Health Guide: August 2008

Shark Cartilage and Cancer

Written by Mystic on Sunday, August 10, 2008

Rationale / Background / Claims

In 1971, Dr Judah Folkman published a hypothesis regarding tumour growth which stated:

-	Tumours cannot grow without a network of blood vessels to nourish them and to remove waste products.
-	Inhibiting the development of new blood vessels (angiogenesis) in tumours may be a potential anti-cancer therapy.

As cartilage does not contain blood vessels, it was reasoned that it may have an inherent mechanism for preventing angiogenesis. Supporters believe that a protein present in the cartilage is responsible for this action.
The cartilage theoretically should be most effective against fast-growing, highly vascularised tumours, such as those of the breast, cervix, central nervous system and liver.
The number of cancers found in sharks is quoted as being insignificant.

What does the therapy involve?

Shark cartilage is available as either pills or loose powder. Powdered cartilage can be taken either orally or rectally.
Depending on a person’s weight, the dosage could range from 40g to 90g per day.
When taken orally in the form of the powder, it is mixed with either water, milk, vegetable juice (eg carrot, tomato) or with a fruit nectar (eg pineapple, apricot). The powder is mixed with the juice in a blender to produce a frothy shake. These shakes are consumed three to four times daily, usually 30 minutes prior to meals. Theoretically, when taken on an empty stomach, the drink passes rapidly through the stomach acids, thus avoiding breakdown of the active proteins.

Here are some cautions for a person with cancer regarding shark cartilage

Children and pregnant women should not take shark cartilage because if the cartilage does work as an inhibiter of blood vessels it could adversely affect growing children and the growing foetus.
Those who have had recent surgery should not take shark cartilage because it can theoretically impair healing.
Avoid shark cartilage enemas if you are neutropenia (have low white blood cell count). You can induce a life threatening infection.
Some shark cartilage may contain additives, fillers and contaminants.
Shark cartilage can cause diarrhoea which can affect the patient’s ability to tolerate conventional cancer treatments.

Evaluation

Human trials on the effectiveness of shark cartilage in the treatment of cancer were conducted in Cuba. The study initially reported that patients “felt better” several weeks after starting on shark cartilage. This study was however later reviewed by the National Cancer Institute (NCI) which felt the data was incomplete. A subsequent study was reported at the American Society for Clinical Oncology in 1997. Patients with advanced cancer were given shark cartilage for twelve weeks. Of the fifty eight patients treated there was not one complete response or partial response to shark cartilage. Only two patients had a significant improvement in quality of life. There are currently some ongoing studies of shark cartilage at a number of institutions but no positive trials have been published in scientific literature.

Costs and Commitment

The cost is approximately $90 for 400 capsules, or $100 for 200g of powder.

In Summary . . .

Studies performed on shark cartilage at the National Cancer Institute in America have not demonstrated that shark cartilage is effective as a treatment for cancer.

