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EXTENT OF CANCER – TYPE OF CANCER
The extent of the cancer is the next factor to consider. We have already seen that a major drawback of both surgery and radiation is that they are local forms of treatment. For most of the cancers listed at the beginning of this section, radiation alone can produce a cure only if the cancer is confined to the primary site and the nearby lymph nodes. Another requirement for curability, as we have seen, is that each of the growths must be quite small.
Certain types of non-Hodgkin’s lymphoma can also be cured by radiation provided they are localised to one or two groups of lymph nodes. Again, in some cases, the chance of cure would be higher with chemotherapy. Make sure you find out all about each treatment from someone who is experienced in its use before making a decision. As in many situations, your doctor may decide which treatment is ‘best’ without discussing it with you or offering you any options. In this case you will have to ask directly for the alternatives. You might also have to insist on referral to the appropriate specialist in order to get the information you need.
*272/40/1*

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TYPE OF CANCER – DESCRIPTION
Lymphomas warrant a separate mention because they don’t spread in the same way as most tumours. Hodgkin’s disease can be cured by radiation provided it is present only in lymph nodes and the spleen. If it involves other organs such as the liver, bone marrow, or lungs, it can only be cured by chemotherapy. This is not to say that radiation is always the best choice of treatment even for Hodgkin’s disease that involves only lymph nodes and spleen. In some such cases, chemotherapy has a higher chance of producing a cure. The chances of cure by each method depend on the type of Hodgkin’s disease (there are four different types under the microscope), whether or not you have symptoms like fever and weight loss, how big the nodes are and where they are located. If you have Hodgkin’s disease, ask about the likely benefit and the likely cost of having either radiation or chemotherapy or both together. You may not be told that there is an alternative unless you ask directly. By the way, surgical removal of the involved nodes is not an effective form of treatment in Hodgkin’s disease. Surgical biopsy is necessary to make a diagnosis. Surgical exploration may also be recommended in order to assess the extent of the disease. In neither case is the surgery actually a form of treatment. Hodgkin’s disease cannot be cured by surgery.
*271/40/1*

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SIZE OF CANCER – LOCATION OF CANCER
I have already explained that small cancers are much more likely to be cured by radiation than large ones, and that a lower dose is needed for smaller growths. Even if you have one of the radiosensitive types of cancer listed above, radiation may not be the best form of treatment if it is large. The likely side effects of the high dose that would be needed could make surgery a better alternative. In fact, radiation used on its own may not even be a realistic alternative. It simply may not be possible to cure your cancer by radiation without producing very serious or life-threatening complications.
This depends to some extent on the next factor?the location of the cancer. If it is in or near tissues which can give rise to particularly dangerous or unpleasant radiation reactions, the safe dose of radiation will be less than if it is in a less critical location. The location may determine whether radiation or surgery is the better choice.
*270/40/1*

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CONSIDERING ALTERNATIVES ? GENERAL INFORMATION
Here are a few examples of the sorts of situation you could be faced with.
Early cancers of the larynx (voice-box) are equally likely to be cured by radiation as by removal of the larynx. Radiation has the very great advantage of preserving the ability to talk. However, more advanced cancers have a better chance of being cured if they are removed. If this applies in your case you will have to balance the benefit of a higher cure rate against the disadvantage of loss of the voice-box when deciding which treatment to have.
A small retinoblastoma has an equal chance of being cured either by radiation or by removal of the eye. Radiation is clearly preferable if it can preserve vision. This is sometimes possible when the tumour is small and suitably located. On the other hand, if vision is going to be lost anyway, it could be better to remove the eye, because an artificial eye is likely to look better than an irradiated one.
The chances of living five years without any cancer recurrence is the same when a small breast cancer lump is removed and the breast irradiated as when the patient has a mastectomy (removal of the breast). It is also very likely that the eventual cure rates are the same, although this has not definitely been proven. If you have breast cancer and don’t wish to have a mastectomy, insist on your right to discuss your case with a radiotherapy specialist. This will give you the best chance of finding out what facts and figures apply in your particular case before making a decision.
Let’s look at some other considerations which may influence your choice when it comes to deciding between radiation and other forms of treatment. Factors which can influence the likely cost and benefit include size, location, extent and exact type of cancer as determined by microscopic examination.
*269/40/1*

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CONSIDERING ALTERNATIVES – INTRODUCTION
You should consider each of the possible treatments separately and combined when making your decision. For example, you could decide that radiation plus surgery, or radiation plus chemotherapy, is better than either treatment alone. Alternatively you may decide that the extra benefit likely to be gained by combining two treatments is too small to warrant the additional likely cost. Don’t forget that your doctor is likely to recommend the treatment which has the best chance of curing you, whatever the likely ‘cost’. You need to know about all aspects of the possible cost before deciding whether this is the treatment that is best for you. For example, for many people the likely eventual appearance and function of the involved part are easily as important as the cure rate. In general, one of the major advantages that radiation has over surgery is that it produces a less drastic change in appearance and function. This is not a hard-and-fast rule? there are exceptions to it. You need to find out what applies in your particular case. Don’t be embarrassed to tell your doctor that the final appearance and function are important in deciding which treatment is best for you. You’re the one who has to live with it. You can ask to see ‘before’ and ‘after’ photos of people who have been treated by each method. You might prefer a treatment that will alter your appearance less even though it has a smaller chance of curing you. That is fine as long as you understand that a treatment that is less likely to cure you is also less likely to prevent the cancer from growing back again in the same place (local recurrence). Such a local recurrence could be disfiguring, uncomfortable and difficult to treat. Ask how likely this is to happen with each treatment and how it could be treated if it does. Take this information into account when making your decision.
*268/40/1*

