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if not treated early and adequately. They differ in certain characteristics, such as location in the body, microscopic appearance, and response to treatment. Their histories of development may be quite dissimilar and it is probable that the conditions which may precede them also differ greatly. 8. Are all tumors cancerous ?

No. Tumors are of two kinds—benign (usually harmless) and malignant or cancer. 9. What is the difference between a benign and a malignant growth?

Benign growths usually have a limiting membrane and push aside the cells of the tissue in which they are found. They never spread to other parts of the body. Malignant cells grow between normal cells, infiltrating the tissues by means of rootlike extensions. Unless adequately treated, cancer cells colonize (metastasize) to other parts of the body. 10. How can we tell if a growth is cancer?

By pathological examination of a small portion of the suspected tissue under the microscope. In advanced cases, physical examination alone of the patient may give the diagnosis. However, when this is possible the growth is often too far advanced to offer much hope of a cure. 11. What is the difference between sarcoma and carcinoma?

The difference is chiefly one of appearance under the microscope and the locations where they grow. Sarcomas are found in connective tissue, carcinomas in epithelial or lining tissue. Both are cancer. Sarcoma is seen more often in younger age groups. 12. Are cancer and leprosy related ?

No. Leprosy is à chronic, infectious, contagious disease caused by a germ. While cancer is a chronic disease, it is not infectious or contagious and its cause is obscure. 13. Can lower animals develop cancer?

Yes. Cancer may be found in all forms of life, both plant and animal.

2. WHAT CAUSES IT

14. What causes cancer?

The essential cause is unknown. Many factors are involved, but the most common is some form of chronic or prolonged irritation. This irritation may be of several kinds, as chemical, thermal (heat), or mechanical, as friction. 15. Is cancer caused by a germ?

There is no definite scientific evidence that cancer in humans is caused by a germ. 16. Does cancer come from a single bruise?

A type of bone cancer may rarely result from a single severe injury. It is believed that a single injury to soft tissue, such as the breast, will not cause cancer to develop. 17. What is the relation of food to cancer?

In certain individuals, vitamin B deficiency may result in changes in certain tissues, particularly of the mouth and lips, which may ultimately become cancerous. In general, however, so far as is known, no food or combination of foods has any influence on the cause or cure of cancer. 18. Will irregularity in eating cause cancer of the stomach?

There is no scientific evidence that it will, since cancer of the stomach occurs in people who eat regularly the most healthful foods. 19. Does eating hot foods cause cancer?

There is little evidence that the temperature of food is an important factor in the development of cancer. 20. Does the use of alcohol bear any relation to cancer of the stomach?

Not so far as is known. Alcohol may have an unfavorable effect on stomach tissues of some persons, but no more so than other substances taken into the stomach with food or drink.

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21. Is cancer hereditary in human beings?

There are probably inherited tendencies to form cancer of different types. Since, however, the method of inheriting such tendencies is obscure and undoubtedly complex, the presence of cancer in one or both parents should be merely a cause of greater alertness in looking for and recognizing suspicious conditions on the part of the individual. There is no need of fear or of a fatalistic attitude. The facts do not justify them. 22. Can cancer be transmitted by kissing or casual contact between persons or

between persons and animals? No. There is no authentic record of cancer having been transmitted by kissing or by any contact, accidental or otherwise, either between persons or between persons and animals. 23. Do corns ever become cancerous ?

Cancer may occur in any tissue of the body, but since a corn consists entirely of nonvital cells it could not in itself develop cancer. 24. Do freckles ever turn into cancer?

Simple freckles do not. However, flat moles containing certain pigment of a bluish-black color and looking like dark freckles, may become cancers and should be checked periodically. 25. Do hemorrhoids turn into cancer?

No. Hemorrhoids are enlarged veins in the rectal wall. Cancer is occasionally found in the tissue above the hemorrhoids, so "bleeding piles” should be examined carefully to determine whether cancer is present. 26. Can one's mental condition influence the course of cancer?

Not so far as is known. Cancer is a disease of body cells. One's mental condition has no effect on the course of the disease since this malignant change is apparently due to physical rather than mental processes.

3. DEFENSE MEASURES

27. How can one guard against cancer?

By preventing, so far as possible, prolonged irritation to any part of the body. Specifically, protection from overexposure to the sun and wind, prompt repair of all birth injuries to the womb, permitting the breasts to function normally, repair of jagged teeth, avoidance of ill-fitting dental plates, self-control in using tobacco, correction of chronic constipation-in short, elimination of unnecessary abuse of any tissue is a commonsense method of helping to guard against cancer. 28. What is meant by a precancerous lesion"!

Any abnormal condition that, if permitted to continue, may develop into

cancer.

29. What are some of the more important precancerous lesions?

White spot disease on mucous membrances, especially of the mouth; dry, scaly, itching patches on the skin, particularly the face; sores caused by jagged teeth and ill-fitting dental plates; dark colored moles subject to irritation; unrepaired injuries due to childbirth. These should all be investigated by a physician. 30. What precautions should be taken to avoid cancer of the mouth?