Rationale / Background
Vitamin C is the general name for a group of compounds, chiefly ascorbic acid and dehydroascorbic acid (which is readily converted back into vitamin C in the body). In the 1970’s Dr Ewan Cameron and Dr Linus Pauling published Cancer and Vitamin C, which proposed that taking regular high doses of vitamin C can play a part in both prevention and in the treatment of cancer. Cancer patients are reportedly significantly depleted of ascorbic acid. Cameron and Pauling believe this indicates substantially increased requirements and utilisation of this substance in order to boost the person’s resistance to disease.
What does the therapy involve?
In 1991 Dr Cameron published a protocol for the use of vitamin C in the treatment of cancer. The protocol recommends that all cancer patients receiving vitamin C be given an initial 10 day course of intravenous ascorbate, followed by an oral maintenance dose to be continued thereafter. The importance of continuous rather than intermittent administration is emphasised. Oral vitamin C is to be taken to what is called bowel tolerance. When the body’s maximum saturation tolerance is reached, diarrhoea results. The aim is to reach an oral dose which is just below this point. This is achieved by taking several divided doses of vitamin C throughout the day, usually in a powdered form mixed in a glass of water. The standard recommended dosage is 10 grams/day. In addition to vitamin C therapy, it is recommended other supplements be taken. A flyer distributed in 1991 by the Linus Pauling Institute recommended daily doses of 6,000 to 18,000mg (6 to 18g) of vitamin C; 400 to 1600IU of vitamin E; and 25,000 IU of vitamin A, in addition to other supplements.
Here are some cautions for a person with cancer regarding vitamin C
As the dosage levels of vitamin C are increased, absorption falls markedly. At the level of dietary intakes (about 30-180mg), vitamin C is approximately 90% absorbed. Absorption falls to 50% with a dose of 1,500mg (1.5g), and to 16% with a dose of 12,000mg (12g). Several reviews have concluded that vitamin C has little toxicity. Protection from toxicity is due to two factors: the efficient excretion of excess ascorbic acid in the urine when doses exceed 130mg per day; and the limited absorption capacity of the gut. With large doses of vitamin C, most passes on to the colon (large intestine). Little is known about compounds produced from vitamin C by the bacteria in the colon. Intestinal symptoms can occur with high doses of vitamin C, including nausea, vomiting, bloating and gas. Depletion of certain minerals (such as calcium) can occur. More serious risks include haemorrhage and rebound scurvy (ie vitamin C deficiency, occurring upon sudden withdrawal of large doses of vitamin C which the body has become accustomed to receiving). Intravenous vitamin C can harden the vein, making other intravenous therapy difficult to administer. High intakes of ascorbic acid increases the excretion of oxalate in the urine, which may contribute to a greater risk of kidney stone formation. High intakes of vitamin C are not recommended for people with iron storage disease (iron toxicity can occur) or in patients with chronic renal failure. Megadoses of the other mentioned vitamins can be dangerous, especially in the case of vitamin A, as liver toxicity and other associated effects may occur. It has been suggested that antioxidants (such as vitamin C) interfere with the ability of radiation and chemotherapy to kill cancer cells, due to the mechanism of action by which these treatments work. Thus combining vitamin C with these treatments should be fully discussed with a doctor.
Evaluation
The evidence cited by Pauling and Cameron to support their claims has not proved to be scientifically valid. The subjects used to compare vitamin C against placebo (“dummy” pills/treatment) were not comparable, hence accurate conclusions cannot be made. Three studies were reported in 1979, 1983, and 1985, which were conducted in a reputable clinic according to accepted scientific protocols. It was found that patients given 10,000mg (10g) of vitamin C daily did no better than those given a placebo.
Costs and Commitment
Vitamin C is readily available at Health Food outlets.
In Summary . . .
Many studies have demonstrated a strong link between high consumption of fruit and vegetables with a low incidence of certain cancers. Conversely, low fruit and vegetable intakes are associated with an increased risk of developing cancer. The relationship between overall diet and cancer tends to be strong. However, as you restrict the emphasis to individual nutrients found in foods, the relationship becomes less clear. This is probably because we have not discovered all of the important nutrients contained in foods, some of which may have cancer-fighting properties. It is therefore unjustified to single out a particular nutrient as protective against cancer, or indeed as a cure for cancer, until reputable scientific studies have demonstrated this to be the case.

Rationale / Background
Ian Gawler is an Australian veterinarian who has developed an integrated approach to cancer which combines diet, detoxification, stress management, positive thinking and meditation techniques. His belief is that by utilising all these means “the body’s natural healing response can be helped to reassert itself”. Gawler himself recovered from advanced metastatic osteosarcoma (bone cancer). Gawler’s beliefs about the causes of cancer are very similar to those of Max Gerson. He essentially believes that cancer is a multifactorial, degenerative disease which results from our food and environment being too far removed from nature.
What does the therapy involve? In order to optimise healing Gawler suggests the following is important:
To make conscious and informed decisions about all the treatment options, be they conventional, complementary or alternative treatments. Embrace your decisions positively to release the positive potential of the mind, emotions and spirit.
Gawler devised the following basic concepts for his therapy:
Avoid known problems. Any vitamin and mineral imbalance needs to be corrected. Digestion should be restored and flooded with fresh, vital, pure and suitably prepared food Eating should be a joy not a cause of stress.
Diet is a major component of his approach.
The diet is based on vegetables, grains and fruits. Ideally 70% raw foods and the rest lightly cooked. Have no added salt, sugar, refined foods and caffeine and chemical additives. The diet should be low in fat especially animal fat and low in protein. There are many low protein sources recommended in the diet which add to the overall total eg grains. He suggests that 500gm total per week be taken from the high protein sources listed in descending order of preference.
Vegetable proteins such as soy beans, tofu bean curd, lentils, chick peas are the preferred sources. Fish preferably deep sea fish. Dairy products. Meat ie lean white meat, lean red meat.
Low alcohol consumption. High fibre.
Preparation of the food.
Where possible use chemical free produce eg organic vegetables. Preferred utensils - stainless steel, cast iron, glass, tin, enamel, earthenware but not aluminium. Preferred cooking methods - steaming, dry baking, wok with water. Prepare food with love and joy.
Attitude.
Important to pause for a moment’s stillness before a meal and affirm the value of good food to your health.
Gawler recommends that if you are making major changes to your diet that you first seek professional guidance. Here are some cautions for a person with cancer regarding the Ian Gawler Approach
Gawler’s book You Can Conquer Cancer contains nutritional analyses of the maintenance diet he suggests. Levels of vitamin E, vitamin B12, and zinc are low. To correct this he advises nutritional supplementation. The diet is also low in energy, and the analysis is based on the needs of a healthy person, not someone with increased energy requirements as is the case for individuals with cancer. People may lose weight on this diet which is not generally advisable for individuals with cancer. If a person does not get well using this therapy then it is seen as a defect in the person’s own will rather than a defect in the therapy itself. This is an enormous burden to place on someone with cancer.
Evaluation
There is no scientific evidence available which demonstrates the diet can cure cancer.
Costs and Commitment
The Gawler Foundation in Victoria offers a 10 day residential program for around $2,400
The contact details for the Gawler Foundation are: www.gawler.org
There is a time commitment involved in undertaking this program with the shopping, food preparation and relaxation techniques. Stephen Taylor who was trained by Ian Gawler and has also recovered from cancer runs a similar course at Tayen Park in Clare South Australia. The charge for this course is by donation. Contact details for Stephen Taylor are:PO Box 614, Clare 5453, tel: 8842 3114, email: tayen@rbe.net.au

