CANCER: CONVERTING FEARS INTO CONFIDENCE

Read the expert opinion …

Me: Good morning Doctor Walter

Dr. Walter: Good morning

Me:  Could you briefly tell me something about yourself and your career?

Dr. Walter: Yes.

I am a registered hematologist and an internist oncologist here in Hamburg. I completed my studies in medicine in Hamburg but afterward, I took a scientific education in the USA, and then I returned to do my specialist training in the university clinic Eppendorf.  I  completed my studies of medicine in Hamburg and then did a scientific education in the USA.

After my specialist education in the Eppendorf University  Clinic, I was a leading senior physician in the clinical University of Rosenheim Upper Bavaria for about two years. Also active there in hematology-oncology and since 2004 here in Hamburg north northwest of Hamburg, Pardon, from Hamburg north east settled as a hematologist internist oncologist.

Me: Ok. So, what is your area of research or activity?

Dr. Walter: I’m not active in research at the moment.

Previously, my research focus was the Phylogenetics of solid tumors, which is ultimately the chromosomal genetic change in solid tumors.

Now my main focus is the treatment, diagnosis, and treatment of malignant diseases of the blood and tumors.

Me: Now we come to the issue of cancer. What is actually cancer?

Dr. Walter: If you want to spell out cancer then you can say cancer does not exist at all.

There are a variety of malignant diseases that share certain properties.

Why they are described as malignant but ultimately differ in their manifestation, in their dynamics, in their treatment capacity, and in what they do with the patients.

Cancer basically happens when an auxiliary construction occurs and turns into a tumor that eventually becomes a disease.

But malignant diseases can be very different.

Me: How does it arise and what does it cause?

Dr. Walter: This is quite complicated. In many cases, we do not know at all how malignant diseases develop.

What we know is that for some malignant diseases, genetic history can be a major cause. That is a fact. 

For example breast cancer in women, is a kind of thick intestinal carcinoma. In addition, one assumes that is quite a hereditary disposition, thus susceptibility to cancer there.

Then, of course, there are the various environmental e effects.

Then there are effects of personal behavior; like smoking and alcoholism are the major causes of this disease.

For example, if someone works as a chemical worker or if you have been working in a refinery where prerequisites are not sufficient, the risk of cancer might be high.

A variety of examples can be found where there is a rare case of cancer in the family history; it is

hard to determine what triggered him or her.

Me: Ok. What types of cancer are there and which occur most frequently?

Dr. Walter: There is of course a variety of unclear evil illnesses. …hum! Almost every organ and every organ system can become ill.

But if you look at the statistics, then certainly stand here with us here in Central Europe and also in the USA where breast cancer is common in women and lung cancer in men or said to be the disease of the intestine. Above all, intestinal tumors in men still have prostate carcinoma.

Me:  What cancers are usually curable, and which are usually fatal?

Dr. Walter:

It also depends on the stage at which you catch the disease. This means whether they have a very early diagnosis where they are still able to cure the patient with relatively limited measures or at least have a chance of cure or if the disease is diagnosed at an early stage.

So it is actually, let’s say, like the tumor itself, although, some can be

complicated.

This is, for example, the tumors of the pancreas or the malignant tumors of the brain, the Glioblastoma.

But, actually, if you discover a solid tumor in an early stage, they have a higher chance of healing than an advanced one; and it is only possible in exceptional cases.

Me: How dangerous are genetic “pre-stresses” (e.g., parents who had cancer)?

Dr. Walter: Yes, there we come to the point which I have just mentioned before. There are, of course, clearly demonstrable genetic conditions that predispose to cancer.

This is the case, for example, in breast cancer of a woman with this so-called BRCA1 or BRCA2 mutation.

Studies show that these people with cancer had relatives who had breast cancer, ovarian cancer, and often at a very young age.

Then there are the intestinal tumors, which occur particularly in the family polyposis coli. So there is a change of intestine or intestinal gland species with small flowers.

These are relatively well-defined genetic precursors, and cancers.

Everything else you have to say remains to a certain extent speculative. Of course, an accumulation of cancer in a family is already suspected, but it is not always possible to establish a comprehensible genetic basis.

