How breast cancer spreads
Cells from the primary tumour can spread to other parts of the body to produce secondary tumours. This spread is known as metastasis and can occur via the blood or lymph vessels. The secondary tumours are called metastases. Spread may also be local, to areas around the breast, or even across the abdominal or pleural cavities.
Breast cancer most commonly metastasises to bone, lung, liver, ovaries and brain. Lymph node metastases are the first to occur and are the most commonly seen. The malignant cells become lodged in these areas and multiply to form further tumours.
Although both breasts can be affected simultaneously, it is more usual for the second breast to become involved after a period of years, if at all. Rarely, spread to the second breast occurs via the lymph vessels.
Differentiation of tumours
Tumours can be well differentiated, containing easily identifiable cells which clearly resemble the tissue from which they were derived; poorly differentiated, with a mixture of cells which it is difficult to identify; or moderately differentiated, an intermediate form. The prognosis for a well-differentiated tumour is always better than for a poorly differentiated one.
Staging
There are various methods of classifying the development of breast cancer, known as staging. The TMN method, used until quite recently, is now generally considered unhelpful as it relies on subjective observation and has a high inter-observer variation.
Staging of cancers of the breast is now based on factors such as the following.
* Has the tumour infiltrated into a large area (i.e. what size is it) or is there evidence of lymphatic or blood vessel invasion?
* Is it well differentiated, i.e. does it look like normal breast tissue that has gone out of control?
* Are the auxiliary lymph nodes involved?
* Is the tumour confined to the ducts of the breast (intraductal cancer)?
This last factor is important because tumours which are completely contained within a duct can usually be cured by surgical removal of tissue containing the duct and the growth within it. Intraductal tumours, once removed, do not tend to recur.
A commonly used system stages cancers on a scale of I to IV, tumours at stage I (confined to the breast) having the best prognosis; stage IV denotes metastatic cancer at distant sites within the body.
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Cancer
Evidence over many years shows that whatever financial and other resources are put at the disposal of western medicine will be swallowed up. In fact one researcher has calculated that by doubling the current expenditure longevity would not be altered significantly. Half of the increased expenditure since the 1950s has gone in higher prices. The other half has gone largely on more hospital beds, more technology, more hospital admissions, more health employees and more in-patient days in hospital. But in spite of all of this the major killers-heart disease, strokes and cancer-have declined little. The exception to this is the decline in heart disease deaths in the US that has occurred over the last fifteen years. This has almost certainly come about as the result of lifestyle changes and not increased expenditure on curative medicine. Although it is difficult to make
accurate estimates it is generally agreed that about 2 per cent of healthcare expenditure goes on preventive medicine in most western countries, yet we are told from the cradle that prevention pays and that a stitch in time saves nine. Just how true are these claims?
Trying to assess the value of a preventive programme is a complex task. It is not too difficult to work out the cost-effectiveness of a simple curative procedure because the end-point is often fairly clear and you know what the starting point (an ill person) is. But when it comes to spending money on prevention there are many problems, some of which arise because the person involved is healthy and the benefit conferred on him or her, or on society, may not be easily quantifiable in terms of money and may occur many years after the original expenditure on the preventive measure.
When trying to work out how financially worth while a preventive health programme is we have to consider four main points: (1) The positive and negative effects of the programme; (2) how many of these effects can be clearly related to a preventive programme; (3) what value can be put on the results and (4) the balance of the advantages and disadvantages of the programme.
As an example let’s look at screening for breast cancer. The effects of the programme will include: the cost of convincing women they should be screened; the cost of their time off work or other duties to go to be screened; the cost of actually getting there; the cost of the screening itself (both in people and equipment); the cost of following up the abnormal findings; the cost of treating those who have abnormalities but who would have otherwise gone untreated; the cost of any doctor-induced problems (i.e. other problems which the screening programme itself brings into being) and their follow-up treatment; and the savings resulting from the reduced use of medical and other facilities by the women who have a cancer detected early and so do not need more expensive treatment.