The Cancer Council South Australia recognises that people with cancer, their families and friends will seek out information about alternative and complementary therapies. These methods may also be referred to as “unproven”, “non-toxic”, “unorthodox” or “unconventional” therapies and represent methods which are not scientifically proven by random clinical trials. The following information is intended to help with making decisions about the use of such treatments. We also recommend you read “Making an informed choice”. Rationale / Background / Claims Dr Max Gerson developed this treatment in the 1920’s. He believed cancer was a result of faulty metabolism, brought about by poor nutrition and long-term exposure to chemical and environmental pollutants. His theory was that cancer cannot occur unless the functions of the liver, pancreas, immune system and other body components have degenerated. The aims of the Gerson therapy are to:
Boost the body’s natural immune system to heal the cancer. Rid the body of poisons. Stimulate enzyme production to improve digestion. Correct the balance of vitamins and minerals in the body. Promote a positive attitude towards the body and towards life.
The therapy claims to be a whole body approach to healing which can reactivate the body’s ability to heal itself and then reverse the conditions that support the growth of malignant cells. What does the therapy involve? Two main principles are applied:
A low-fat, low-protein, salt-free diet with additional supplements. A detoxification program to help eliminate toxins and waste materials.
The diet is a core component of the therapy. Its main features are described in the following points:
The daily regime requires 13 eight-ounce glasses of fresh organic juice be consumed at hourly intervals. The 13 juices include one orange, four of green leaf and five apple/carrot all selected and prepared in a specific way. Meals are restricted to salad, baked potatoes, oatmeal and raw and cooked fruit and vegetables. Two tablespoons of linseed/flaxseed oil are also included on a daily basis. Meat is not allowed and other sources of animal protein are not permitted for the first six to twelve weeks, after which it is kept to a minimum. Among the items forbidden indefinitely are salt, coffee, nuts, berries, drinking water, alcohol and all canned, preserved, refined, bottled or frozen foods. No aluminium utensils are to be used and a special grinder and press are required to make the juices. Patients receive daily medications, including thyroid extract, pancreatic enzyme, potassium iodine, niacin and an intra-muscular injection of vitamin B12. Potassium iodine solution is added to each of the ten fruit and vegetable juices.
The key detoxification method is the coffee enema which patients are taught to self-administer five times throughout the day, four hours apart. This is said to stimulate the liver in the removal of toxins, and increase the production of bile. As a further aid in detoxification, some patients may receive an oral dose of castor oil on the first day. This is then alternated after the initial day. Here are some cautions for a person with cancer regarding the Gerson Method Within three to ten days, the patient can expect to experience what Gerson termed “an allergic inflammation reaction” or “healing reaction”. The timing of these reactions is hard to predict. Nausea, vomiting, intestinal spasms, fever and headaches are among the symptoms reported. Risks from enemas include perforation or rupture of the colon (large intestine), infections transmitted through use of the enema devices and serious fluid, electrolyte, and vitamin imbalances. The level of supplementation can lead to toxicity or disrupt the metabolic balance. Evaluation There is no evidence in the peer-reviewed literature that enemas are useful in detoxifying the body. The Gerson regime requires extensive commitment in order to undertake the therapy and a support person is absolutely mandatory. The treatment methods have documented risks and there is no reliable scientific evidence to support the validity, safety and usefulness of the program. Costs and Commitment This therapy is available at the Gerson Institute in San Diego, California, USA at a cost of approximately US$4,900 per week, with an additional US$200 or more per week for laboratory testing. It is recommended a companion accompany the patient to the clinic, at an additional cost of US$330 per week. Supporters recommend a three to eight week stay. A three month supply of Gerson medications costs US$550, and a juicer costs a minimum of US$240. Cancer cures are said to be achieved only by strict adherence to every aspect of the diet and techniques. It has been estimated 12 - 16 hours a day are required for shopping, preparing the food and cleaning the equipment as instructed. Juices cannot be prepared ahead of time. In Summary . . . The Gerson regimen requires an extensive commitment in order to undertake the therapy, and a support person is mandatory. The treatment methods have documented risks, and there is no reliable scientific evidence to support the validity, safety, and usefulness of the program. For further information contact the: The Gerson website www.gerson.org

