Doll made of liver cancer cells

On Tony Isaacs’s Curezone, a forum member is asking advice on how to treat advanced liver cancer. The patient in question – the forum member’s mother – has previously undergone surgery. However, according to Tony Isaacs, it is precisely surgery that causes cancer to metastasize:

The thread is here.

Tony Isaacs, as well as many other alternative “health advisors” for that matter, regularly make the claim that surgery is the main cause for cancer to metastasize. Since we have a pathologist on board here, I decided to ask him whether there is any truth in this. Here’s what he said:

There is no such thing as a protective coating separating a cancer from the normal structures of an affected organ. Some cancer cells loose their adhesiveness, which probably contributes to their invasiveness, but this is a property of the cancer cells itself.

There has been a discussion of risks of implants of cancer cells after needle biopsy of metastatic lesions. Because of this risk it has been contraindicated to do a liver biopsy if curative surgery was an option. But the risk is so low, that this restriction is being removed from the forthcoming guidelines. 

Surgeons strive to remove healthy tissue at a safe distance from the cancer itself. And the surgical margin clearance is a very important factor in the chance of survival. With rectal cancer we have increased the survival to 82 % by introducing chemoradiation before the operation. See for instance this study. This makes the tumor shrink to such an extent that margin clearance is technically possible.
 
But Tony has not explained how he believes metastases arise when the tumor has not been touched in anyway by a surgeon. 

No, indeed he has not. Well, perhaps he’d care to enlighten us on this some day… 

Vascular invasion of cancer cells

This is an example of the microscopic appearance of vascular invasion. In the middle you can see a vein with cancer cells inside. The transportation of cancer cells through the blood stream is a real and commonly observed phenomenon.

Another opinion of Hamer that can easlily be checked is that immunohistochemical examination of a metastasis is useless because as he puts it: “…this procedure does not identify metastasizing cancer cells but only proteins, released from a tumour”.  And he believes that a webpage about “Atomic Force Microscopy” backs him up on this view. Needless to say the website says nothing of the sort. In fact, immunohistochemistry clearly identifies proteins within the cancer cells and thus shows us where the metastatic cancer cells originate from.

To understand how immunohistochemistry really works you only have to know two things:

1) Cancer cells try to imitate the normal cells of the organ they originate in – including the production of structural proteins characteristic  of the cell type in question.
2) These structural proteins can be detected through immunohistochemistry.

The photo below is a microscopy photo from a large bowel cancer, where you can see the adjacent normal cells on the left, and the cancer cells that try to imitate them on the right.

Cancer cells imitating normal cells

An important structural protein in normal large bowel cells is a protein called “cytokeratin 20”. If the pathologist looks at an immunohistochemical staining for “cytokeratin 20” he sees positive reaction in the cancer cells as well as in those normal cells the cancer imitates. It looks like the photo below. The brown color shows where cytokeratin 20 is present. Again the normal cells are on the left, and the cancer cells are on the right.

Immunohistochemical staining of cancer cells

Now let’s make this fact useful. The photo below is a microscopy photo of a core biopsy from a liver metastasis without the use of immunohistochemistry. The cancer cells are at the top of the picture, and the normal liver cells are at the bottom.

Core biopsy of liver metastasis without immunohistochemistry

A pathologist has no trouble in telling which cells are normal and which cells are cancerous, but based on this alone it is not possible to tell where the cancer comes from. Immunohistochemical staining for cytokeratin 20 staining on the biopsy looks like this photo:

Core biopsy of liver metastasis with immunohistochemistry

It shows that the cancer cells contain the same structural protein as the cells of the large bowel (and the cancers that originate from them). And sure enough this patient did turn out to have a large bowel cancer.

So, in conclusion:

1) Cancer cells do appear in the blood stream
2) Immunohistochemistry does show cancer cells
3) Cancer cells have features of the cells from which they originate – and this is readily seen through immunohistochemistry.

Lung cancer cell, Wellcome Images Awards 2009

All the images can be viewed on the Wellcome Images website. The Biomedical Collection holds over 40 000 high-quality images from the clinical and biomedical sciences. Selected from the UK’s leading teaching hospitals and research institutions, it covers disease, surgery, general healthcare, sciences from genetics to neuroscience including the full range of imaging techniques.