Me: Should one be more or less afraid of cancer in the  21st century than before?

Dr. Walter: (laugh) So, I think, in the twenty-first century based on the advances we have made, both in terms of early detection as well as in the field of therapy, it’s justification to be less afraid of cancer.

In the past, the disease was mostly discovered in patients in a very advanced stage due to the lack of awareness, because early detection measures are also offered to you, so we only take, for example, Preventive Colonoscopy, therefore colonoscopy in people over 50 years simply not noticed. This means we are now discovering tumors by the majority earlier and we have also increasingly been treated by new forms of therapy that provide a better way to treat it.

Nevertheless, cures for many diseases have not been discovered completely.

Me: Can you recommend informational sites or books on cancer?

Dr. Walter: So there is, of course, a very nice series of information brochures from the Government Cancer Society.

Then there are possibilities to get in contact with self-help groups. They usually also have relevant literature or they can give more information about books.

For example, there are cancer organizations. Then there are cancer information services.

There are already a number of places that provide information and also publish brochures.

Me: Now let us talk about cancer diagnostics

Is there a distinctive symptom of cancer?

Dr. Walter: This is not easy to answer.

There are, of course, symptoms that are suspicious of the presence of malignant disease, but not conclusive.

These are, for example, rapid, unexplained weight loss.

This is a clear performance curve that cannot be explained otherwise.

These are of course depending on what disease it is.

Can the blood stain in the stool or blood stains when coughing?

This may also be lymph node swelling. This is very dependent on what disease is; which organ system is infected and whether this disease already causes some problems, for example in the intestine and the intestinal passage no longer function properly.

But there is nothing really superordinate and many tumor diseases remain undetected for a long time because they do not have any or only nonspecific symptoms.

Me: Is the symptom of cancer equal in men and women or are there some differences?

Dr. Walter: The symptoms are actually dependent on what a disease is, which organ system is affected and whether the disease affects any surrounding

structures. This means if she presses anything on something presses in the growth.

To this extent, there is no difference. The perception of these symptoms and the consequences drawn from these symptoms may be quite different.

So women are certainly more sensitive and look for the doctor earlier than men.

Me: Ok! How good is the present state of a cancer diagnosis?

Dr. Walter: So one can say in the industrialized countries the state is very high. This means, of course, we also have access to the necessary diagnostic measures, depending on the health system, and on the short-term access to the necessary diagnostic measures. Therefore, I see no problems now.

Me: Which procedures are the most effective?

Dr. Walter: It mostly depends on the tumor.

Some diseases can be healed with surgical measures.

It depends on the stage. Some diseases need chemotherapy.

Bei manchen reicht eine Strahlentherapie.

Partially, we need to do combined radiation chemotherapy. This must be according to the stage of the disease as well as to the general condition of the patient.

Me: How important is an early diagnosis for the healing chances?

Dr. Walter: Yes, as I had mentioned before.

So in many diseases, it is so that an early diagnosis in a low stage increases the chance to be cured significantly.

It does not apply to all diseases, but to a lot of them. We can take again breast cancer, colon cancer, and lung cancer as examples.

Their early stages can be cured with a relatively high probability.

Me: What percent of deaths due to cancer could be avoided by early diagnosis or treatment?

Dr. Walter: I would have had to look at the statistics before. Now I cannot say that percentage. I would guess roughly around 50 percent maybe.

Me: Will the cancer diagnosis completely change my life? Can one stay fit for work?

Dr. Walter: Again, I have to say again, it depends on what the disease is.

If we take all the diseases, malignant diseases from the area of hemophilia, there are diseases that do not make the patient sick at all subjectively.

He does not feel sick. Often it must not be treated for a long time. This means this is absolutely a malignant disease, where a normal life works and so it’s completely normal. There are others where the patient falls completely out of his normalcy because he has to go through a whole bacterium on the diagnostic as well as on the therapeutic measures which then sometimes also has a planned end.

For example, in the case of planned adjuvant chemotherapy after surgery, if one is doing an after-treatment, to ensure the surgical result in metastasis.

This is a considerable burden for the patient over a certain period of time. After that, this therapy is finished and there is, of course, also the

a situation where the patient’s life as a working person comes to an end.