What are sunscreens? Sunscreens are products which protect the skin against the damaging effects of the sun's ultraviolet radiation (UVR). They contain chemicals which either absorb or reflect the UV rays which would otherwise burn and damage the skin.
Ultraviolet radiation and skin damage There are three types of UV radiation - UVA, UVB and UVC. Naturally occurring UVC does not reach the earth's surface as it is absorbed or scattered in the atmosphere. UVB is primarily responsible for sunburn, suntan and, after many years, premature ageing and skin cancer. UVB also depresses the immune response which is the body’s system for fighting infection. UVA causes skin damage contributing to premature ageing and skin cancer.
What protection do sunscreens give? SPF 30+ sunscreens filter out 97% of the UVB rays. Sunscreens that are labelled BROAD SPECTRUM also filter out at least 90% of UVA. Sunscreens are tested on human volunteers. Using a grid pattern, some patches of their skin are covered with sunscreen and some are left uncovered. They are then exposed to an artificial source of UVB in a laboratory. The Sun Protection Factor (SPF) is determined by comparing the time it takes for the patches of skin with sunscreen to show minimal redness with the time it takes to produce the same amount of skin redness without sunscreen. The SPF on a sunscreen label should only be seen as a guide to the strength of the product. It should not be used to calculate the period of protection offered by the sunscreen. As many things affect the time it takes for an individual to burn, it is impossible to calculate accurately a "burn time". Therefore the SPF rating on a sunscreen label should not be used to determine a "safe time" before burning will occur. Damage to the skin begins as soon as the skin is exposed to the sun. Sunburn is the extreme level of this damage. It is a mistake to believe that damage only occurs if there is sunburn. The effects of the sun on the skin are cumulative so the damage is building up even without burning. No sunscreen offers complete protection against UV radiation. Even if a sunscreen is reapplied regularly, a small amount of UV still reaches the skin. It is still possible for the skin to be sun damaged even with sunscreen protection if exposed to the sun repeatedly for prolonged periods.
What are the regulations regarding sunscreens? Australia has had a standard for the testing and labelling of sunscreens since 1983 which has been revised regularly since then. Prior to March 1997, the maximum SPF allowed on a sunscreen label in Australia was 15+. Since then the maximum SPF that can be claimed for a sunscreen is 30+. The current regulations for sunscreens are documented in the Australian/New Zealand Standard, AS/NZS 2604:1998 and apply to sunscreens produced and available in Australia. It specifies how sunscreens should be tested, the standard they must reach and how they should be labelled. The testing is done under strict laboratory conditions. The Australian Standard also refers to the water resistance of a sunscreen which relates to the product's ability to remain on the skin after immersion in water and still test at its SPF number. "Protection times" shown on labels relate only to this water resistance. They do not relate to the degree of protection against sunburn offered by using the product, ie the SPF number. In Australia, sunscreens have to be listed on the Therapeutic Goods Administration’s (TGA) Australian Register of Therapeutic Goods (ARTG). They can only be listed on this register if they comply with the Australian/New Zealand Standard.
What is the correct way to use sunscreens? Sunscreens should be applied to clean, dry skin 20 minutes before being exposed to the sun. It is not necessary to rub sunscreen creams into the skin until they vanish. The cream will be absorbed into the skin over the 20 minutes prior to exposure to sunlight. The amount of sunscreen applied should be enough to easily cover the exposed skin, eg one teaspoonful of cream for one arm. If it is difficult to spread the sunscreen over the area, it is likely that not enough has been applied. Sunscreen should be reapplied about every two hours. The reason for this is not because sunscreens lose their effectiveness after two hours, but because they may have been inadvertently removed during normal activity such as nose-blowing, sweating or brushing up against something. It is not uncommon for areas of skin to be missed or inadequately covered during the first application of sunscreens. Reapplication will reduce the risk of inadequate protection.
How effective are roll-ons? The testing of sunscreens as set out in the Australian Standard does not include testing the method of application. As it is difficult to judge how much sunscreen has been applied when using a roll-on, it is recommended that the ordinary sunscreen or lotion can be used for the first application and roll-ons used for top-up reapplications.
What are the costs and benefits of using sunscreens? It has been clearly shown that sunscreens reduce the risk of sunburn. As *sunburn* is a risk factor for all types of skin cancer, the recommendation to use sunscreens has been based on the assumption that preventing *sunburn* should reduce the risk of skin cancer. Sunscreens should not be the only approach to preventing skin damage. They should be used in conjunction with clothing, hats and where possible, avoiding the direct sun in the middle of the day. Sunscreens are not a substitute for these other forms of protection. Short term side effects from sunscreens may include skin irritation, and less commonly, skin allergy, blackheads and acne formation and dryness or oiliness of the skin depending on the type of sunscreen used. The likelihood of these reactions occurring depends on the sensitivity of the skin and the number and concentration of the chemicals in the sunscreen. Although most people focus their concerns on the active sunscreening chemicals in a product, there are other chemicals in the sunscreen base which can cause problems. In general, the incidence of true allergy to the chemicals in sunscreens is low. The more common side effect is skin irritation. The long-term side effects of regular sunscreen use are unknown. Sunscreens have not been available for long enough and used by a sufficient number of people for an extended length of time for there to be any guarantees against long-term side effects. However, to date there is no evidence to suggest that long term side effects are likely. Para amino benzoic acid (PABA), a chemical rarely used in currently available sunscreens, was linked to a higher risk of skin allergy. There was also some concern, in the past, about its carcinogenic effect but this has never been supported in laboratory testing. Oxybenzone, which is also called Benzephenone - 3, is a chemical which absorbs UVA rays. It is sometimes included in sunscreens. It has been used for about thirty years and has never been shown to be toxic to humans or animals. Current information indicates that there is much more to be gained from using a sunscreen in conjunction with other forms of protection, than avoiding its use and risking sunburn, premature ageing and skin cancer.
How do I choose a good sunscreen? There are many different brands of Broad Spectrum sunscreens available. They can be bought as creams, milks, gels and clear lotions. Different brands use various combinations and proportions of chemicals. For this reason, one brand may suit your skin better than others. Creams are thicker and tend to be more expensive per gram than lotions. Lotions can be milky or clear. Clear lotions and gels have an alcohol base and are less sticky but more drying than creams and milks which usually contain moisturisers. Some manufacturers incorporate substances like Titanium Dioxide and/or Zinc Oxide in their sunscreen. These provide a thin film of micro-fine particles which reflect the UV rays. These products may leave a white film or sheen on the skin. Chain stores and supermarkets often sell their own brands which are usually cheaper than others. Sunscreens produced by cosmetic companies are generally the most expensive. Look for a sunscreen labelled:
SPF 30+ Broad Spectrum
A water-resistant sunscreen is recommended when activity is likely to result in heavy sweating or for water-sports.
What about sunscreens labelled for babies and toddlers? These sunscreens contain the same sunscreening chemicals as 'adult' products. Generally the only difference is that they use a gentler base and do not contain perfumes. There is no evidence to suggest that the use of sunscreen on small areas of a baby’s skin is associated with any long term side effects. For a small proportion of babies, like adults, some sunscreens can cause minor skin irritation. In such cases it is recommended to try a product which is specially formulated for sensitive skin. Babies must be protected against sunburn; the damage that begins in childhood can lead to skin cancer later in life. The best protection for your baby is to avoid direct sunlight especially in the middle of the day during summer. When outdoors, babies and toddlers should be protected with hats, clothing and shade as much as possible. Sunscreen should be applied to those areas that cannot be protected with clothing.
Do sunscreens deteriorate after time? Sunscreens have a shelf life of between 2 and 3 years. Sunscreen products have been required to carry an expiry (use-by) date since 1 September 1994. Sunscreens can deteriorate if they are exposed to heat and/or air for long periods. Store sunscreens in a cool dry place and ensure the cap is replaced tightly after use.
Key points about sunscreens
No sunscreen offers complete protection against the sun. Hats, clothing and shade should also be used. A thick coating of zinc cream does block out the UV totally. It works by reflecting the rays. However, as it is thick and completely coats the skin it is only appropriate for small areas such as noses, ears and lips. All brands of Broad Spectrum sunscreen with a SPF 30+ which comply with the Australian/New Zealand Standard AS/NZS 2604 provide effective protection when applied correctly. Using a SPF 30+ rather than a SPF 15 sunscreen halves your risk of sunburn for the same length of time in the sun. SPF 30+, however, should not be used to increase the amount of time you spend in the sun. Sunscreens should be applied to clean, dry skin 20 minutes before exposure the sun. They should be applied liberally - eg about one teaspoonful of cream for one arm. Sunscreens can be applied as a moisturiser under make-up. Sunscreens can be applied as a moisturiser under make-up. Babies under one year old should not be exposed to the direct sun. When taking babies outdoors avoid doing so between 11.00 am and 3.00 pm (daylight saving time) if possible. Natural protection, that is hats, clothing and shade, is best. However, small amounts of sunscreen can be applied to areas that cannot be protected with clothing.