The annual Wellcome Images Awards reward contributors for their outstanding work. This year, nineteen extraordinary images have been chosen by a panel of judges based on the ability of the picture to communicate the wonder and fascination of science.

The selected images are now on display on the Image Awards website, which explains the stories behind the pictures: how the images were created, what they add to scientific understanding and why the judges picked them out as the best images this year.

Embryonic mouse head. Wellcome Images Award 2009

There were also two special awards, one given to the makers of animations showing the intricate structure of a mouse’s head during development and the other for the unique capture of sensory nerve endings, both showing an astonishing level of detail and accuracy that has previously not been possible with conventional microscopy techniques.

You can click here to view the winning images of 2009 (on the website, click Awards 2009, then click the link given in the text)

See also:
How it’s made – the art of science
See this: images of cancer

Through my twitter I came across an article in the New York Times about a problem that many mainstraim doctors and patients are faced with.

The article is about doctors bending the rules of clinical trials in order to get patients enrolled in clinical trials for which they would otherwise not qualify.

The article presents a real and very poignant dilemma with which many patients and doctors are faced. As it says in the article, a compromised trial has no value, which may mean that admission of a possibly life saving treatment will be postponed or even denied definitely. But even if the problems do not come to light, it can harm patients because of flawed trial outcomes. So it is imperative that all the rules be applied as strictly as possible. But what about the patients?

Imagine your doctor has just told you that you cannot be cured, that all he can offer is palliative treatments and that you must expect to die in a foreseeable time. What would you do? I think all of us would be prepared to try anything to extend their time with our loved ones as long as possible. So when you hear of a clinical trial in which a new cancer drug is tested, but you are told they won’t let you enrol because you might compromise the trial, this is unspeakably bitter, for patients and their family, but for doctors as well.

No pain and all gain for the quacks

Alternative “healers” are not faced with dilemma’s like this. They do not have to carry out difficult and often very expensive scientific trials to get a drug accepted on the market, for their products are sold as “supplements” only and consequently, they are not burdened by the rigorous ethical rules that apply to real science and medicine. They can make far-reaching claims without having to worry about legal consequences, as long as they make sure the infamous “Quack Miranda Warning” is somewhere on their website. It is easy for them to lie to patients with stories of  false hope and empty promises of cure. Not bothered by any ethical qualms, they step in where medicine and science stand with their hands tied by the ropes of their professional ethics.

What can we do?

Mainstream medicine and science are and should be bound by a great number of ethical rules and professional and scientific standards and bending the rules of science is never a good thing in our opinion.

Therefore, in mainstream medicine there is a thing called “Compassionate Use”. Compassionate use refers to the treatment of seriously ill patients with new, unapproved drugs or treatments when no other options are available. 

Although compassionate use is also subject to ethical rules and standards, there often are a surprising number of ways to get treatments normally available only in a trial (or offered in one) outside of a trial, and frequently patients are simply not told that they may be able to obtain a treatment outside a trial (also called off protocol or  expanded access to investigational drugs). So the first thing you should do is: ask.

You can click on the following links for more information on expanded use and how to obtain treatments:
Rules to Help Patients Gain Access to Investigational Drugs
Resources: Compassionate Use
Terminally-ill cancer patients to be offered ‘last chance’ experimental drugs
Brits Turning To Experimental Cancer Drugs 

I’m sorry if I seem a tad triumphant, I don’t mean to, honestly. But I just could not let this go. Unbelievable as it sounds, apparently überquack Hulda Clark died of cancer, multiple myeloma to be precise. Now how in the world can this have come about?

See also Respectful Insolence.

In the UK, statutory regulation of practitioners of herbal medicine and acupuncture has been advocated by a House of Lords’ Select Committee and by three subsequent Dartment of Health (DH) working groups as well as the vast majority of respondents to a previous DH consultation on this subject (the Pittilo consultation and report). The NIMH is strongly in support of statutory regulation of this sector. They feel that only statutory regulation of this sector can enable the public to identify qualified practitioners and maintain the availability of a full range of herbal medicines in herbal practice. The same discussion is going on in other countries, the Netherlands for example. For our Dutch readers: click here.

