Nariman Malik, BSc

Gynaecologic cancers remain a leading cause of cancer-related deaths in Canadian women. The three malignancies focussed on in this article, endometrial cancer, ovarian cancer and cervical cancer, have good prognoses if they are detected in their early stages. As such, it is of utmost importance that primary health care physicians be aware of Canadian guidelines for detecting these conditions and their limitations.

Endometrial Cancer

When diagnosed early, endometrial cancer is highly treatable and has a high survival rate. Stage I, grade I endometrial cancer has a five-year survival rate of 98%. This type of cancer most often presents as post-menopausal vaginal bleeding early in the course of the disease. Any woman who presents with unexplained post-menopausal bleeding should undergo endometrial assessment which can lead to early detection and improve the chances for a cure.

Detection

To identify women at risk of developing endometrial cancer, the progesterone challenge test can be used. In the United States, it had been recommended that all post-menopausal women should undergo this test at each annual examination. There are currently no Canadian recommendations regarding this test.

Ruwaida Dhala, BSc, MSc

Vaccination has one of the greatest impacts on disease prevention. Most vaccines generate protective immune responses against a pathogen, preventing disease initiation. Often the immunity generated by vaccines to specific pathogens is lifelong. Preventative vaccines are not effective in cancer prevention, however, mostly because cancer antigens elicit poor immune responses. For this reason many cancers evade the immune system. Cancer vaccine strategy focuses on eliciting anti-tumour responses in patients that are already afflicted with cancer. These vaccines will presumably prevent cancer progression and reoccurrence rather than prevent cancer initiation.

In order for the body to mount an immune response, the invading pathogen, or components of it, must be exposed to the immune system. There are two major components of the immune system, humoral and cellular. Humoral immunity is involved in the generation of antibody responses. These antibodies are usually directed against extracellular pathogens such as bacteria. Most preventative vaccines rely on this arm of the immune system.

Cancer and Nutrition: Be Cautious When Making Dietary Recommendations

Eleanor Brownridge,
Registered Dietitian

While a number of major dietary components--including fat, total energy, salt, red meat and alcohol--have been implicated as contributing to specific cancers, current case-control and cohort studies do not support some of the predominant hypotheses that are influencing Canadian eating habits. A major reason for the current level of certainty is the challenges inherent in nutrition epidemiology.

Diets are extremely complex. Nutrients are found in a multitude of foods, and their absorption and activity is influenced by other dietary components eaten at the same time. People change their eating habits over time and we have no idea as to the relevant latency period for various diet-related effects.

Michelle Durkin, BSc

The most common form of cancer today is skin cancer. Approximately half of all new cancers diagnosed are one of three defined types: basal cell carcinoma (BCC) , squamous cell carcinoma (SCC), or malignant melanoma (MM). Although the age of diagnosis is decreasing, most skin cancers do not appear until after the age of fifty, making this disease a serious threat to the elderly population. Fortunately it is also a disease which is successfully treated if detected early.

Epidemiology
The incidence of nonmelanoma (BCC and SCC) and MM skin cancers has increased so significantly over the past few decades it may have reached epidemic proportions, particularly in the United States and Canada. It has been projected by the National Cancer Institute along with the Center for Disease Control that in 1999 alone, skin cancer (all types combined) will claim the lives of nearly 9,200 people in the United States. Besides increasing annual incidence, more women are getting skin cancer and people are getting skin cancer at younger ages.

Individual types of skin cancer follow different morbidity and mortality distributions. About 80% of skin cancers are BCC, 16% SCC, and 4% MM. The mortality rate for nonmelanoma skin cancer is decreasing and that of melanoma is increasing.

Darla E McKay

In our family, everyone always called Uncle Dale to ask any questions that were remotely medical in nature. After going to our family doctors and being diagnosed with a very long, unpronounceable word, we knew we could ask our "family doctor" to explain it to us in a way we would understand. But what about those families who are not lucky enough to have a medical professional in their midst? What if you or someone you care about has just been diagnosed with cancer? What if you are getting questions about cancer and want to be able to tell people where they can get credible information about cancer?

The Canadian Cancer Society's Cancer Information Service (CIS) was launched in October 1996. The CIS is used by cancer patients and their families and friends to get information quickly to help them manage and cope with their disease. Information can be provided by telephone, mail, and via the Internet.

The toll-free, bilingual service is available to all Canadians Monday to Friday (9 am to 6 pm) by calling 1-888-939-3333.

Barry Goldlist, MD, FRCPC, FACP

Last year as I was watching the National News on CBC, I was treated to a classical good news, bad news medical scenario by Peter Mansbridge. The first report was the good news; the proportion of deaths each year in Canada caused by cardiovascular disease was declining. The bad news was that the proportion of deaths caused by cancer was increasing. I felt like screaming "Peter, of course. It has to add up to 100% each year, if one goes down another has to go up!" However, in truth it is not just an issue of proportion. The prevalence of cancer is clearly rising in western society, and the reason is very straightforward. Old age is the major risk factor for many types of cancer, and our society is aging.

This has led to a tremendous growth of research concerning cancer in the elderly, and into the fundamental connection between aging and cancer. I am not confident, however, that the clinical care of elderly cancer patients has been influenced by recent advances in geriatric medicine. In the United States, many medical oncology training programs have started to include geriatric modules in their curriculum. I am unaware of this occurring in Canada. Although the wards of cancer hospitals now have a high proportion of frail elderly in their beds, few hospitals have advanced practice nurses with expertise in geriatrics to help in the nursing management of these patients. Geriatric medicine consultations are very uncommon, and even more importantly, formal programs to rehabilitate elderly people after aggressive therapy (surgery, radiation, chemotherapy), do not currently exist. The Health Services Restructuring Commission in Ontario, to its credit, recognized this deficit and mandated the newly formed Toronto Rehabilitation Institute to develop an oncology rehabilitation program. The funding and success of programs such as this might have a great impact on the quality of life of elderly cancer patients in the future.