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MEN?S ALCOHOLISM – CIRRHOSIS: DON’T PICKLE YOUR LIVER
Most men know more about needlepoint than they do about cirrhosis, a bit surprising considering cirrhosis of the liver is the third leading cause of death for men between the ages of 25 and 65.
Cirrhosis results when liver cells die, permanently scarring the soft liver tissue. Unfortunately, the liver is not an organ you can do without?it’s responsible for the storage and filtration of blood and the secretion of bile; it plays a key role in breaking down carbohydrates, fats, proteins, minerals and vitamins; and it converts potentially toxic substances into harmless ones.
“Alcohol is the most prevalent cause of cirrhosis by far,” says Vlado Simko, M.D., Ph.D., associate professor of medicine at the State University of New York Health Science Center at Brooklyn, New York. Cirrhosis has other causes. But for men in this, country, alcohol is the culprit to watch.
What really makes cirrhosis so dangerous is the way it sneaks up on you. Experts cite a wide range of warning signs?deep fatigue and weakness, nausea, yellowish skin, small spider-like blood vessels that may appear just under the surface of the skin?then in the next breath admit that most of them appear only after liver damage has become extensive.
“Probably the earliest sign of liver disease is weakness,” says Paul S. Pickholtz, M.D., a gastroenterologist in private practice in Yonkers, New York. “But you don’t usually have any of the other symptoms until you’re already in trouble.”
Given the insidious nature of the disease, experts recommend you adopt a simple approach. “You shouldn’t get to the point where you have cirrhosis because once you do, you’re in trouble,” says Dr. Pickholtz.
So avoid steady drinking. Cirrhosis isn’t brought on by the occasional weekend binge?it’s the result of daily drinking over 10 to 15 years.
“The liver has a remarkable potential for regeneration,” says Dr. Simko. “If you give enough time between bouts of drinking, even if there’s damage to a significant amount of liver cells, other liver cells will regenerate and replace the damaged cells. But if the damage occurs every day, that’s difficult to recover from.”
Outside of watching your drinking, probably the best thing you can do to prevent cirrhosis, says Dr. Simko, is to get a hepatitis B vaccine. Next to alcohol, hepatitis is the largest cause of cirrhosis. A hepatitis B vaccine works simply?it will stop the disease before it starts. Talk to your doctor if you don’t remember ever having received a vaccine.
*35/257/8*

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CURE OF CANCER
There are some types of cancer which can be cured by radiation alone, unassisted by any other form of treatment. These include cancers of the skin (squamous cell and basal cell types), lip, tongue, lining of the mouth, tonsil, salivary glands, sinuses, back of the throat, larynx (voice-box), back of the eye (retinoblastoma), thyroid gland, oesophagus (gullet), breast, bladder, prostate gland, cervix (neck of the womb), uterus (womb), bone (giant cell tumours, Ewing’s sarcoma), brain (medulloblastoma) and lymph nodes (Hodgkin’s disease and some types of non-Hodgkin’s lymphoma). Lymphomas starting in other organs can also be cured by radiation. Radiation is also very useful for controlling the symptoms of these types of cancer. In this section we will be discussing only radiation used with the aim of cure (see pages 00 for symptom control).
Please understand that I am not saying that radiation is always the ‘best’ way of trying to cure these types of cancer. Neither am I saying that radiation can cure every person with cancer of these types. Far from it. I am simply saying that radiation should always be considered for them. Whether or not it is the ‘best’ treatment for you depends on how its likely cost and benefit compare to the likely cost and benefit of other possible treatments in your particular case.
*267/40/1*

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WHAT BENEFITS CAN BE ACHIEVED WITH RADIATION TREATMENT? PART 2
Radiation treatment is highly specialised. The person who can give you the most accurate description of the part that radiation could play in your treatment is a radiotherapy specialist. A radiotherapist is much more likely than other doctors to know exactly what results could be achieved and what the side effects are really likely to be. You have the right to have the opportunity to ask questions of a specialist who knows the answers. Don’t be fobbed off by any other doctor who dismisses your request for a referral with a statement like: ‘It would do you more harm than good’ or ‘If / thought you should have it, I would already have referred you’.
Remember that the reason to insist on a referral is not that you know you should have radiation treatment. It is that you suspect it might help you. After discussing your case with the radiotherapist, you may decide that you don’t want to have radiation treatment. Don’t be embarrassed if this is your decision. It doesn’t mean that you were wrong to insist on the referral. Seeing a specialist gives you a better chance of obtaining the reliable and accurate information that you need to make the best possible decision.
*266/40/1*