Me: Is the diagnosis generally presented to the patient in an honest or stepwise manner?

Dr. Walter: So relentlessly honest, always has such a bit of surprise. The patient has in any case the right to know exactly what is wrong with him. He must also because otherwise, he can’t understand again why we do any diagnostic things with him. The patient must know what he has, what is to be expected, and how his chances stand. He must know this in any case and in this respect one must say the diagnosis is presented to the patient comprehensively and openly. This can be quite gradual. This can also be adapted to what the patient signals he wants to know. There is a beautiful sentence “you do not have to say everything that is true. But everything you say must be true “. So I would see it.

Me: Ok. Therefore, let’s come to the topic “cancer treatment”.

What forms of treatment are available? Which are most effective?

Dr. Walter: There are, of course, three classical pillars of oncology: surgery, radiotherapy, and drug therapy. Which of these procedures used in each individual patient’s disease is simply crucial in determining what the patient is, at what stage, and what is acceptable to him? To this extent, one has to say which is the most effective method or, better nowadays, which combination of procedures is the best. It is clearly determined by which disease the patient has, at which stage he is and in which general condition he is.

Me: What are the advantages and disadvantages of radiation therapy?

Dr. Walter:

Radiation therapy, of course, has the advantage that it is a locally acting therapy. That is where it radiates there it also works. With today’s modern procedure, a relatively steep drop in dose has been observed. That is to say, send a dose in the target area while the surrounding area is spared to a large extent. This is certainly an advantage. At the same time, however, this is a disadvantage of radiation therapy, since radiation therapy can only be used where it is a relatively circumscribed area. That is a circumscribed problem. The ray field that the radiation

therapists say again and again for the beam field must not become too large because then they simply have too many side effects. So let’s say the local effectiveness of radiation therapy is both an advantage and a disadvantage.

Me: What are the advantages and disadvantages of chemotherapy?

Dr. Walter:

So you just have to say that we begin from the classic chemotherapy that we have done over 30 to

40 years earlier and move toward the so-called targeted therapies; the so-called “part of therapies”.

These are antibodies. These are the so-called small molecules, which were designed specifically for specific genetic changes in the tumor cells and specifically attack them. This means that we are moving away from a relatively nonspecific treatment approach to an ever more deliberate and more subtle approach in therapy, drug therapy. Of course, all these approaches we are using have some side effects. But let’s say through the progress of drug development, the side effects are sometimes slightly different. So you just have to summarize it.

Me: Is the treatment often associated with severe psychological stress?

Dr. Walter: This is quite true. When you see treatment as a whole. So let’s say a bigger surgery is a surgical procedure in the chest area that is of course very stressful for the patient. It can be a problem for him after a long time. Also, chemotherapy depends on what drug is used. Besides surgery can be stressful and also radiation therapy can cause local problems like skin redness, fatigue, or exhaustion.

Me: What are the burdens for my social environment,  friends, and family?

Dr. Walter: One can summarize that basically if the patient has fallen ill with a tumor, at least nobody in the family and circle can remain untouched from the illness and the patient then often experiences quite different things.

Either people suddenly withdraw from him. This means that their environment changes in the social realm or sometimes also in the positive sense people who have not taken care of them so far suddenly appear. There are sometimes also quite

abstruse ideas about whether cancer is contagious or anything else. Patients are often overwhelmed with recommendations, suggestions, and what they should do now. In many cases, cancer is also a problem for cancer patients due to physical changes affecting the social environment. This can be a problem due to medication which causes impotence or surgery where patients lose parts of their body that have a sexual meaning. Let us take women who lose their breasts. All this plays with cancer is a huge burden for not only the patient but also the environment and its relationship to its environment.

Me: And what help can the patient expect from you?

Dr. Walter: So there is, of course, the possibility that the patient in a self-help group contributes. There are people who have already lived through all this; they can often give him or her often valuable hints. Then there is of course the possibility to turn to a so-called psychologist. So psychologists who have already specialized in the psychological care of tumor patients. And one of the two or both can often help the patient.

We do not want to ignore, of course, that also for people who are religiously tied, people from their

the religious community, priests, or similar can be an important support.