Is it true that statutory regulation will protect the public against the risks of alternative medicine?  Many people think not and we agree with them. The pitfalls and downsides of the suggested regulations have been aptly described in a submission that was sent to the Pittilo consultation. You can read it here. There is a summary on DC’s Improbable Science, as well as extensive information on the Pittilo consultation.

On October 26, 2004, Stephen Serenelli died of bowel cancer.

Initially he was treated conventionally, but under the strong influence of his wife Eileen and Ian Shillington, a naturopathic doctor and Scientologist, he decided to follow alternative treatments only.

The alternative treatments made him feel weak and miserable and resulted in his tumour becoming inoperable. This almost certainly shortened his life considerably, as well as seriously compromising his quality of life.  The fact that the alternative treatments wore him out so much may also have decreased his survival time. 

Shortly before his death, Serenelli wrote a letter to his ND Ian Shillington. Serenelli also kept a diary during his illness.

De-licensed German physician Ryke Geerd Hamer claims he can cure cancer without surgery, radiation or chemotherapy.

He states that cancer is always caused by an (unexpected) emotionally traumatic event and the only way to cure it is by solving the ensuing emotional ‘conflict.’

It isn’t exactly rocket science to establish that he is very wrong, both about the cause of cancer and the best way to treat it.

If  Hamer is right, then everyone seeking psychotherapy for emotional traumas also has cancer and every cancer patient having psychotherapy will always be cured of their cancer. Yet both are not the case, as the following will show.

• Personality factors, including the so-called cancer-prone personality risk profile, do not appear to be related to breast cancer incidence. None of the personality factors in this study were statistically significantly associated with an increased risk of breast cancer, with or without adjusting for the medical risk factors. Also, the occurrence of a combination of various personality traits did not appear to be related to breast cancer development. 
• In 2007, three replication studies were published, which indicate that the hypothesis that psychotherapy prolongs life should be abandoned, because no evidence was found for enhanced survival after participation in psychosocial interventions.
• There is insufficient evidence to advocate that group psychological therapies (either cognitive behavioural or supportive-expressive) should be made available to all women diagnosed with metastatic breast cancer. Any benefits of the interventions are only evident for some of the psychological outcomes and in the short term. The possibility of the interventions causing harm is not ruled out by the available data.
• Existing data do not support the claim that psychotherapy prolongs survival, and there is an inadequate basis for specifying a mechanism by which such an effect would be produced.

We’ve said it before and we say it again: the reality is that cancer cells just don’t give a hoot about what we think or how we feel.

If you want to find out about the things that really help to prevent cancer, you can click here. And if you should ever be diagnosed with cancer, then please, please stay away from people like Hamer and their ilk.

The ECCO is Europe’s oldest and largest scientific conference on cancer and currently the ECCO 15 – ESMO 34 in Berlin is in full swing.

Here’s a short overview of some of the main highlights. 

Breast cancer

Dr Jetske Ruiterkamp and Dr Miranda Ernst of the Jeroen Bosch Hospital, The Netherlands, found that it is useful to remove the primary tumour in women with metastasized breast cancer (stage IV).

The researchers discovered that those patients who had received surgery survived for considerably longer than those who had not – an average of 31 months as opposed to 14. The five-year survival rates of the two groups also showed significant differences, with 24.5% of the surgery group being still alive five years later, whereas only 13.1% of those did not have surgery were still living five years on.

This is particularly important because most women and oncologists opt for palliative treatment in this stage. 

There are a number of possible explanations for this,” said Dr Ruiterkamp, “but we think that the most likely is that by excising the primary tumour, we reduce the number of circulating tumour cells elsewhere in the body. It is also possible that surgery reactivates the immune system.

Surgical removal of primary tumour improves survival in metastatic breast cancer patients.

Again breast cancer: switching from Tamoxifen to Exemestane provides a considerable advantage in the prognosis of early stage breast cancer:

We found that six years after changing treatment, women who got exemestane were 18% more likely to remain disease free and were 14% less likely to die than those who stayed on tamoxifen.

Switching early breast cancer patients to exemestane improves long-term survival.

It is also important that breast cancer patients continue taking their medication: 

Patients who stopped study treatment (tamoxifen or exemestane) had significantly higher chance of a recurrence; the chance was between four and five times higher among this group than among those who continued their treatment.