Hormones and breast cancer The relationship between the use of HRT and breast cancer is unclear and women with breast cancer or women at increased risk of breast cancer, should make decisions based on careful discussion of the potential risk factors involved. The possible increased risk of breast cancer from HRT with combined oestrogen and progestin has to be balanced against any short-term or long-term benefits for individual women. These possible benefits include relieving the symptoms of menopause and reducing the risks of bowel cancer and osteoporosis. Large studies conducted in the US to confirm these risks and benefits have recently been reported1,2.
Advice for women with breast cancer There have been a number of studies looking at HRT and its possible benefits or risks for women with breast cancer. There is insufficient evidence to state that HRT is dangerous to women with breast cancer, but there may be some increase risk of breast cancer recurring or a new breast cancer developing with long term use. This risk may be outweighed by the immediate and potential long term benefits of HRT, in some cases.
Making your decision The following advice is provided to assist women with breast cancer or women at increased risk of breast cancer to make an informed decision about HRT, in discussion with their own doctor.
Preventative use of HRT for women without menopausal symptoms HRT is generally not recommended for women who do not have any menopausal symptoms. However, post menopausal women who have had breast cancer diagnosed may be treated with the drug Tamoxifen for up to 5 years. Tamoxifen is a hormone drug and has been widely and successfully used. As well as reducing the chance of breast cancer recurrence, this drug may also provide some protection against osteoporosis and the possibility of heart disease.
The use of HRT for women with menopausal symptoms Women, including those with breast cancer, may suffer from menopausal symptoms such as hot flushes that will interfere significantly with their day-to-day living. When making a decision about using HRT, the severity of a woman's symptoms and their impact on the woman's daily life must be balanced against the possible protective or damaging effects of HRT. If you are experiencing menopausal symptoms you need to discuss the advantages and disadvantages of HRT with your own doctor and often a specialist. You may also like to discuss other treatments for individual symptoms like hot flushes. Your decision about treatment may depend not only upon your symptoms but also on your own particular life circumstance, your beliefs about your health, your medical history and your family. To relieve menopausal symptoms HRT may need to be given for 1-10 years. However to reduce the risk of osteoporosis or bowel cancer HRT needs to be taken for longer. You should discuss this with your doctor. Some women choose to stop their HRT or reduce their doses after 1-5 years and see what happens. Your doctor may also advise you to try and 'wean' yourself off HRT after a few years. As yet there are no results from well designed trials where women after breast cancer have volunteered to be randomly allocated to HRT or a dummy tablet (a placebo) and followed up for many years. However, there are now six studies of women who themselves choose to take HRT, and breast cancer recurrent rates in these women are less than in women who chose not to take HRT. This is reassuring but the studies are open to possible bias. Here are some helpful hints if you are having menopausal symptoms and are thinking about HRT:
Talk with your GP, breast specialist, oncologist or gynaecologist about your symptoms and the benefits and risks of HRT. Seek further information and other opinions if you wish. Ask your doctor to refer you to other specialists. Read books on menopause and HRT, many of which are available from your local library. These are written for all women and contain some useful general information. You may also find that a local community health service or women's health service may have a library or information service that you can use.
Take time with your decision. Only you can know how much your menopausal symptoms are affecting your daily life. In the end only you can make the decision about HRT. If you decide to use HRT check with your doctor about whether you need to have more regular check-ups.
Key points
There is insufficient scientific evidence that HRT is either safe or dangerous for women with breast cancer. There is a possibility that HRT may increase the risk of breast cancer recurring or a new breast cancer developing. The immediate and long-term benefits of HRT may outweigh the risks. Decisions about HRT need to be made on an individual basis. HRT is generally not recommended as a prevention measure for women who have no menopausal symptoms.
Making decisions about HRT can be difficult for many women; it may be even more difficult if you have had breast cancer or if you are at increased risk of breast cancer because your mother and/or sister developed breast cancer before menopause. Unfortunately there are no clear cut recommendations about the use of HRT for women with breast cancer or at increased risk of breast cancer. This information sheet has been written to help you with any decisions you might want to make about HRT.

