Tools for the Toolbox: Cancer

I’m a little uneasy about the whole idea of writing a post about using cancer as a fictional tool, because it’s such a devastating disease to patients and family members. But it is an important disease type, and I see it used everywhere in stories. Basically, whenever someone wants to deliver an emotional wallop. So…I’m going to give you some info on it.

But remember, cancer sucks. There’s nothing about cancer that doesn’t suck. And chances are, everyone in your audience will either know someone with cancer or have it themselves. So when you write about cancer, as with all diseases, try to remember that these are the things that destroy lives and tear families apart. Please write with a conscience.

And please take a moment to send some good vibes to anyone who is suffering from cancer, and to their families and friends. They could really use it.

And now, to the fictional world. As I’m sure you’ve seen in any number of stories, this collection of diseases can make a very useful tool for plot and/or character development.

Cancer is a general term to describe a type of disease: the runaway growth of a cell line. (This is also called a “neoplasm”, which means “new growth”.) Cancer can happen in practically any cell of the body. It’s a huge collection of diseases.

On the fiction end of things, cancer is a remarkably versatile disease type. So you can use it for many different situations, with practically any character.

What is it?

Cells have a mechanism for replicating themselves, dividing into daughter cells.

As you might imagine, there are a lot of brakes in place, so that cells divide only on the proper schedule. Because if the brakes are broken, the cells keep dividing and dividing. . . and you get unregulated, runaway growth.

Here’s a good visual for the kind of exponential growth we’re talking about (though the video shows quickly-dividing bacteria, and the cells we’re talking about divide much more slowly.)

You can imagine that even something as small as a mammalian cell could start taking up some room if there were enough of them in one area. And this is what a tumor is: a collection of uncontrollably-dividing cells.

If it’s a cancer of blood cells: the cells don’t stay together to form a mass, but they still divide uncontrollably, taking over the bloodstream by sheer numbers and making the fluid equivalent of a “tumor”.

Who gets it?

Anyone.

Old, young. Black, white. Male, female. Educated, uneducated. Anyone who has replicating cells can potentially get cancer. That’s you. That’s everyone you know. That’s everyone you’ll ever meet. Heck, it’s also everyone you’ll never meet!

However, certain types of cancer are more common in certain populations. For example, breast cancer is more common in women then men (although men can also get it). Prostate cancer is exclusively found in men, since women don’t have prostates. Male smokers are 23 times more likely to develop cancer (and not just lung cancer, by the way) than non-smokers. (I don’t have the specific statistic for female smokers, but I’d bet an arm and a leg that it’s similar. And I kinda need both of my arms and legs. Just saying.)

The NIH cancer-info site has a section on statistics about who’s getting cancer in various populations. It’s a good place to go looking: National Institutes of Health: National Cancer Institute

But to be honest, if you need one of your characters to have cancer, you can give them cancer. No matter who they are. I’m not going to call foul.

Why do you get it?

If the DNA of a cell (the blueprints that tell a cell how to act) becomes damaged in such a way that causes the brake mechanisms to fail, the cell may become cancerous. This damage can happen in many ways.

— A person can be born with genes that cause a cell line to become cancerous, such as in familial adenomatous polyposis.

— A person’s environment can cause enough damage that their cells become cancerous, such as with UV exposure and melanoma (a runaway growth of the pigment-containing cells in the skin.) There are also some environmental factors such as the human papillomavirus (HPV) that appear to cause cancer.

— A person can put substances in their body that damage the genes in their cells in a way that causes cancerous growth patterns, such as with smoking and various types of cancer including lung cancer.

— A person can have a genetic predisposition to developing a cancer, but will only develop the cancer if they are also exposed to an environmental factor or toxin.

The way your character gets cancer will probably depend on who your character is, how old, if anyone in their family has had cancer, and what they are exposed to either through their work or their living environment. It’s good to turn to the books to see if any known diseases fit your character type. Again, the National Institute of Health is a good place for this kind of selection research. It has sections on Cancers by Body Location/System, Childhood Cancers, Adolescent and Young Adult Cancers, and Women’s Cancers. It also has a wealth of other information. Go thou and research!

What are typical symptoms of cancer?

You can pretty much figure out what symptoms your character will have based on the function of the organ that has the tumor, and the function of any nearby organ that might be squeezed by a mass of growing cells. Also think about squeezing off a blood supply to a nearby organ, blocking lymphatic drainage, or squeezing the nerves in the area.

If it’s a tumor in the intestines, your character will likely eventually have trouble defecating due to blockage. If it’s a tumor blocking the common bile duct, your character will have symptoms that result from the blockage of the flow of bile and the resultant back-up through the liver: their stool will be gray/white and their urine will be brown, they could have pain on the upper right side of their abdomen (and classically, the pain could radiate to their back), and their skin could turn yellow (jaundice).

Beyond that, there are some classic, non-specific symptoms that many cancers share. Since the uncontrolled cell growth steals a lot of the groceries that the body would rather use to fuel its non-cancerous cells, a person could experience an unexpected and unintended weight loss and fatigue. Cancer cells can release chemicals into the body that generate unexplained fevers as well.