The next step involves putting values on the programme. There are several questions that need to be answered. Obviously the cost of convincing women to be screened has to be related to the numbers who actually come forward. If it costs 100 pounds per woman simply to persuade her to be screened this alters the whole balance of worth of such a screening to the community. What about the increase in doctor-induced diseases? Is it possible that by having too many false negatives we give women false confidence, causing them to ignore lumps in the future? Or that by giving too many false positives we worry people so that they end up having unnecessary and worrying operations?
The last thing we really have to be sure about is what good the screening actually does and which part of it is most worth while. Obviously doing a total physical examination and an X-ray every six months would be a way of detecting breast cancer early but the side-effects of the X-rays, and the costs, would be enormous.
Lastly, a price has to be put on the whole thing and this can be difficult. The actual cost of delivering the medical side of such a programme is, of course, easily worked out but the benefits (peace of mind, improvement in life expectancy and so on) are much more difficult to evaluate financially.
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General health
If you’re having a hard time pinpointing the hidden calories in your diet, take a tip from Jim Gorman. The 33-year-old public relations supervisor from Hoboken, New Jersey, will tell you to look in the bottom of your empty glass. He knows from experience.
In 1995, Jim gave up all sugary beverages and alcohol for Lent, resolving to drink only water and club soda. By the time Easter rolled around, he was 20 pounds lighter. “I wasn’t really looking to lose weight,” he says. “But I have to admit that I was a bit bulkier than I wanted to be.”
Since then, Jim has kept his weight between 158 and 163 pounds, appropriate for his 5-foot-11-inch frame. He attributes his trim physique to his continued ban on sugary beverages. “Staying away from soda, lemonade, sweetened iced tea, and other flavored drinks has made all the difference on the scale,” he says.
While Jim sticks with water and club soda at home, he may order a beer or two when he’s socializing with friends. “I don’t
WINNING ACTION
Be wary of liquid calories. Alcohol and sugary beverages can contribute to weight gain—and they don’t do a thing to fill you up. A 12-ounce glass of beer supplies 146 calories; 12 ounces of soda, 150 calories; and 8 ounces of fruit juice, about 100 calories. If you’re having a tough time losing weight, take account of your liquid calories. Substitute water for your sugary beverages. You’ll be a lot happier eating a 300-calorie meal than quaffing a few colas. As for alcohol, save it for special occasions (like losing 10 more pounds), and stick to light beer or wine.
And remember to sip, not gulp.
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Weight Loss
These are drugs which make the bronchial muscles relax, and are therefore useful in asthma. There are three types of bronchodilators: |32-adrenoceptor agonists, xanthines and anticholinergics.
? 2-adrenoceptor agonists
Antagonists are drugs such as antihistamines which bind to receptors and block the effect of the natural messenger (eg histamine) that normally binds to the receptor. Agonists have the opposite effect. They bind to receptors and stimulate the cell, in the same way that the natural messenger would – in other words, they mimic the effects of that natural messenger.
The (32-adrenoceptor agonists mimic the effects of adrenaline on the bronchial muscles, by binding to receptors for adrenaline. These are called (52 adrenoceptors, hence the name of the drugs. They include salbutamol (Ventolin,
Ventodisks, Volmax, Cobutolin, Salbulin, Salbuvent, Asmaven, Aerolin-Auto), terbutaline (Bricanyl, Monovent), fenoterol (Berotec), pirbuterol (Exirel), reproterol (Bronchodil), rimiterol (Pulmadil). Sometimes such drugs are combined with corticosteroids (see below), as in Ventide, which contains salbutamol.
Of all the bronchodilators, these drugs have the most specific effects on the bronchi. They are now preferred to isoprenaline (Iso-Autohaler and Medihaler-Iso) which has a less specific effect, and tends to combine with adrenaline receptors in the heart muscles as well as those in the bronchi, sometimes causing irregular heartbeat, flushing and headaches. Isoprenaline is combined with a sympathomimetic, phenylephrine in Duo-Autohaler and Medihaler-Duo. ,
Isdetharine (Numotac) is another nonspecific 6-agonist. It is combined with phenylephrine in Bronchilator.Orciprenaline (Alupent) is a drug of the same type that is partially selective for bronchial muscles, and has similar side-effects.
