In the late 19th century, the response of surgeons to cancer was to cut away huge amounts of healthy tissue as an insurance policty that they had “got it all”. In head or neck cancer, surgeons removed part of the jawbone; in breast cancer, they removed the breast, lymph nodes and most of the chest wall. If you had cancer of the pelvis or internal organs in the early part of this century, you might lose the entire lower half of your body.
Although these days the treatments are less mutilating, today’s doctors have continued with the notion that every last cancer cell must be cut, burned or chemically blasted away.This is why most cancer specialists fear, more than anything, a “local recurrence”. This means the cancer has returned to the spot where it was first detected.
Although fewer doctors persist with mutiliating surgery, and the efforts are afoot to adopt conservative surgery in many areas, doctors still employ complicated mixtures of chemo, radiation and surgery to ensure against the return of one single cell.
However, Dr Richard Evans, an American surgeon, is one of the few with the courage to challenge this paradigm of all out nuclear warfare. Dr Evans, who scoured much of the medical literature about cancer, discovered that in many types of cancers, although conservative surgery without radiation or chemo does produce more local occurrances, patients don’t die one day sooner than those who also get chemotherapy or radiation as well. In other words, he writes, “there is no survival disadvantage to leaving tumour cells alone and simply observing the patient.”(Making the Right Choice, Avery Publishing, Garden City Park, NY, 1995). This is also the case with soft tissue sarcomas cancers of muscle or fat, and skin cancer. Dr Evans cites studies demonstrating that when surgeons use slightly larger margins (1-2 cm) in excising certain types of tumours, patients live just as long as they might with chemo or radiation, but without the side effects or the dangers that the either treatment offers.
In their understandable zeal to help patients with this most mysterious of diseases, many doctors underappreciate the problems of radiation. The aunt of one of our readers was put on a course of chemotherapy which virtually destroyed her lung cancer. However, just to “put the icing on the cake, ” as her doctor put it, he sent her for a short course of radiotherapy to mop up the last traces. Within a couple of months she was dead of lung cancer. At that point, her doctor admitted that radiotherapy can often “trigger” the cancer off again.
It’s time for doctors to admit that their safest, and most potent weapon against cancer is often conservative surgery. This is not an argument for surgery, so much as an argument against piling on multiple treatments which haven’t been shown to work. In this case, less, in the right hands, is more.