Benign	A growth that is not cancerous.
Caesium	A radioactive substance used for internal radiation.
Carcinoma	Medical term for cancer.
CT Scanner	Cumputerised tomography.
Chemotherapy	The use of drugst to kill cancer cells.
Electrons	A type of radiation used for treating cancers which lie close to the skin's surface.
Field	The area of the body to be treated.
Follow up	Visits to your doctor following treatment.
Fraction	A daily treatment of radiation.
Gray	Dose unit of radiation.
Implants	These are forms of internal radiation treatment.
Laser	A light source that is used to help position you accurately for treatment.
Linear accelerator	A high-energy x-ray machine used for external radiation treatment.
Malignant	A cancerous growth with the ability to spread to other parts of the body.
Metastases	Secondary cancers or growths which have spread to other body parts.
Nuclear Medicine	A branch of medicine using radioisotopes to diagnose diseases.
MRI [Magnetic Resonance Imaging]	A technique using magnetic fields to produce images of body organs.
Oncology	The study of cancer.
Primary	The site at which the cancer originated.
Radiation Oncologist	A specialist skilled in the use of radiation.
RADS	Radiation measurements - the term GRAY is now used.
Radioisotopes	Radioacitve substances.
Radiation Therapist	A health profesional trained to plan and administer radiation treatment.
Radiologist	A specialist doctor who uses x-rays to diagnose disease.
Secondaries	See metastases.

