some months, it may become shiny and ulcerate (or break open) in the centre, sometimes
leaving a small dimple. It rarely spreads to other organs.
- Squamous Cell Cancer (SCC): This often appears red and scaly at first, and is easy
to mistake as eczema or an infection. After a while, it too may grow and ulcerate.
They often persist despite the treatment of eczema and often feel harder than normal
skin.
- Melanoma: Melanoma can start from an existing mole that gets bigger, more raised
or darker. It can also arise where no mole existed at all. While a BCC or SCC occurs
mainly on areas exposed to sunlight, melanoma may affect other areas such as the
scalp, the palms or soles of the feet, the buttocks, or the genital organs. Melanomas
make up less than 5% of skin cancers and, if caught early, more than 90% of these
cancers are curable, says Craig Sinclair, chairman of The Cancer Council Australia's
Skin Cancer Committee and Director of the Cancer Education Unit, The Cancer Council
Victoria.
Detecting Skin Cancer
All Australians should check their skin on a regular basis and see a GP if any lump
or sore appears to be growing or refusing to heal.
Any change in the texture or appearance of a mole should also be thoroughly investigated
by a GP, who may then refer you to a dermatologist, surgeon or radiotherapist.
Treatment Options
The cure rates for skin cancer are very good, but it must be caught early. People
who develop BCC have around a 98% chance of cure. For those with SCC, the figure
is greater than 90%. The message is clear, the earlier the detection, the more likely
the chance of cure.
If a GP sees a suspicious lump or mole that needs to be investigated, he or she
may take a biopsy (remove tissue for testing) or write a referral to a specialist.
Depending on the type of skin cancer, the treatment options include surgery to remove
the tumour, radiotherapy, cryotherapy (freezing the affected area with liquid nitrogen)
and laser (a narrow beam of light that destroys the cells of the affected area).
Recently a cream containing the immune stimulant imiquimod has been approved for
the treatment of confirmed superficial Basal Cell Carcinoma (BCC) where surgery
is considered inappropriate, says Sinclair.
People who have had a skin cancer may develop another, so a doctor will advise a
patient on a program of check-ups. This may include visiting the doctor on a regular
basis so that the doctor is able to thoroughly check the patient's skin.
Prevention is Vital
When outside take particular care to protect yourself, especially between the hours
of 10am and 2pm, or 11am and 3pm during daylight saving time. Wear a broad-brimmed
hat, shirt or blouse with a high collar and long sleeves as well as good quality
wraparound sunglasses. Make sure to use a high factor sunscreen, of at least SPF30
and, in the sun, apply a generous dose of it regularly.
Lung cancer
Lung cancer still causes more deaths in Australia than any other cancer, yet it
is one of the most preventable forms of the disease. In 2000, lung cancer accounted
for 22.8% of male cancer deaths, 14.8% of female cancer deaths, and 5.3% of all
deaths in Australia.
Who's at Risk
Smokers are by far the highest risk group for lung cancer. In Australia, smoking
causes 90% of all lung cancer cases in men and 65% of cases in women, says Andrew
Ellerman, chairman of The Cancer Council Australia's Tobacco Issues Committee and
Manager of QUIT South Australia.
Certain industrial exposures and atmospheric pollutants, including environmental
tobacco smoke, can also increase the risk of lung cancer, but their overall contribution
is small compared to that of smoking.
Prevention of Lung Cancer
The main message for lung cancer prevention is clear: do not smoke. Avoiding smoking
will not only profoundly reduce the risk of lung cancer, but also the risk of a
number of other cancers and chronic diseases.
There are a number of ways to help people quit smoking, including nicotine replacement
therapy, courses and pharmacological aids. Support from family and friends can make
a big difference, as can sound advice from a health professional or the Quitline.
Most smokers prefer to quit on their own, with 90% of smokers successfully quitting
without aids. However, many smokers may make several attempts to quit before succeeding.
The key is to have a good plan, keep trying and to learn from previous attempts.
For more advice on quitting, call the Quitline on 13 18 48 or talk to your GP.
Detecting Lung Cancer
There are a number of methods for diagnosing lung cancer, such as x-ray and sputum
cytology (phlegm analysis). Lung cancer screening of high risk individuals was investigated
in several clinical trials in the 1960s and 1970s, but screening didn't alter the
natural course of the disease. However, future trials are likely to be undertaken.