Side-effects can also occur with the specific p2-adrenoceptor agonists, such as salbutamol, although they are generally less of a problem. They include tremor, nervous tension, headache, flushing and dry mouth. Taking the drugs from an inhaler reduces the side-effects by targeting the drug on the bronchi – this allows a much lower dose to be used than if the drugs were taken by mouth.
The effects of these drugs lasts for up to six hours, and the timing of doses should be geared to the patient’s needs. Learning how to operate the inhaler properly is very important, as the drug can be ineffective if the inhaler is misused.
Even if they are used at quite high doses over long periods of time there seem to be no serious ill-effects with these drugs. On the other hand, they do not reduce the sensitivity of the bronchi, as sodium cromoglycate does, so once they are discontinued their beneficial effects cease. A combination of the two drugs is sometimes used.
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Allergies
Janet was 40 years old and had been ill in various ways since she was twelve, with rhinitis, severe migraine, urinary problems and pain in the region of her kidneys. During her thirties she had also developed depression which had led to two suicide attempts and resulted in electroconvulsive therapy. Over the past six years she had made over 100 visits to her family doctor, spent 63 days in hospital, visited outpatients 49 times and taken 34 courses of drugs.
Janet was then tried on an elimination diet which excluded all commonly eaten foods. This provoked the
worst migraine she had ever experienced at first, but then left her feeling a great deal better. On testing, a glass of milk produced sneezing, rhinitis and headache, whereas wheat left her depressed with a severe migraine. Eggs produced a headache, nausea and pain around the kidneys. Eating maize resulted in nausea and fatigue. By avoiding these four foods, Janet has remained very well. In the six years since her treatment she has visited her doctor five times, spent only two days in hospital and not required any drugs – a striking contrast to her previous six years.
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Allergies
The final step takes us to the least rigorous form of elimination diet, in which most fruits, vegetables, fish and meats are allowed, but wheat and other cereals, milk, eggs and other common offenders are excluded. This diet is quite good enough for many people, but those with multiple sensitivities tend to slip through the net because they are still eating some foods which cause symptoms.
One other form of elimination diet should be mentioned here. This uses elemental diets during the exclusion phase, rather than any foods. Elemental diets are made from various ordinary foods, but these are treated to break down the food molecules into smaller pieces. They are similar to the hydrolysate formulas used for babies who are sensitive to cow’s milk but they are designed to be eaten – or rather drunk – by adults. In theory, the molecules that remain in the elemental diet are too small to cause any allergic reactions or other problems. In practice, some people with established food sensitivity do react to them, because the fragments of molecules they contain are too reminiscent of the original molecules. For many people, however, they are very effective.
Various drawbacks are associated with elemental diets. Firstly they taste dreadful. Secondly they are very expensive – the cost of living on them and nothing else is about £20 per day. Although they are available on the National Health, they are classified as ‘borderline substances’ which means that they can only be prescribed for certain named illnesses – suspected food sensitivity is not one of these. The elemental diet that most doctors prefer to use is Vivo-nex, and this is only available on prescription. Another form of elemental diet, Elemental 028, is available without prescription, but this contains sugar (sucrose) to which some people are sensitive. Nevertheless, it might be useful as a last resort for someone who is intolerant of a great many foods and has therefore not succeeded with an elimination diet. You should not try out an elemental diet without the help and advice of your doctor.
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The timing of responses in the diet varies. Most children recover within a week or two on the initial stages of the diet, but others take up to three weeks. Foods should only be tested once there is a noticeable and sustained improvement. If this does not occur, then revert to the normal diet and consider other options. It may be that your child has chemical sensitivities – reading Chapter Nine should help you to assess this possibility. Be prepared to reconsider the likelihood of emotional stresses and strains.
The procedure for testing foods is slightly different for hyperkinetic syndrome. Although a few may take up to a week of daily feeding with the culprit food before they respond, this is probably fairly unusual. The response time for most is between 15 minutes and four hours. Reintroduced foods should be fed in the morning, and again in the afternoon, if there was no reaction, or only a slight reaction, to the first feeding. A normal-sized portion should be eaten, except in children who have asthma or urticaria, where a very small amount should be tried first, in case there is a severe reaction. If, by the morning after, there is no reaction to the food, then it can be incorporated into the diet, and testing begun on a new food. As always, in an elimination diet, it is important not to eat too much of any one food.
