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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How To Talk Doctor! Lesson 5.

Lesson 5: “-oma”.

-oma = “Tumor” or “swelling”.

Though this is not a perfect rule, when you hear “-oma” on the end of a word, it usually suggests cancer of some sort.

Used alone with a prefix that designates a tissue type, “-oma” classically has a connotation that suggests a benign tumor rather than a malignant one. (Ex: adenoma = benign tumor of a glandular epithelial cell type; chondroma = benign tumor composed of cartilage.) That’s not always true, though. So don’t depend on it.

Let’s try it!

“-oma”-words that have to do with tumors:

Carcinoma – This is a general term for a neoplasia (neo = new; plasm = growth) that originates from an epithelial cell type. (The body is made of four main cell types: epithelial, connective, muscle, and nerve.)

Epithelial cells cover things, secrete things, and transport things from one side of a membrane to another. Epithelial cells constitute the skin, the linings of the mucous membranes, glands, the lining of the bladder, and the linings of various ducts and tubes within the body.

After age 45, more than 90% of all tumors are derived from cells of epithelial origin.

The Culprits.

Lymphoma – Classically used to describe neoplasias of white blood cells (immune cells) that tend to stay in discrete masses. (There’s some overlap with “leukemias”, which are neoplasias of white blood cells that classically involve the bone marrow and often present with tumor cells in the blood.)

This is what a “mantle cell lymphoma” looks like under a microscope. I saw a patient with this type of lymphoma just last week.

Lipoma – A benign tumor composed of fat cells. (Lipos = fat)

There are also malignant tumors composed of fat cells, known as liposarcomas. My first-ever surgery as a third-year medical student was actually a liposarcoma removal. The thing was beach-ball-sized. And guess who got to hold it out of the way as the surgeons removed its connections to the patient’s abdomen? That’s right! My first surgery experience consisted in standing with my arms completely wrapped around a heavy, gigantoid tumor made of fat cells. For at least four hours.

It looked a little like this:

Have you hugged your liposarcoma today?

Incidentaloma – This is a tumor (or other finding) found by coincidence on an imaging study that was actually looking for something else entirely. These can be benign or life-threatening, and are often completely asymptomatic (a = without; symptomatic =….well, you got it).

This was an MRI study of the lumbar spine (the stack of rectangular objects in the middle). This patient also has 'arrow sign': the radiologists are drawing attention to a mass around the distribution of the left adrenal gland. Surprise!

“-oma”-words that don’t necessarily have to do with tumor (except maybe in the Latin sense of the word):

Glaucoma – This is a group of eye diseases characterized by certain changes in the visual field and the cup of the optic nerve. Often associated with high pressure inside the eye.

This is what a doc is looking at when they shine a bright light into your eye. This is what the back inside surface of the eye is supposed to look like.

This is glaucoma. Notice that the optic nerve (the circle in the middle) looks like a cup; the indentation in the middle is far bigger than it’s supposed to be.

Stoma – This is an opening in the body that may resemble a mouth. Sometimes refers to a hole made in the body and maintained to allow drainage.

Stoma

MOMA – This is a museum in New York.

It’s pretty swell, but I don’t think that counts.

Now go forth and understand some doctor-talk!

References:

Robbins and Cotran. Pathologic Basis of Disease. 7th edition. Elsevier, 2005.

Junqueira, Luis Carlos; Carneiro, Jose. Basic Histology: text and atlas. 11th edition. McGraw-Hill, 2005.

Pictures:

http://images.google.com/imgres?imgurl=http://www.radsource.us/_images/0509_6.jpg&imgrefurl=http://www.radsource.us/clinic/0905&usg=__LICH_TJrQI4iKkKmn_jpCsjFjpA=&h=266&w=350&sz=41&hl=en&start=10&itbs=1&tbnid=rvMhgF5JntpO4M:&tbnh=91&tbnw=120&prev=/images%3Fq%3Dincidentaloma%26hl%3Den%26sa%3DN%26gbv%3D2%26ndsp%3D18%26tbs%3Disch:1

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 will come to your home and hug your beach-ball for at least four hours. It will almost certainly confuse your children.

Published in: on March 30, 2010 at 12:51 am  Comments (2)  
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