Understanding Cancer

A checkup is a fishing expedition for the earliest evidence of any silent disease or disorder, including cancer. The focus of the routine physical depends on your age, vulnerability, and sex. If you have specific symptoms, fears, or susceptibility, your doctor will perform a targeted exam. But don't wait until you're sick. Get your physical while you're still healthy.

During a general checkup, a careful, total body physical exam is extremely important. Beware of any doctor who examines you while you're partially dressed; you should be wearing nothing so that every part of your body is visible. No exam is complete without an examination of all your lymph glands- in the neck, the armpit, and the groin- as well as a digital evaluation of the rectum and, in women, a pelvic exam too.

After the physical, you should have your urine checked for evidence of infection, blood, and abnormal proteins; your stool should be analyzed for the presence of blood (it's not always visible to the naked eye); and your blood should be drawn for a spectrum of tests. Recent government legislation prohibits Medicare from reimbursing you for screening blood tests if you have no specific complaints. If you're in the Medicare age group, or if you're younger and your insurance carrier or managed-care company won't pay for routine blood tests, then arrange with your doctor so that he or she performs them anyway.

In order to detect early cancer, certain tests should routinely be done at varying intervals, not necessarily annually, depending on your age, sex, and the type of cancer (or other disease) to which you are especially susceptible. Although X rays of the upper gastrointestinal tract and barium enemas are still widely used, newer techniques are often preferred when there is a suspicious finding. For example, the CT scan is a special procedure in which a computer is hooked up to an x-ray machine and a series of detailed pictures is taken at different levels or 'cuts' of the tissue being examined. This provides an in-depth analysis of a particular region of the body, such as the chest or the abdomen. Endoscopy allows the doctor to view the interior of the body through a thin tube with a light and a little snare at its end. (Such an exam is named for the organ being studied: A colonoscopy looks inside the colon; gastroscopy views the stomach; and bronchoscopy visualizes the respiratory system.) Looking directly at these tissues makes it possible to remove a polyp or to snip a piece off any suspicious tissue that is present and send it to the lab for analysis. The pathologist stains the cells, looks at them under the microscope, and can tell whether they're cancerous, and, if so, whether they are likely to grow slowly or quickly.

Radionuclear scanning is a noninvasive procedure in which you are given a mildly radioactive substance orally or by injection. A scanner measures the radioactivity level of the area or organ being evaluated and prints a picture of it on paper or film. The radioactive uptake pattern reveals the presence of growths and other abnormalities in the target tissue.

Ultrasound is a useful diagnostic procedure that is usually done to clarify a suspicious finding in the physical exam. High-frequency sound waves that cannot be heard by humans are directed toward the organ in question. Their 'echo' bounces back to produce a picture called a sonogram, which appears on a monitor, and is then printed on paper for a permanent record. Sonograms are especially valuable in the diagnosis of heart disease. However, they also reveal cancers in the abdomen that the doctor cannot feel, for example, in the pancreas, gallbladder, or liver.

Magnetic resonance imaging (MRI) involves the use of a powerful magnet linked to a computer that gives detailed pictures of various areas of the body. There is no radiation involved; the derived information is viewed on a monitor, and then printed out. With the exception of endoscopy, the MRI probably yields more information about cancer than any of the other diagnostic procedures described above.

Cancer Focused Exams

On what aspects of the checkup should the doctor concentrate when looking for cancer? Listed below are some of the cancer-focused exams that you should have on a regular basis in order to detect the disease at an early stage.

• Breast Cancer: Women over the age of sixty-five who are at greatest risk for breast cancer (there is more detailed information on this subject at the end of this chapter) should take the following three steps to ensure its early detection:

1. A mammogram. Properly done and carefully interpreted, this X-ray procedure identifies a breast tumor as early as two years before it can be felt.
2. Self-examination of your own breasts every month. Learn the right way to do it either from your doctor or by phoning the National Cancer Institute at 1-800- 422-6237 (1-800-4-CANCER). They'll send you a free booklet.
3. A breast exam by your doctor during your regular checkup or at least every year.

• Uterine and cervical cancer: As a woman grows older, her risk of cancer of the uterus and cervix increases. Some women stop seeing their gynecologist after menopause because they think that since their periods have ended, there are no more potential "female" problems. That's a mistake. Someone—a gynecologist or your family doctor—should do a pelvic exam and Pap test once a year regardless of how old you are. Although some doctors believe that if you've had a normal Pap test for three consecutive years after menopause, you may skip it, I still recommend that it be done annually.
• Cancer of the colon and rectum are also more common in older persons. Three tests can detect this malignancy:

1. The guaiac stool test (also called the fecal, or stool, occult test, or hemoccult test) reveals the presence of traces of blood in the stool not visible to the naked eye. You can do this one yourself with a kit available at all pharmacies. It comes with explicit instructions. A chemical is added to the specimen, and a change in color indicates the presence of blood.
2. An annual rectal exam, in which the doctor feels for any bumps or irregular areas of the rectum. (This is a must at every regular checkup. Insist on it.)
3. Colonoscopy every three to five years beginning at age fifty. A long thin tube is inserted via the rectum and threaded the entire length of the colon. (Sigmoidoscopy is a similar procedure, but the instrument doesn't reach nearly as far.) This allows the doctor to inspect the lining of the bowel and detect any polyps or growths.

• Prostate cancer is the most common malignancy among American men, 80 percent of whom are sixty-five and older.
• Skin cancer: Your doctor should inspect your skin carefully in the course of every routine physical exam. That's not done often enough. Some "blemishes" can be so tricky that your doctor may refer you to a dermatologist once a year to have your entire body surface checked for malignant or premalignant lesions. You can improve the chances of finding one early in the game by inspecting your skin yourself. Look for and report anything that's suspicious to you, especially if it's changed in size, texture, color, its borders have become irregular, or is a sore that doesn't heal.

Look specifically for moles or pigmented spots on the skin. (Doctors call them nevi.) They first appear as small, flat, tan or brown spots that slowly become raised. In time, they can flatten again, become flesh-colored, and disappear. Nevi are specific cells in the skin (melanocytes) that have heaped up in a cluster instead of spreading out evenly. (Melanocytes give the skin its natural color. When you sit in the sun, your melanocytes produce more pigment, darkening and tanning the skin.) Most people normally have anywhere from ten to forty nevi, and develop new ones from time to time until approximately age forty. At least one of every ten of them is dysplastic, an unusual-looking or atypical mole different from the rest. Dysplastic nevi are more likely than the others to develop into a melanoma. (However, most don't.) Any skin lesion that's the least bit suspicious looking should be biopsied. That's the only way to be sure it isn't malignant.

You should check your mouth at regular intervals, and so should your doctor and dentist. Look for changes in the color of your lips and tongue. Then open wide and inspect the inner cheeks; search everywhere for scabs, cracks, sores, white patches, swelling, or bleeding. Report what you find to your doctor.

Skin cancer is the most common tumor in this country, in both men and women. Fortunately, most skin cancers, such as the basal or squamous cell types, are localized, easily removable, and rarely threaten life. However, a malignant melanoma is potentially fatal and must be removed early—before it spreads through the body. This cancer is caused by exposure to ultraviolet radiation from the sun, sunlamps, and tanning booths. People at greatest risk for melanomas are those who've already had one, who have close relatives with them, who were badly sunburned as children or teenagers, or whose skin is fair and burns or freckles easily. The incidence of malignant melanoma rose almost 80 percent between 1973 and 1988, and it continues to do so—more than any other cancer.

 

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