*Loss of appetite* Depending on the radiation treatment site, you may lose interest in food or find eating difficult. The doctor or hospital dietician will help if you have problems with some foods, eating, or weight change. Eating a healthy and varied diet is important to restore body strength and repair normal cells damaged during the treatment. It is important to maintain your weight. Even if you are overweight, do not try to lose weight until you have finished all treatments. Some hints listed below may help if you've lost your appetite:
Eat when you are hungry, even if it is between mealtimes. Eat smaller meals more often. Keep nutritious snacks such as fresh or dried fruit and vegetables, cottage cheese, milk, and fruit juices handy for when you feel like eating something. Create a pleasant dining atmosphere by using soft light, quiet music, or brightly coloured table accessories. Vary your diet and try new recipes. Eat with family or friends, or if eating alone, turn on the radio, television, or music for company. Use days when you do feel like eating to catch up on food intake. Discuss having a glass of wine or beer with meals with your doctor or nurse. A little alcohol is known to increase appetites. Buy some convenience foods that are easy to make eg: canned creamed soups make good-tasting and nutritious sauces served over fish, chicken, or toast. Together with canned or fresh fruit, juices, or dairy foods, they make well balanced and easy-to-make meals. Remember to drink plenty of fluids.
If these suggestions don't help, consult your doctor, nurse or dietician.



External Radiation is electronically produced by a linear accelerator, deep therapy or superficial therapy machine. This form of treatment is painless and it is similar to having an x-ray taken. The type of cancer and the affected part of your body influences the choice of treatment machine. Some machines are better at treating cancers near the surface of the skin, while others are used to treat cancers deeper in the body. These machines have several things in common. The first is that they're big! They may appear threatening, but you will soon get used to the size. You'll also get to know the staff and procedures at the treatment centre and will feel more at ease. These machines may make noises something like a vacuum cleaner and are moved up and down and around you so that the radiation can be directed at the tumour from different angles. It is normal to feel a bit anxious. Try to relax and remember that machines are operated by trained staff called Radiation Therapists and are always checked by the Radiation Physicist, who make sure the equipment is working correctly. *Your first visit* During the first visit with the Radiation Oncologist, they will review your records, talk about your general health and examine you. The Radiation Oncologist will then decide if radiation therapy will help you and if so the type of radiation best for you. Other tests may be ordered to give the Radiation Oncologist more information about the cancer. You will be able to discuss this and ask any other questions you wish. It is helpful to have a family member or friend at the consultation. Usually this is all that happens at this visit. *What is planning?* Planning usually occurs on your second visit and it is the essential preparation for your treatment. You will be given an appointment to visit the radiation treatment centre for planning. Planning may involve having an x-ray on which the Radiation Oncologist can mark the precise location and size of the cancer. The x-ray is taken on a special machine called a simulator. Sometimes planning may involve other x-ray procedures such as CT scanning. Once treatment is prescribed, tiny dot-like marks (tattoos) are pinpricked on the skin with ink that cannot be wiped out, to indicate the exact areas that need to be treated. The amount of radiation and how it is given depends on the type of cancer, the area being treated, your body's response and your size. Occasionally, special devices may be used to ensure you are in the same position each time. For instance, for many treatments involving the face and the neck, a perspex mask called a shell will need to be made during planning. This is worn during treatment and allows the marks to be placed on the shell instead of the skin. The mask is not uncomfortable and you will still be able to hear, speak and breathe normally. During your planning, you will meet with the Radiation Therapists who are specifically trained to deliver your treatment. They work with the Radiation Oncologist in arranging a treatment plan and treating you. You will see your doctor regularly during treatment and sometimes changes will be made to the treatment plan along the way. Also at your first visit you will probably meet the Radiation Oncology Nurse, whose special training enables them to help you throughout treatment. They work closely with the doctor and can also answer questions about the treatment. *How long is a course of treatment?* The treatment length is tailored specifically on the total dose needed to treat your specific cancer. Treatment varies from one single dose to between 30 and 35 doses. The terms for radiation dosage is the Gray. The total dose is divided into smaller doses known as fractions. Treatments are usually given once a day, Monday to Friday. In order to reduce the effects of radiotherapy on healthy cells, treatment is generally planned for small daily doses daily over a set period of time. The treatment period may be up to 6-7 weeks, depending on the total dose needed. Some treatments are given only once or twice a week and occasionally they may be given more than once a day. Remember, it is very important to have your treatments in order to receive maximum benefit. If you are unable to attend please notify the staff at the treatment centre to avoid concern and confusion. *Will the treatment be painful?* Radiation Therapy is not painful. A radiation therapist will take you to the treatment room where you will be positioned on a table beneath the machine, using the marks on your skin as a guide. The table can be rather hard and if you are too uncomfortable, tell the therapist who may be able to make you more comfortable. Although alone in the treatment room, while the machine is operating, the therapist will be observing you through a window or TV monitor and an intercom is usually available. It is important to relax, breathe normally and lie as still as possible, as this ensures the treatment is accurate. The total amount of time spent in the treatment room is usually 10 - 20 minutes. The machine is only turned on after the therapists have made sure you are in the correct position. The actual treatment usually takes a very short time - a few minutes at most. *Will I be radioactive?* No. External radiotherapy does not make you radioactive. It is safe to be with your children, family and friends both throughout the treatment and after the treatment has been completed.