Me:  Now let’s come to cancer prevention.

Dr. Walter: Cancer prevention, ok!

Me: What can I do to keep my cancer risk as low as possible? What helps? What can I prevent?

Dr. Walter:

Good! This is, of course, a wide field but what you can basically say is that you should avoid cancer prevention; of course, things like smoking, excessive alcoholism, being overweight, or lack of movement… These are the things one can generally say. Otherwise, you have to look at what working environment you live in for example.

If you work with hazardous materials, you have to take care of the emergency and then also to warn that the appropriate protective devices are there or the corresponding regulations are respected. Um, it all belongs to it.

Me: Is this a lifestyle, so to say?

Dr. Walter: Lifestyle is certainly crucial. Let’s say once again if there is a genetic disease then one must do, of course, for example, corresponding precautionary examination more regularly and earlier than other people who do not have that.

Me: What do you think of today’s diet?  Are  there  nutritional concepts that make the development of  cancer  more  unlikely (vegetarianism, etc.)

Dr. Walter: So, at the moment, in our society, we have several experts to say quite honestly. There are, so to say, the “fast food aficionados’ ‘ who say: what else? Everything will be alright. And then we have on the other side a broad but also a very broadly diversified movement of people who eat healthy food. This goes from vegetarians to vegetarians. This goes to people who are now going into the paleo diet. So they feed themselves like stone people. What is certain is that a very rich, very salty diet containing lots of preservatives is certainly more prone to cancer.

It is known that dietary habits have an influence on cancer development. One must mention Japan as an example.  In  Japan, gastric carcinoma is extremely frequent.

What led back to it is that just in the food of the Japanese often also just fermented food plays a big role.

Therefore I think a vegetarian diet with an emphasis on vegetables, fruit but also meat but perhaps more so in the sense of Sunday fried would be good. And also not much alcohol. All these nutritional habits can lead to a good form not only against cancer but also against cardiovascular diseases.

Me: Is smoking really a cause of cancer?

Dr. Walter: Definitely! And not thinking only about lung cancer like much but for example also about cancer of the bladder. This is proved obviously and we also see the statistics. We are slowly seeing a decrease in the incidence of lung cancer in men. This is attributed to the fact that thanks to the appropriate campaigns smoking among men simply no longer socially acceptable in the last decades. That is in terms of the percentage that men smoked less already for some decades and now this transforms itself with the decrease in the frequency of lung cancer. It is different with women. Women have not smoked earlier than the 50s and 60s at all. This was as injurious for a woman

who smoked as for men. Then in the course of emancipation women thought that smoking is a lifestyle and now we see furthermore an increase in lung cancer cases among women. This is an apt argument for me.

Me: Are stress and cancer-related?

Dr. Walter: There is no really reliable data. One cannot say this thus. No.

Me:  Thank you!  When am  I particularly at risk of developing cancer?

Dr. Walter: Hum! Somewhat difficult question. Should I refer now to life, age, or … So cancer is any age … Hum! There is cancer in children. There is cancer among adolescents, in middle age, the high age. The certain disease occurs in certain phases of life and then of course it must be said:

How is my lifestyle?

B How is my family background and

C  At last in which working sphere I move? Provided that one cannot answer the question clearly.

Me: How long should I wait for unclear symptoms before I contact a doctor?

Dr. Walter Comes thus a little bit on what the complaints are. It is said to be classic that if someone has an uncertain cough for three weeks afterward, he should go to the doctor and clarify this. It can also be bronchitis.

If we now take someone who has sudden blood in the urine then I would not wait again three weeks. I would go straight to the urologist. Or blood in the stool and the patient does not know that he has hemorrhoids for example.

Then I will go faster. Or he breaks blood or something like that does not have to be anything malicious. This can also be a normal complaint or something else. With rapid weight loss I would also rather go to the doctor.

Many symptoms are also so unspecific on the other side that they are not weighted as such.

Me: What if a nearby person with suspicious symptoms refuses to see a doctor?

Dr. Walter: Then helps them, actually, only with patience and empathy.

And it helps only to convince the patient with patience and empathy to go, nevertheless, to the doctor.

Ultimately, a real impact on someone is only when you sit down and argue and convince people. And there is no other possibility.

