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.

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Published in: on June 30, 2010 at 9:03 am  Comments (6)  
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When Your Audience Might Know More Than You Do

“My mother has rheumatoid arthritis, and there’s no way she could pick a lock like your character did in chapter twelve!”

“There was an article on that exact condition in the March 2003 issue of the New England Journal of Medicine, and it said that. . .”

“Dude. I don’t know much about osteogenesis imperfecta. . . but “osteo” means “bones”, and you’re talking about the kid’s pancreas. . .”

Using real-world diseases in a work of fiction has a large number of potential pitfalls. Here are a few tips about how to make your pestilential plot point a little more plausible.

Research is your friend.

If you’re going to use a specific, known disease in your story, seriously consider doing a fair amount of research. Chances are, some of your readers will have that condition, or their mothers will, or they’ll be physicians or nurses or physical therapists, or other people who know their stuff. They’ll know if you’re making things up, and they won’t hesitate to call you on it. It might seem like a lot of extra work to make sure you don’t lose those readers, but in my opinion, it’s worth it.

If you’re not swimming in spare time that you can use for research, though, there are a couple of tricks to help you avoid the otherwise-nearly-inevitable eye-rolls.

Start from the symptoms, then mix-and-match.

You need your character to have trouble breathing. You need a vague, plausible disease process to serve this plot point, but that’s all you need; the story itself is elsewhere.

(1) Pick an organ system.

Points to you if you picked the lungs. Bonus points if you also thought of the heart! (I plan to do a series of posts on the various organs and what they do, but it’s probably going to take a while.) Let’s go with the lungs, for now. Disease-of-the-lungs = breathing problems. Good. Plausibility meter just ticked up a notch.

(2) Pick a disease type.

What you choose for this will depend on the way you need the disease to act.

Let’s say that based on your story, your character needs to develop their lung condition slowly, and the lungs need to degenerate in a way that can’t be cured, just delayed. You’d probably want to go with an autoimmune disease for that one. Autoimmune-disease-of-the-lungs. Okay. Another tick of the plausibility meter.

(I’m also planning a series of posts on disease types [infection, mechanical injury, autoimmune, cancer, etc.] and how they generally act as a class. But if you’re in a rush and can’t wait for me to churn those puppies out, find your nearest friendly medical library; the librarians there will probably be able to help you out. Medical librarians rock. Shout-out to medical librarians!)

(3) Wave your hands in a distracting manner.

You’re a writer. You know how to do this. You have a character with an autoimmune disease of the lungs. Now dazzle your audience with your shiny description of his struggle to become a world-class athlete before his lungs crap out on him! Good job; most people will now read right through, because there’s nothing silly, easily disproven, or pseudo-medical in your prose that will snag their attention away from the story you’re telling.

If you have a disease in mind, but it’s not exactly right. . . back off on the specificity.

If you’re too specific with the disease you’re using, you’ll run into a couple of problems if you start taking liberties.

(1) Your knowledgeable readers will roll their eyes at unexpected things.

Reader- “Hey, I have Parkinson’s, and I haven’t been able to get up out of a chair on my own for five years! There’s no way he would be able to get out of the house in time!”

(2) You’ll spend way too much time describing how your character’s disease differs from the actual disease.

Author- “Yeah, it acts just like Guillain-Barré Syndrome, but it develops slowly, over a period of years and she was born with it instead of contracting it from. . .”

Reader- ::snooze::

Very few people will fault you (or probably even notice) if you take some small liberties with a disease process in your work of fiction. As long as you stay as close to plausibility as possible, you can mold the disease to fit the story. But the more you play with a specific process, the more chances you have to really get your facts wrong. People can only suspend their disbelief so far before the suspension cable snaps.

If you’re going to play with the disease process, consider avoiding the actual disease-name-drop. Vagueness can be your friend, in certain circumstances. But don’t cross the fine line that separates artistic-licensed vagueness from information-withholding. You’ll lose readers that way, too.

Information-dumps will get you in trouble.

If you don’t know much about the disease, your info-dump will be a minefield. Avoid the temptation to describe what you think is going on in your character’s body. Focus instead on the symptoms he experiences, and his reactions to them. And make sure everything you say moves the story forward in some way.

If you do know a lot about the disease, your info-dump will be a quagmire. Avoid the temptation to describe the biochemical anomaly in loving detail. You’ll lose your entire audience, even people like me who love this kind of thing. Maybe you’ll be a little safer if you write hard sci-fi. But I like hard sci-fi, and I still want things to move along while I’m getting my recommended daily allowance of awesome-science-idea.

All in all, it’s best to know what you’re talking about. Research is key. But sometimes it’s not possible, or the plot point is too small to justify the time it would take. At that point, I hope that these tips will help you get on with your story.

Picture: http://www.icanhascheezburger.com


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 were real medical information, I will stand by your bed and describe a biochemical anomaly in loving detail. I will adjust my volume according to your depth of sleep.

Published in: on January 27, 2010 at 1:49 am  Comments (3)  
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