Keep the mouth clean. Have jagged teeth repaired or removed. Do not use an ill-fitting dental plate which causes a sore on the gums. If white spots appear in the mouth or on the tongue, stop the use of tobacco and see a doctor. 31. What precautions should be taken to avoid cancer of the skin?

Dark colored moles and warts, if subject to irritation, should be removed. Itching, scaly patches on the skin should be treated before they become open

Fair-skinned people, especially, should avoid continuous overexposure to direct sun rays. Recurrent fever blisters on the lip should be carefully examined. Keep the skin clean. 32. Should all moles be removed?

No. A flat colorless mole is probably as harmless as a freckle. Bluish-black hairless moles, especially when subject to irritation, should be removed. Any

sores.

mole or wart showing change in size or color should be promptly and completely removed and the removed tissue examined by a pathologist to determine if cancer is present. 33. Can immunity to cancer be acquired as with diphtheria or typhoid fever?

Production of immunity is possible only in diseases caused by germs. As cancer is not in this class, immunity cannot be developed against it. 34. Why do many people wait before consulting a physician when cancer may

be present or suspected ? Primarily because of fear or ignorance of the signs of cancer and of the vital importance of securing treatment early. Some people also think there is a social disgrace in having cancer and so hide the fact from their physicians and often from friends and relatives. This is not a justifiable attitude. 35. Can a tuberculous person ever have cancer?

He can. The presence of tuberculosis or any other disease gives no assurance that cancer may not also develop. 36. Why don't the white corpuscles in the blood kill cancer cells?

The chief function of white blood corpuscles is to protect the body against bacteria or germs. They kill germs and combat infection. They have no effect on cancer cells. 37. How can we control cancer!

First, by a prompt visit to a physician when suspicious signs or symptoms appear. Intelligent alertness by the individual may well save his life.

Second, by having complete, annual physical examinations. Women over 35 should be examined twice a year.

Third, by the physician's “high index of suspicion” of cancer in all patients. Fourth, by diagnosis at the earliest possible moment, followed by adequate reatment.

Fifth, by a widespread knowledge, both lay and professional, of the character of cancer, its causes, method of spreading, the value of early diagnosis and adequate treatment, and means of protection.

Support of such organizations as the American Cancer Society is essential.

4. HOW TO DETECT IT

38. How can you tell if you have cancer without seeing a doctor?

You cannot. A regular thorough physical checkup by your family physician is your best guard against cancer, plus an examination when one of the seven danger signals or warnings appears. You are the first line of defense against cancer because you, and you alone, can recognize a danger signal and heed its warning. 39. What are some of the early signs of cancer?

There are seven common ones. They are often called the seven danger signals of cancer.

1. Any sore that does not heal.
2. A lump or thickening in the breast or elsewhere.
3. Unusual bleeding or discharge.
4. Any change in a wart or mole.
5. Persistent indigestion or difficulty in swallowing.
6. Persistent hoarseness or cough.

7. Any change in normal bowel habits. You should go at once to a doctor upon the appearance of any one of them. Memorize this list. 40. I8 pain an early symptom of cancer?

No, except in a cancer of bone or nerve tissue. Pain usually is a late symptom and when it comes the growth is often far advanced. 41. Why should cancer be diagnosed and treated early!

The sooner it is found the less likely it is to have spread to other parts of the body where successful removal is impossible.

42. How long is it safe to wait after suspicious symptoms appear before consulting

a physician? Any delay is dangerous. Go at once to a doctor and ask for a thorough examination. 43. Why are periodic examinations necessary!

The earlier a cancer is treated the greater the chance of a cure. Through periodic examinations cancer may be detected in its early stages, before the individual has noticed any sign or symptom in himself. 44. What should comprise a thorough physicial examination?

Careful inspection of the entire body surface. Heart, blood vessel, and lung examination. Examination by sight and touch of accessible organs, such as the mouth, nostrils, ears, throat, chest, breasts, womb, and rectum. Examination of stomach and intestines by X-ray when indicated. Microscopic examination of blood, urine, and any suspected tissue. In women, special examination of the breasts. Other examinations as indicated, as of the eye, bladder, and prostate by appropriate methods. 45. Is bleeding always a sign of cancer?

No, but bleeding should be promptly and carefully investigated to determine if it is due to cancer. A small percentage of bleeding nipples are due to cancer. Bleeding from other body openings, as rectum or bladder, should be carefully investigated to rule out cancer. Unnatural vaginal bleeding, especially after the change of life, is always suspicious. 46. Does blood in bowel movements indicate cancer!

