Appended below are comments of a Goan cancer surgeon and researcher on Gilbert's recent post on the so-called Goan grandmother's kaanneo about cancer in the "Science as a religion" thread. The name of this gentleman is Jayant S. Vaidya. He has practised cancer surgery in Goa, Mumbai and the United Kingdom. He has done cutting-edge cancer research in Mumbai and the U.K. Currently, he works as an academic and professional cancer surgeon and a molecular oncology researcher in the U.K. I am posting his comments because both he and Gilbert have given me permission to do so. He is not a member of Goanet. I would be happy to provide you with his email address upon request.
Cheers, Santosh ______________________________________________________ JAYANT'S COMMENTS Old grandmothers in Goa did not really know much about cancer, let alone about effect of surgery. There is no such myth (that removing a cancer is dangerous) prevalent specifically in Goa. There are stories all over the world of someone who had a cancer removed and died subsequently, propagating the wrong conclusion that it was the surgery that caused the demise. Obviously, this is false logic. For prostate cancer a "surgery vs no surgery" randomized trial has indeed been done, and has proven that surgery actually saves more lives (albeit, with a risk of some different side effects, e.g. impotence and incontinence, as opposed to the bad effects of the tumour, e.g. obstruction and pain) - but it certainly saved more lives, not the other way round (see references 1 and 2). An experiment slightly similar to that described by the author was performed in rats by Dr. Bernard Fisher in 1960s. Recently, studies of anti-angiogenic effects of primary tumour have suggested a similar effect in animal models. These studies have not been generally replicated in humans, and there is little evidence for such effects in humans. Papers cited on this issue are from Judah Folkman's group (see references 3 and 4). But even these papers have not specifically suggested that surgery is detrimental. More importantly, the effects described in mice have nothing to do with the immune system. However, it will be with such experiments that science will progress, and not with Old grandmothers' tales, most of which have been proven wrong. For some types of cancers, excision of tumour could have deleterious effect on the patient, but in reality this is the exception rather than the rule. In fact, a recent paper in JCO suggests that surgery even in the presence of metastasis is good for the patient. Perhaps, there is some point in not doing incomplete surgery, as it appears that trauma of surgery may be detrimental, and some new treatments appear to counter this effect (see reference 5). It appears that the current best treatment for solid tumours is surgical excision, with adjuvant systemic and local treatment. Even in children, where there is considerable success from chemotherapy, surgery remains to be needed for solid tumours. Immune system-boosting techniques and anti-angiogenic therapies are still being tested in clinical trials and would be welcome addition to anti-cancer armamentarium, if they are eventually proven to be effective. REFERENCES: 1. Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ et al. Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 2002; 347(11):790-796. 2. Bill-Axelson A, Holmberg L, Ruutu M, Haggman M, Andersson SO, Bratell S et al. Radical prostatectomy versus watchful waiting in early prostate cancer. N Engl J Med 2005; 352(19):1977-1984. 3. O'Reilly MS, Holmgren L, Shing Y, Chen C, Rosenthal RA, Moses M et al. Angiostatin: a novel angiogenesis inhibitor that mediates the suppression of metastases by a Lewis lung carcinoma. Cell 1994; 79(2):315-328. 4. Holmgren L, O'Reilly MS, Folkman J. Dormancy of micrometastases: balanced proliferation and apoptosis in the presence of angiogenesis suppression. Nat Med 1995; 1(2):149-153. 5. Massarut S, Baldassare G, Belleti B, Reccanello S, D'Andrea S, Ezio C et al. Intraoperative radiotherapy impairs breast cancer cell motility induced by surgical wound fluid. J Clin Oncol 2006; 24(18S):10611. _______________________________________________ Goanet mailing list [email protected] http://lists.goanet.org/listinfo.cgi/goanet-goanet.org