If you are concerned about lung cancer detection, consult your GP.
Treatment Options
Treatment options for lung cancer range from surgery through to radiotherapy and
chemotherapy. Lung cancer is often detected when it is no longer potentially curable
through surgery. There are also palliative treatments to reduce the pain and discomfort
of lung cancer symptoms such as persistent coughing, haemoptysis (coughing up blood)
and airway obstruction. Lung cancer is a particularly aggressive tumour and patient
outcomes are poor in relation to other cancers.
Breast cancer
Around 11,000 Australian women get breast cancer (and more than 2,500 will die from
it) every year.
Much about the causes of breast cancer remains unknown. Increasing age is the greatest
risk factor. Approximately 75% of breast cancers cases occur in women who are over
50 years of age. Lifestyle factors such as obesity and diet, as well as the trend
for later child bearing, seem to slightly increase a woman's risk. Small additional
risks are associated with alcohol consumption and some forms of hormone therapy.
While a strong family history increases risk, only about 5% of breast cancer is
related to family history. Because breast cancer is relatively common, multiple
cases may occur in one family purely by chance.
Detecting Breast Cancer
Early detection may lead to increased survival and/or improved quality of life due
to less invasive treatment, says Alison Peipers, manager of Cancer Education Programs
for The Cancer Council Victoria.
Screening mammography, especially for women aged 50-69 years, is currently the best
method available for detecting breast cancer early. BreastScreen Australia provides
free mammographic screening for women aged 50-69. Currently the scientific evidence
is not strong enough to recommend regular screening mammography as an effective
tool for detecting early breast cancer in women aged 40-49. Nevertheless, women
aged 40-49 may request a free screening mammogram. Appointments can be made by phoning
13 20 50.
All women are encouraged to be familiar with the normal look and feel of their breasts.
They should see a doctor if they notice any unusual breast changes. Different tests
might be needed to find out what has caused a breast change. Reassuringly, most
unusual changes are not due to breast cancer.
Treatment Options
Most early cancers can be treated by removing just the tumour and often the glands
in the armpit, followed by local radiotherapy (xray therapy). The cosmetic result
is better and survival is usually as good as removing the entire breast.
Larger tumours may require a mastectomy - the surgical removal of the whole breast.
If a woman so desires, she can have surgical breast reconstruction post-surgery.
Additional treatments like endocrine (hormone) therapy, chemotherapy, radiotherapy
or removal of the ovaries may be offered after individual assessment.
Specially trained breast care nurses, situated in many hospitals, guide a patient
through treatment and help with continued support. There are also volunteer support
services in most hospitals and cancer support groups are also increasing in number.
Research May Offer Hope
Clinical studies during the last 50 years have clearly shown the value of different
treatments. Tamoxifen is a form of endocrine therapy usually given for five years
after surgery. It helps reduce the risk of recurrence of breast cancer in some patients.
Newer endocrine therapies may be even better. Chemotherapy is also effective, especially
for women whose tumour is unsuitable for endocrine therapy.
Hormone Replacement Therapy (HRT)
Recent controversy surrounding the link between HRT and increased risk of breast
cancer has concerned many women. Whether or not to take HRT is a matter that every
woman should discuss with her breast cancer specialist or GP.
Bowel cancer
Bowel cancer (also known as colorectal cancer) is the second most common cause of
cancer related death in Australia, yet it is also a highly curable disease if found
early. In 2000, there were more than 12,400 new cases of bowel cancer and more than
4,700 deaths from the disease.
The risk of developing bowel cancer increases with age, says Terry Slevin, chairman
of The Cancer Council Australia's Nutrition & Physical Activity Committee and Manager
of Education and Research, The Cancer Council of Western Australia.
Most people who develop this type of cancer are over the age of 50. It is thought
that up to 75% of bowel cancers could be prevented by changes in diet and physical
activity as well as other healthy lifestyle factors. People with any of the following
symptoms should see their doctor:
- Bleeding from the back passage or any sign of blood in a bowel motion
- An unexplained and persistent change in bowel actions
- Unexplained tiredness
- Lower abdominal pain or a persistent feeling of fullness.
Screening tests can help identify precancerous polyps (growths in the bowel) and
early cancers, at a stage when treatment works best.