Movements streaked with bright blood or the occurrence of black or tarry stools should have prompt and thorough investigation. The assumption that rectal bleeding is merely due to hemorrhoids, or piles, is most dangerous since such bleeding may be due to a multiplicity of causes, including cancer, which require prompt treatment. 47. Does blood in the urine indicate cancer?

It may, but it may also be caused by conditions other than cancer. A careful examination is essential to rule it out. 48. Is it true that cancer generally develops among people in poor health!

There is no known relation between the status of one's health and the development of cancer. Regular checkups by your physician at your request provide the best safeguard against cancer as well as against other types of disease. 49. How can we diagnose cancer of the stomach?

The best method is X-ray. The outline of the interior of the stomach when filled with a dense substance, as barium sulfate, will often give clues to the presence of cancer. Certain chemical tests of stomach contents are sometimes of value. In late stages a lump may often be felt through the body wall. 50. Are all hospitals equipped to diagnose and treat all kinds of cancer?

No. To be adequately equipped for this purpose a hospital must have an operating room; a laboratory for the microscopic diagnosis of tissue; X-ray equipment suitable for diagnosis and for treatment; and must own or have access to a sufficient quantity of radium. To make this equipment effective there must be physicians adequately trained in its use. 51. Is cancer more frequent among negroes than among whites?

Proportionately fewer cancer deaths are reported among negroes than among whites, but this perhaps is due to poor reporting of the disease.

5. HOW TO TREAT IT

52. How should cancer be treated?

By surgery, X-ray, or radium, or a combination of the three in the earliest possible stage of the disease. 53. Are X-ray treatments good for all kinds of cancer?

No. Treatment depends on type and location of the growth. Some cancers will not respond to X-ray or radium treatment but must be treated by surgery or other means, as certain hormones or isotopes.

54. What is the difference in the action of X-rays and radium on cancer tissue!

There is no essential difference. When properly used both will destroy cancer cells without seriously injuring the normal cells with which they come in contact. 55. How is radium used?

Radium in hollow needles is inserted into the cancerous growth or in the tissue surrounding it, or both, and removed after treatment is concluded.

Radium in a suitable container may be placed in contact with the growth, as in cancer of the skin. In larger quantities it may be used at a distance from the body, the rays passing through an opening in the container into the cancerous growth. The emanating gas of radium, known as radon, in suitable containers may be used in the same manner as the radium salt from which it is obtained. 56. Why is radium so expensive to use?

No less than 5.9 tons of a mineral which is half uranium must be processed to extract a single gram of radium. To extract a pound, 2,680 tons of such a mineral would be required. As minerals containing radium are not often this rich, in actual practice a yield of 1 gram of radium in 10 tons of ore is considered very good, and even minerals which yield only 1 gram in 200 tons are processed. It is, therefore, not surprising that the price of radium is about $20,000 per gram. 57. Do surgical or radiation treatments spread cancer!

No. On the contrary, such treatments tend to limit the spread of cancer. 58. Can the spread of cancer be stopped or retarded temporarily!

At times it can. Certain cancerous growths, hopeless from the standpoint of cure, may be controlled temporarily by proper treatment. Sooner or later, however, these growths may fail to respond to further treatment. 59. What should a person do who thinks he may have cancer

Go to his physician at once for a thorough physical examination. 60. Is cancer curable only in the early stages?

Yes, in the large majority of cases. At times, however, cures have been obtained after the cancers have been present for a long time. The type of cancer always has an important bearing on its curability. 61. How long will an untreated cancer patient live?

This will differ with each individual and with the location and type of cancer. 62. Is it ever possible to state that a cancer has been completely cured? If so,

how much time must pass before the cure is recognized ?

After a cancer patient has been treated and has remained free of recurrence of disease for a period of 5 years, the chances for reappearance of the tumor are extremely small. (In a few rare instances cancer has recurred 8, 10 or 20 years later, so that a semiannual physical examination is a must for these patients.) 63. If you have been cured of cancer, can you develop another cancer? In the

same place? In some other part of the body? Yes. Regardless of a patient's past medical history, including the treatment of a previous cancer, he should be examined at regular intervals. Because of the tendency for cancer to reappear at the place of a previously existing growth or nearby, a patient should have a regular follow-up at least every 6 months. A new cancer may appear at the same place or in another part of the body. 64. Is there any known serum cure for cancer?

No. A serum is of value only against a disease due to a germ. Cancer is not caused by a germ; therefore, serums are of no value in its treatment. 65. Is it ever safe to rely on salves or medicine to cure cancer?

No. No paste nor salve will penetrate the tissues far enough to destroy deepseated cancer cells; neither is there any medicine that will destroy cancer cells without also injuring normal cells with which it comes in contact. 66. Is there any chemical that destroys cancerous tissue?

There is some evidence that a few chemical substances such as the nitrogen mustards (chemicals related to the poisonous mustard gas) partially destroy cancerous tissues in some forms of cancer and leukemia. These chemicals are not cures but may alleviate suffering and may prolong life.

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