Assuming the diet is effective, and you discover what foods or additives cause the problems, then you have to decide on a plan of action. Again, you should discuss this with your doctor. Avoiding the foods in question may be quite difficult, especially at school or with friends, and you may wish to reconsider other options, especially if your child is not affected all that severely or if he reacts to a great many foods. Drugs are one option, and you should discuss the pros and cons of these with your doctor. Another, more controversial form of treatment, is neutralization therapy. Although this is not accepted widely among the medical profession, there are many reports of it being used successfully for the treatment of hyperactive children. If you decide on avoidance of the food, bear in mind that the child’s sensitivity may disappear in time. The culprit foods should be retested at one- or two-yearly intervals, to see if they still produce the same symptoms.
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IgE molecules are just as specific for their antigen as other antibody isotypes but they operate in a rather different way. Their main function is to defend the body against parasites such as ringworms and flukes – these are much larger than bacteria and viruses so the body has different strategies for killing them. In the tropics, where parasites are common, quite high levels of IgE may be found even in non-allergic people. Cooler conditions are not as favourable to parasites and they are far less of a health problem – in non-allergic people living in temperate climates, the level of IgE is usually very low.
Like other antibodies, IgE molecules are produced by B cells. But once they have been produced, the IgE molecules behave difference from most other antibodies in that they attach themselves to mast cells and basophils. These two types of cell look slightly different under the microscope, and whereas basophils are found floating in the blood, mast cells are embedded in the solid tissues of the body. Mast cells are better known and understood, so we will conveniently ignore the basophils from here onwards: the two types of cell probably work in much the same way.
Although the stem of the IgE molecule is attached to the mast cell, the antigen-binding sites are still free. So when the right, antigen comes along, it will bind to the IgE molecules. This is the signal the mast cell has been waiting for. Packets of chemicals inside the cell are suddenly released to the outside, where they act as messengers, causing major changes in the cells and tissues around them.
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During the past few years butterbur, or Petasites, has proved itself as a valuable remedy, one that has achieved quite astonishing results. Since it is a strong remedy, the mother tincture is not usually tolerated by the average patient and it has to be potentised to lx or 2x, or even higher. If the patient, for example one suffering from a tumour or cancerous growth, notices a very strong reaction, he will have to take the remedy in a weaker potency. Let me add that this reaction is a sign of having made the right choice, that the remedy is appropriate. All that is left to do is to ascertain the potency that is tolerated by the patient. To find the individual tolerance, it will be necessary to ignore the usual directions; instead, add one drop of Petasites to a glass of water (200 ml/7 fl. oz) and take frequent sips during the day. After 8-10 days the body will have become used to that particular strength and the dose can be increased, using one drop to 100 ml (3.5 fl. oz) of water. Continue taking this dilution for eight days, then add one drop to 50 ml. In time, the body will tolerate Petasites in even stronger doses.
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Herbal
What long and faithful service is rendered by our feet! We take it for granted that they will support the whole weight of our body and take us wherever we want to go every day of our life. Nevertheless, as a rule we neglect the daily foot bath that they so urgently need and deserve. For the feet perform not only a mechanical but also an eliminative function, although this may generally be ignored. Everyone knows about perspiration of the feet and although it can become offensive and unpleasant when excessive, so that we would like to get rid of it, it does have a purpose. Suppressing this perspiration can have extremely serious consequences. Granted, it is most disconcerting when others become aware of the strong odour, and cases have even been known where smelly feet led to a divorce. Excessive sweating of the feet should really be looked upon as being the action of a safety valve of the body; when it reaches the point where it becomes embarrassing the sufferer should do something about stimulating the kidneys and the skin by natural means. For if you try to suppress foot sweat, the toxins will remain in the system and cause havoc, leading to various ailments. The types of problem that might arise from such action, together with some suggested alternatives for dealing with excessive foot sweat.
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