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THE RETURN OF INFECTIOUS DISEASE: WHAT WE CAN DO TO HELP PREVENT THE SPREAD OF TUBERCULOSIS
While the early part of this century saw major improvements in sanitation, housing and the provision of fresh wholefoods accessible to the general population, we are approaching a period in which the growth of our population has led to renewed overcrowding. Also, because of concentrated populations and now saturated disposal sites, a decline in effective sewage and waste disposal, along with a reduction in the quality of wholefoods and increasing exposure to environmental toxins and stresses, all decrease our capacity to resist infection on the one hand and optimise the conditions for its spread on the other.
Nor will the answer come from new medical therapies, not even antibiotics, for the new strains of tuberculosis which are emerging to plague our society are becoming progressively resistant to the antibiotics traditionally used to treat the disease. We can only challenge and change the direction of a society destined for ill health when we become aware of what that direction is. If, as I suspect, we are recreating the optimum conditions for the initiation and spread of infections, along with a whole host of new diseases of civilisation, reliance upon immunisation and therapy will provide little more than a cosmetic treatment of a much deeper health problem.
PRACTICAL PREVENTIVE METHODS
The control of tuberculosis will require a community effort and there are some measures we can all take individually and as a community to help.
We must as a community refuse to allow the problem of homelessness to grow. We need to pressure government bodies capable of improving this situation into action. We also need to organise community support groups, as they are now doing in some American cities, to assist government bodies insufficiently funded and staffed in the eradication of those environmental conditions conducive to the spread of the disease.
REDUCING THE RISK OF TUBERCULOSIS
Everyone can take steps to reduce the risk of contracting tuberculosis or of spreading the disease. These hints also make good sense as a general guide to keeping healthy:
Try to avoid overcrowded, indoor situations whenever possible. If you must expose yourself to high-risk situations, do what you can to ensure that ventilation is adequate. Open windows and doors whenever possible and go outside at regular intervals for fresh air.
Take note of people with persistent coughs in crowded places and keep your distance from them. If you know them well enough and you suspect tuberculosis, ask them discreetly if they have been checked for the disease. Give them this piece on the subject or some other relevant literature to read.
If you have to spend lots of time in crowded nightclubs or other high-risk situations, make certain that you stay away from these places if you are already sick or rundown and feeling unwell or chronically fatigued. When your resistance is down, you are far more likely to become infected. If you are unwell or have the flu, you also have a responsibility to stay away from these places so that you do not infect others.
If you are being treated with antibiotics for the infection, make certain that you take the tablets as directed and finish the course of the drug treatment. Failure to do so may cause mutations in the strains of tuberculosis virus and thus make them drug-resistant.
Make certain that you receive the proper nutritional balance and appropriate variety of whole, fresh foods.
Avoid or minimise the intake of substances such as alcohol, caffeine, tobacco and other drugs.
Monitor your own health and the health of your family, and keep in contact with health professionals who can advise you of the early warning signs of the disease. Do what you can to ensure that the environments in which you live and work are as clean and well ventilated as possible.
Get sufficient rest and exercise regularly.
*32/107/2*

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TAKING CARE OF CHILDREN: SAVING BUBBLE BABIES
In Houston, a 12-year-old boy named David has lived in a germ-free room since birth. When he goes out, he wears an astronaut’s suit to keep the bacteria and viruses away. He lives in a bubble.
David suffers from one of the most mysterious and deadly of children’s diseases – immune deficiency. He was born without the ability to fight off even the most common germs. If any microbe gets to him, it could kill him.
Bone marrow transplants, so promising for young leukemia patients, also are making headway against immune deficiency disease. Three-year-old Phillip Ryan Wissar of Miami was born with this disease. He got bone marrow from his brother Randy, 6. Doctors at Memorial Sloan-Kettering Cancer Center in New York City first removed certain white blood cells from the marrow that could attack Phillip. Randy’s marrow grew in Phillip’s body. Now, when Phillip gets colds and other infections, he defeats them. Dr. Richard O’Reilly, of Memorial Sloan-Kettering, says almost two thirds of immune deficient children now survive such bone marrow transplants.
*63/266/5*

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WHAT BENEFITS CAN BE ACHIEVED WITH RADIATION TREATMENT? PART 1
Read this section very carefully. I strongly recommend that you make sure that you discuss your case with a radiotherapist (specialist in radiation treatment) before making a treatment decision if any of the following circumstances apply to you. The first is the easiest: when your doctor recommends radiation. In this case there will be no problem about getting a referral! However, there are also other circumstances where I believe you would be wise to insist on referral to a radiotherapist, even if your doctor objects. Firstly, if you have a type of cancer which is listed here as being very sensitive to radiation. Secondly, if you believe that any of the situations described here where radiation can play a useful part apply to you. Thirdly, if you have any other reason to believe that radiation treatment could help you?say, from talking with other people with cancer, friends or hospital staff or from something else you have read.
*265/40/1*