It occurs to me that at this point I should say: Please keep in mind that these symptoms don’t automatically mean you have cancer. They can show up with other diseases, too. If you have a symptom you’re worried about, talk to your doctor about it. It’s his job to sort stuff like that out.

When do you get it?

It’s most common in older populations. According to the American Cancer Society, 77% of all cancers are diagnosed in people age 55 and older.

But that doesn’t mean older people are the only ones who get it. You can give any one of your characters cancer, no matter what their age is.

However, do your research. Some types of cancer are more common in certain age groups. So, pick your organ of choice and look in a pathology text or on the NIH website to see if there’s any particular cancer type known to be likely in your character’s age group.

Where do you get it?

Cancer can happen in any organ. There are some organs that are more likely to develop cancers than others. For example, the heart and eyes are far less likely to develop a neoplasm (although it does still happen).

Here are two graphs showing the most common cancer deaths by year and type of cancer, separated by gender. (Please note that it’s the deaths from cancer that this graph shows, not how common the cancers themselves are. But it might give you a general idea about which organs like to create deadly cancers.)

How fast does it grow? How fast does it spread?

It depends on the type. Some cancers, such as Basal Cell Carcinoma, grow very slowly and are less likely to metastasize (spread to other parts of the body). And some, like melanoma, can grow very fast and spread to every organ system in a person’s body, long before the first symptom presents. It really depends on the type of cancer and where it shows up in the body. Research, research, research. (Sensing a pattern here?)

So, how can you use cancer in fiction?

Pretty much any way you want to, within reason. It’s a good disease type if you need something that develops slowly over years, and isn’t noticed until it’s too late. It’s a good disease type if you need a character to slowly waste away. It’s a good disease type if you need something that could have been cured early, but was missed and so became incurable.

The limits of cancer are pretty much the limits of your imagination. If you want to use a real disease: pick an organ, dig into a pathology text or the NIH and American Cancer Society websites (links in the “Sources” section), and see what’s available.

If you want to invent a cancer. . . well, you can. Pretty easily. Since it’s a mutation away from normal cell function, cancer acts the way cancer feels like acting. As with any other plot point, (1) do your research; (2) your audience will believe the story you tell as long as you justify it; and (3) keep your embellishments quiet and plausible.

Side note: Every once in a while, I see someone’s genius protagonist come up with “a cure for cancer”. It just strikes me as silly. Finding “a cure for cancer” would involve finding a cure for every single individual type of cancer. (Shout-out to medical researchers, by the way, who are devoting their lives to finding cures for every single individual type of cancer!) But please don’t be that writer. Thanks.

Okay, that’s probably enough for now. There’s clearly more to say, but this post is a long one already. Sorry for the choppy read, too.

Sources:

http://www.cancer.gov (National Institute of Health)

http://www.cancer.org/downloads/STT/500809web.pdf

http://www.cancer.org (American Cancer Society)

The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.

If you do use this as if it’s medical information, I’ll drop a pebble onto your driveway. The next day, I’ll drop two pebbles. The next day, four. And so on.

Published in: on June 30, 2010 at 9:03 am  Comments (6)  
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Hey! Let’s Help This Guy Out!

I’ll let Zach tell you what this is all about.

You can vote here through July 3.

Tell your friends!

Published in: on June 28, 2010 at 7:44 pm  Leave a Comment  

Dr. Gritchhopper. Or, “Lessons From Residency Orientation”

-The worse the communication abilities of the speaker, the angrier they get when you don’t have a clue what they want you to do. And the more likely that they’ll blame you for the problem.

-There are fifty ways to say the same thing.

-Each way takes longer than the one before

-When you work for three hospitals, and two of them do a joint orientation, they don’t coordinate about subject matters. They just have one person from each hospital give a talk about the same topic. During which they say the exact same things. One after the other. Over and over.

-Even after a few years of up-close experience about the awful things people do to each other, pictures of babies with strangulation marks on their necks and full-thickness burns on their hands can still make me feel physically ill.

-I still can’t sit in auditorium seating without pissing off the people in my row. Darn foot-bouncing habit. This is why I never went to class once the lectures were put online.

-The prettier the day, the longer-winded the speaker. And the worse your mosquito bites itch.

-You can take pretty much any one of those stupid “comprehension tests” without having heard any of the orientation lectures. The questions’ wording leads you by the nose.

-There are an awful lot of statistics in the world that I just don’t care about.

-Hammocks make everything better….unless they’re at home and you’re inside in an endless orientation, dreaming about sitting in them in the perfect weather you’re also not sitting in.

-You have a serious problem if your orientation lasts from 8 to 6, three days in a row. It’s an even more serious problem if there is ABSOLUTELY NO INFORMATION disseminated in that time, and none of the MUST DO BY YOUR START DATE tasks get done either.

-There are some jobs that just shouldn’t exist.

-Paperwork is endless and Whac-A-Mole-esque. If you’re not careful, it’ll eat you and everyone you love.

Published in: on June 27, 2010 at 1:29 am  Leave a Comment  
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Bliss

The only thing better than having a classical pianist as a next-door neighbor?