A faecal occult blood test (FOBT) is a simple screening test that looks for tiny
amounts of blood in a bowel motion. Blood can be a sign of early bowel cancer as
some early bowel cancers bleed from time to time. FOBTs can be done at home and
involve taking samples from two or three bowel motions using a test kit.
The samples are then sent to a laboratory for testing. New FOBT kits are easier
to use at home. People aged over 50, without symptoms or a strong family history
of bowel cancer, are encouraged to do an FOBT every two years. Discuss FOBTs with
your GP.
Cervical cancer
Cervical cancer kills more than 250 Australian women a year. About 90% of these
cancers would be prevented if all sexually active women saw a doctor for a Pap test
every two years.
Like all screening tests, a Pap test is not 100% accurate but it is still the best
tool available for detecting abnormal changes to the cells of the cervix that, if
left untreated, may lead to cervical cancer. (Talk to your doctor about ways of
increasing the accuracy of your Pap test.) Women should start having a Pap test
about a year after their first sexual contact or at the age of 18, whichever comes
later. Sexual contact includes not only intercourse but also female-to-female sex.
The Human Papilloma Virus (HPV or wart virus) is linked to most cervical abnormalities
and virtually all cases of cervical cancer. Although HPV is extremely common, with
four out of five women being exposed to HPV at some time in their lives, most women
with HPV will not develop cervical cancer. Recent research suggests that HPV testing
will be useful in detecting and following up cervical abnormalities. Additonally,
HPV vaccines offer the future hope of preventing cervical cancer.
An Abnormal Pap Test Result
An abnormal Pap test result means that some of the cells of the cervix differ in
some way from the normal cells. It rarely means cervical cancer. A result can be
abnormal for a variety of reasons. The most common abnormality is due to vaginal
infection, hormone disturbance or to infection with human papilloma virus (HPV),
which is very common.
Australia has a well-developed national screening program and state-based registries
to record Pap test results. Follow-up procedures are defined for each type of abnormality.
Some abnormalities may require further investigation, while others can be monitored
by more frequent Pap tests.
Treatment for Abnormalities
Some abnormalities will require further investigation through colposcopy. The colposcopist,
often a specialist gynaecologist, uses a powerful microscope to examine the cervix.
A speculum is inserted into the vagina and a weak acid solution, which turns abnormal
areas white, is applied to the cervix. Sometimes, a small piece of tissue is taken
painlessly from these abnormal areas for examination by a pathologist.
Occasionally, what looks abnormal on a Pap test is normal on a colposcopy and the
only treatment required will be more frequent Pap tests. If abnormalities are confirmed,
surgical treatment is usually recommended.
The most common procedure is to remove the abnormal cells, which may be done using
a loop electrosurgical excision procedure. Alternatively, the abnormal cells are
destroyed with liquid nitrogen, laser or diathermy. When the burnt area heals, the
new cells are normal. Again, more frequent Pap tests may be needed for a time after
treatment.
Severe pre-invasive abnormalities may require a 'cone biopsy' (the surgical removal
of a section of the cervix). This ensures no abnormal cells are missed. However,
this procedure should not interfere with the function of the cervix.
Treatment for Cervical Cancer
If a woman is diagnosed with cervical cancer, she has a number of treatment options
which will be discussed between patient and doctor. Excision and diathermy are commonly
required.
For more invasive cancers, more radical treatments such as hysterectomy, chemotherapy
or radiotherapy are needed.
Hysterectomy is the most common and often the only treatment required for some of
the more invasive cervical cancers. In young women, if possible, the ovaries are
not removed. This prevents a sudden surgical menopause with long-term problems like
the bone-weakening condition osteoporosis. Radiotherapy is added for more advanced
cervical cancers, but unfortunately destruction of the ovaries is inevitable. Radiotherapy
can be delivered externally, or internally by a radioactive implant placed in the
cervix for a few days.
Chemotherapy - the use of powerful drugs which attack specific cancerous cells -
may also be suggested.
Prostate cancer
Cancer of the prostate is the most common cancer of men in Australia, with more
than 10,000 cases being diagnosed each year and it is also the second most common
cause of cancer deaths in men, with more than 2,600 men dying of this disease. But
most men who develop prostate cancer will survive to a normal life span.