Me: Are women more consistent in cancer prevention than men?

Dr. Walter: I would say this already. Women go faster to the doctor. Women are also sometimes more healthy than men. This is known.

Me: OK! What are the most important facts about cancer that everyone should remember?

Dr. Walter: Uuh .. What are the main facts?

So first of all, I would say the diagnosis of cancer is not automatically a death sentence. Cancer is treatable. Cancer is in many cases today also curable or at least with an acceptable quality of life for the patient over a long time stabilizable and as said if anyone suspects him or anyone of his family. If there is something malicious he should not hesitate. Because the sooner something is discovered, the

better the probability of being cured of almost all diseases.

Me: I once read that fragrance candles can cause lung cancer and certain drinks tongues what is the turn on such claims?

Dr. Walter: I have to be careful now. I do not know that there are serious investigations, no.

Me: What do you think of reviews from doctors on the Internet?

Dr. Walter: This is a … I am … I actually have to say, I have an ambivalent position.

This is a two-edged sword. On the other hand, it can of course help others to find a doctor; On the other hand, we all know that the fact is still true when people are satisfied they usually say nothing but when they are upset they always write something or post something on the net.

That is, let’s say such valuations have the risk, of course,  that most of the dissatisfied expressions. And the people who are satisfied do not say something like that. Then, of course, it is never so clear how one avoids someone else

wants to hurt someone else or writes something that has caught the air.

Since I have not read a real strategy as one avoids that so really people put the slander somewhere in the world. This is always the case. How to stand for it.

So I watch it but I would not say it is as good as it seemed. This is already a two-edged sword.

Me: How would you behave if you were suddenly confronted with the diagnosis of cancer?

Dr. Walter: I think simply because of the fact that I have been dealing with cancer for decades and have seen so many people with cancer and also know how the courses can be in the one or the other direction but honestly I think I’ll be simply panicky at first after learning about it. I would be afraid.

How I experience people here as well. Whereby one has to say to some people, who have little knowledge, this little realization is sometimes also a blessing. Because these people simply go into their therapy differently and also deal with their illness differently.

If I know what all things are for hundreds of possibilities, then what you are afraid of is natural. So I think I would be really afraid. Of course, it depends also on what this really is.

Me: Do you have any special advice that you give to patients or potential patients about cancer?

Dr. Walter: There are, of course, the patients who are in therapy. There are, of course, different pieces of advice given to them regarding the behavior. We’ve talked about it before. About the food for example. How do you eat for example under chemotherapy? And what is to be avoided? There are therapies that are particularly concerned with side effects on the skin. There are of course recommendations. How do you deal with skincare? What clothes should you wear? What should be used for skin care or not? So that is already a bit according to the specific situation of the patient. But I always have a suggestion: whatever you want to do, even if it is about alternative therapies, for example, talk to your doctor now. The doctor must be a trusted person for the patient, otherwise, it can happen again and again that patients are doing something along the way, and then any side effects occur, and then the doctor can no longer distinguish. Does this come

from my therapy? Because he does not know anything about the other or comes from something else and then he may make decisions that are harmful to the patient. So whatever you want to do, whatever you want to be therapeutic, how abstruse it is, always talk to your doctor and let him advise you. Let him know. This is one of the most important points.

Me: What are your 5 most important pieces of advice on cancer prevention?

Dr. Walter:

So, if I get five together I do not know. The first is when there are established preventive programs for your gender, your age group is the facts you need to take as reality. So go for a screening colonoscopy. Make it as a woman’s breast self-examination and so on … No matter what is offered. Take precautionary measures. Secondly, listen to your body. Do not try to push away any symptoms. Of course, you can do it for a short time. But it’s just an old fact that harmless things disappear after some time by themselves but not harmless things remain or get worse. These are actually two, but these are the two most important ones.

Me: Okay, okay? So thank you, Doctor Walter. Could we be talking about another kind of cancer or a special kind? For example, Non-Hodgkin’s  Lymphoma or Abdominal Gland Cancer

Dr. Walter: Yes we can. Of course. Me: So we are already done.

Thank you very much.

Dr. Walter: Well done!!! Thank you for reading!