Listening to them practice along with the rainstorm going on outside.

Published in: on June 23, 2010 at 12:04 am  Leave a Comment  

Lessons from ACLS

I’m studying ACLS this week! (That’s “Advanced Cardiac Life Support”.) Basically, what to do when someone’s heart stops. In a hospital, that’s called a “code”. I believe I will use the following procedure when I am called to run my first real code:

You know, except for that awkward not-really-love-scene-in-a-closet thing.

Anyway.

When performing chest compressions during CPR (Cardio-Pulmonary Resuscitation) during a code, you’re supposed to deliver about 100 compressions per minute. (Note: Spelling “resuscitation” correctly took me four tries….)

Major workout.

But, like all workouts, it’s better with music. Because who wants to learn how to count at a rate of 100 beats per minute?

So.

There are two songs that you can use to control the speed of compressions.

One, interestingly, happens to be “Staying Alive”.

The other, ironically, happens to be “Another One Bites The Dust”.

I guarantee you practically every healthcare provider has one of those two songs running through her head as she gives chest compressions. If she doesn’t, her ACLS instructor was likely a zombie. She was lucky to escape ACLS class with her life.

So, now you can sing along the next time you see someone on TV giving CPR! And if they’re doing it at the wrong speed, you’ll know! That way, you can mock them appropriately!

Let’s practice! (Some of these involve spoilers, I think.) Anyway, I give you: A Parade of CPR Absurdity!!!

Note: Guidelines change faster than the epidemiological spread of zombie-ism. So, when some of these were filmed, it’s possible that they were per the guidelines at the time. Some of them.

Added bonus: If you sing out loud, you can make your dog and/or significant other stare at you with an adorable, quizzical look!

The contents of this site, such as text, graphics, images, and other material contained on the Site (“Content”) are for informational purposes only. The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this Site!

If you think you may have a medical emergency, call your doctor or 911 immediately. This blog does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Site. Reliance on any information provided by this blog, or other visitors to the Site is solely at your own risk.

The Site may contain health- or medical-related materials that are sexually explicit. If you find these materials offensive, you may not want to use our Site. The Site and the Content are provided on an “as is” basis.

If you use this as if it were real medical information, I’ll start singing “Staying Alive”. I may or may not accompany myself with chest compressions. Regardless, it will not be pretty.

I’m having a really great month.

That is all.

Published in: on June 19, 2010 at 10:52 pm  Comments (1)  

How To Kill Your Non-Imaginary Non-Friends

Dear mosquito.

That was incredibly rude of you to land on my arm and attempt to distract me from my inaugural out-stretching in my new hammock. But I’m sure you know that.

You got away with that first bite. I didn’t notice you until you started flying away. And then you decided to land on my other arm for another taste.

While I still had you in eyesight.

What a poor decision.

You got greedy, mosquito. And that is why you are dead.

Let this serve a lesson to us all.

Love,

Doctor Grasshopper

Published in: on June 17, 2010 at 9:38 pm  Comments (2)  

Stories From Med School: Impetigo

Caution: yucky picture below.

I went to Honduras during my Last Summer Vacation EVER, between my first and second year of med school. We worked for a month in an emergency room in a small coastal town called Trujillo. It was a fantastic experience.

As I was heading home on the plane, I got a sore throat. Probably picked it up in the ER right before I left.

A day or so later, I developed a rash across the bottom half of my face. It looked like I had grown a beard made of strawberry ice cream.

It itched like crazy.

Of course, it turned out to be impetigo, a manifestation of either a staphylococcus or a streptococcus infection. (In this form, I read at that time, they are clinically indistinguishable.)

It looked a little like this. Over the entire bottom half of my face.

Quiz time!

After I was diagnosed, was my first reaction:

A. Crap! If I didn’t get the chance to treat this in time, it could have progressed into necrotizing fasciitis and disfigured me for life if it didn’t kill me!

B. Wait till my med school buddies see this! They’ll love it! I gotta do a call-around!

I’ll give you a hint. I made sure I had some exam gloves, in case people wanted to poke at it.

You are welcome to draw any conclusions you like about my mental health.

Published in: on June 15, 2010 at 1:18 am  Comments (15)  
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In Search of Ganong

As unpacking proceeds apace, I’ve been slowly unearthing my favorite reference books for blogging purposes.

My Robbins & Cotran: Found. (That’s for pathology stuff.)

My Junquiera: Found. (That’s for histology and basic function stuff.)

My Lehninger: Found. (That’s for biochemistry stuff.)

My Ganong: Still missing. It’s in a box around here somewhere. It’s my favorite physiology text…and physiology is my favorite part of medicine. So naturally, it would be the last to be found. Just makes sense, doesn’t it?

Heeeeeeeere, Ganong Ganong Ganong!

Heeeeeeeeeeeeere, Ganong Ganong Ganong!

Published in: on June 12, 2010 at 6:43 pm  Leave a Comment  

I’m also a writer…

Just hit 20,000 words on my YA novel tonight!

(Yes, progress is very, very slow. Luckily, this is not how I plan to make a living.)

Published in: on June 11, 2010 at 3:44 am  Comments (4)