The prostate is a male gland which sits just below the bladder. The urethra is the
tube that passes through the centre of the prostate and its purpose is to carry
urine from the bladder through the penis to the outside of the body.
After men reach 45 or so, the prostate gradually gets bigger. Most men with a large
prostate have what doctors call a benign prostatic hypertrophy (BPH), which is not
life-threatening, but some may have cancer.
BPH is extremely common in older men, but sometimes it does need to be treated if
it is causing obstruction to the flow of urine. Putting prostate cancer into perspective,
then, it is important for men to note that:
- Most men with a prostate problem do not have cancer
- The tests to detect cancer of the prostate are better than ever
- Prostate cancer usually grows very slowly.
Like most cancers, prostate cancer becomes more common as men get older. But in
older men, it grows more slowly than it does in younger men.
For the minority of men whose cancer is active, the good news is that better treatments
are now available.
Treatment of Symptoms
Doctors involved in the research and treatment of prostate problems stress that
early treatment of symptoms will ensure that pain, discomfort and treatment are
kept to a minimum. These symptoms are usually indicative of a benign prostate condition,
not cancer. Early prostate cancer seldom causes any symptoms.
What are the Symptoms of a Prostate Problem?
Common warning signs are mainly associated with urination:
- Blood in urine
- Retention (inability to urinate)
- Slow starting, stopping and starting again
- Poor stream
- Pain or burning
- Dribbling after urination
- Feeling of incomplete emptying
- Needing to urinate more often and more urgently.
If these symptoms do occur, it is important to check them out immediately with your
doctor.
Protection Against Prostate Cancer Risk
For those in a high risk category, a prostate check is available. The risk of prostate
cancer doubles if your father or a brother has had the disease. In this case, specialists
suggest yearly prostate checks from the age of 40.
Doctors commonly check the prostate by digital rectal examination: a doctor uses
a gloved finger inside the back passage to feel the prostate. This can be combined
with a blood test for prostate specific antigen (PSA). This is a chemical made by
prostate tissue. The level of PSA in the blood rises in both benign prostate conditions
and prostate cancer.
To clarify the diagnosis, a trans-rectal ultrasound - an ultrasound of the prostate
- may be required. If this picture is suspicious, a doctor may use the ultrasound
to guide a very fine needle into the prostate and so take a tiny piece of tissue
(biopsy) to examine under a microscope. This is the only sure method of diagnosing
prostate cancer.
Biopsy also allows the pathologist to estimate the cancer's speed of progress. This
grading is a bit like a speedometer - it says how quickly or slowly the cancer is
likely to grow.
Another important measure of activity is 'staging'. Staging is based on tests to
show whether the cancer is only in the prostate or whether it has spread to other
organs. Grading and staging of cancer help doctors provide advice on treatment.
Treatment Options
Various treatments of confirmed cancer are available so, to make the best possible
decision, a patient needs to know the likely benefits and risks of each. The most
active treatment is not always the best.
If a cancer is silent or slow growing and no other health problems exist, there
may not be a need to start treatment immediately. Regular follow-ups and monitoring
may well be sufficient. But with faster-growing cancer, treatment is definitely
required.
Surgery: An operation is often recommended if a patient is healthy and the cancer
is limited to the prostate itself. Just before removing the prostate, the surgeon
may first take a biopsy from the lymph glands near the prostate. This is to make
sure the cancer has not spread to these glands.
Radiotherapy or radiation therapy: External radiotherapy comes from a machine and
treatments are spaced over a period of six weeks or so. By contrast, internal radiotherapy
requires only a day in hospital for treatment. Pellets of radioactive material are
inserted into the prostate. These pellets are believed to cause fewer side effects
than those caused by treatment with external radiotherapy.
Hormone therapy: Growth of prostate cancer is affected by the male sex hormone testosterone.
So removing both testicles or giving a female hormone or an injection to stop testosterone
production may slow (but not cure) cancer.
Chemotherapy: In extreme cases, where the cancer has already spread, some recent
research has shown that this treatment may deliver some progress in relieving the
symptoms of the disease.
Medical Follow-Up
Apart from checking how the patient is generally, the treating urologist may suggest
a repeat of the PSA test, other blood tests, or x-rays, or CT scans of the pelvis,
spine or other bones (to check for cancer spread to bone).