Keep taking the medicine: study of adjuvant endocrine treatment for breast cancer reveals the cost of patient non-compliance.

Brain metastases

Researchers also found that whole-brain radiotherapy should not be given routinely to all patients whose cancer has spread to the brain. They found that using it after surgery or radiosurgery in patients with a limited number of brain metastases and stable cancer in the rest of the body did not extend lives or help patients remain functionally independent for longer.

Whole-brain radiotherapy after surgery or radiosurgery not recommended for all patients with brain metastases.

Melanoma

Researchers have made significant advances in the treatment of metastatic malignant melanoma – one of the most difficult cancers to treat successfully once it has started to spread. In the phase I extension study, researchers have seen rapid and dramatic shrinking of metastatic tumours in patients treated with a new compound that blocks the activity of the cancer-causing mutation of the BRAF gene, which is implicated in about 50% melanomas and 5% of colorectal cancers.

Dr Paul Chapman, an attending physician on the Melanoma/Sarcoma service at Memorial Sloan-Kettering Cancer Center (New York, USA) and one of the leaders of the trial, said:

We are very excited about these results. Of the 22 patients we have been able to evaluate so far, 20 have had some objective tumour shrinkage. This is impressive as they all had metastatic disease and most of them had failed several prior therapies. A lot of these patients were pretty sick but many of them had a significant and rapid improvement in the way they function. We’ve had patients come off oxygen and we’ve got several patients who have been able to come off narcotic pain medication soon after starting treatment.

Trial of new treatment for advanced melanoma shows rapid shrinking of tumours.

See also the article on Science Update Blog of Cancer Research UK.

Pancreatic cancer

For the first time researchers have shown that by inhibiting the action of an enzyme called TAK-1, it is possible to make pancreatic cancer cells sensitive to chemotherapy, opening the way for the development of a new drug to treat the disease. Dr Davide Melisi said that resistance to chemotherapy was the greatest challenge to treating pancreatic cancer:

Pancreatic cancer is an incurable malignancy, resistant to every anti-cancer treatment. Targeting TAK-1 could be a strategy to revert this resistance, increasing the efficacy of chemotherapy. During the past few years we have been studying the role played by a cytokine or regulatory protein called Transforming Growth Factor beta (TGFbeta) in the development of pancreatic cancer. Recently we focused our attention on a unique enzyme activated by TGFbeta, TAK-1, as a mediator for this extreme drug resistance.

Pancreatic cancer: researchers find drug that reverses resistance to chemotherapy.

Cervical cancer

Cervical cancer could be eradicated within the next 50 years if countries implement national screening programmes based on detection of the human papilloma virus (HPV), which causes the disease, together with vaccination programmes against the virus, according to professor Jack Cuzick. 

While the current HPV vaccines protect against two cancer-causing strains of the HPV virus, soon there would be vaccines available that protect against nine types. If vaccination were to be combined with HPV screening (which is much more sensitive than the currently used Pap smear test), then eventually the cancer would disappear in those countries that had successfully implemented national programmes. However, this would require political will and effort at both national and European level.

It’s important to say up front that the HPV is responsible for all cervix cancer. If you can eradicate the virus, the cancer will not appear. So the current vaccine holds the promise of eradicating about 70-75% of cervical cancers (caused by HPV types 16 and 18), and there appears to be some additional cross protection amongst types that are closely related to 16 or 18, in particular 31, 45 and a little bit of 33. There are new vaccines being planned that will vaccinate against nine types. If they are successful, there should be no need to screen women that have been vaccinated at all. That’s the long-term future: vaccination and no screening. After about 50 years, we could see cervical cancer disappearing.

As the current HPV vaccine only protects against two of the cancer-causing types, vaccinated women will still require screening for the rest of their lives.

Vaccination and testing for the human papilloma virus could eradicate cervical cancer – but the EU and national governments should be taking action now.

Here’s more on the vaccine

Abstracts

For those of you who want to know more: here’s the list of abstracts.

The video of Hamer victim Corinne Thos has been removed from Youtube without the knowledge of the family member who posted it.

We will try to find out what happened and keep you posted!