The most important effect of chemotherapy is that it kills cancer cells. Because normal cells are also damaged, there may be some side effects. The main areas of your body that may be particularly affected are those where normal cells rapidly divide and grow, such as your mouth, digestive system, bone marrow, reproductive system, skin and hair. Not everyone being treated with chemotherapy will have side effects. Cancer treatments produce different reactions in different people, and any reaction can vary from time to time. It may be helpful to remember that:
almost all side effects are temporary and will gradually disappear once the treatment has stopped. precautions can be taken to prevent or reduce any side effects. Possible side effects and ways in which you can help yourself are given on pages 12-22. the success of treatment is not related to the type or severity of any side effects.
If you want to know more about the specific side effects which may be caused by your own chemotherapy treatment, you should ask your doctor, pharmacist or the nurses involved in your care. They know which drugs you are taking and will be able to give you accurate information. If you find that the treatment is making you feel unwell, do tell your doctor who may be able to give you medicines to help. Your doctor may also want to make changes to your treatment to lessen these side effects. Many side effects only occur in the few days following drug delivery and there will be times when you feel quite well between your treatments. Although the side effects of chemotherapy may be unpleasant, they must be weighed against its expected benefits when making your decisions about treatment.

Chemotherapy is given with the positive intention to either cure or improve the outcome for people with cancer. Chemotherapy may also be used to assist other treatments such as surgery or radiotherapy. This is called adjuvant chemotherapy. It may be used:
remission - partial or complete removal of cancer from the body. cure - some cancers can be completely cured by chemotherapy, either on its own or combined with other treatments. control - chemotherapy may control your cancer by shrinking the tumour(s) and restricting its spread. palliation - even if it is not possible to completely control a cancer, shrinking the growth may help you feel better and relieve distressing symptoms such as pain.
Chemotherapy may also be used to assist other treatments such as surgery or radiotherapy. This is called adjuvant chemotherapy. It may be used:
before the main treatment to reduce the size of your cancer and make your other treatment(s) more effective. as an insurance in case some cancer cells remain after other treatments and which could cause problems later. in combination with other treatment ie. radiotherapy.

The cause of breast cancer is unknown. In fact, it is thought that there is not one single cause of breast cancer. It is more likely that a number of factors, some known and many unknown, may work together to trigger the development of breast cancer. Doctors have identified several factors that can indicate that a woman may have an increased chance of developing breast cancer. However, having one or even several of these characteristics does not mean that a woman is certain or even likely to develop breast cancer.
Knowing the risks Gender and age The most important risk factors for breast cancer are being a woman and getting older. Breast cancer is predominantly a disease of women over 50 years of age, although it can occur in women under this age. Therefore increasing age is considered a major risk factor for developing breast cancer. Breast changes A biopsy confirming benign disease with atypical cells can also indicate a risk of breast cancer. This means that while cancer is not present, the atypical cells indicate an increased risk of breast cancer. Family history The degree of this increased risk can be very low to moderately high depending on several factors. These include:
the number of relatives affected the age of relatives at diagnosis the type of breast cancer whether breast cancer was bilateral (in both breasts) breast cancer in a male relative a family history of ovarian cancer
Genetic Recently a genetic link to breast cancer has been found. There are rare inherited faulty genes that occur in about 5% of all breast cancers. In these cases the life-time risk of developing breast cancer is considered to be significantly greater. Cancer history A history of primary cancer of the ovary, uterus, bone or soft tissue is considered a risk factor for developing breast cancer. Previous breast cancer Women who have had breast cancer do have a higher chance of developing a new cancer in the same breast or in the previously unaffected breast. Behavioural and lifestyle factors Some other factors which may also influence the development of breast cancer are:
never having children or having the first full-term pregnancy after the age of 30; a diet high in animal fat, and low in fibre, fruit & vegetables; obesity in post menopausal women; early menarche [start of first period] and late menopause; high intake of alcohol; long term smoking; inactive lifestyle; taking hormone replacement therapy or a hormone drug
Breast cancer is more common in women of higher rather than lower socio-economic status. However, all of these factors together account for no more than 30% of breast cancers. Any woman who identifies with one or more of the above factors should discuss her concerns with her doctor.

Hair and skin care Take good care of your skin while you have chemotherapy. Your skin may be a little more sensitive to the sun than normal, so protect yourself by avoiding the sun in the middle of the day, wearing a hat, shirt and sunglasses when out in the sun and using a good sunscreen (SPF 30+, Broad Spectrum). The drugs may cause your skin to become dry or slightly discoloured. Rub in a little sorbolene or lanolin cream to relieve dry or itchy skin. Any rashes should always be reported to your doctor. Your nails may grow more slowly and you may notice black discolouration or white ridges appearing across them. False nails or nail varnish can be used to disguise split and discoloured nails. Hair loss or thinning can be caused by some drugs which temporarily damage the hair. Remember that many drugs do not cause hair loss, the degree of loss varies with the individual and it is not permanent. Hair will regrow either during treatment or after you have completed treatment.
Look after your hair. Use gentle hair care products and avoid vigorous brushing or harsh treatments for your hair. If possible use a cotton, polyester or satin pillowcase. Nylon can irritate your scalp. Protect your head against sunburn or extreme cold. There are many ways of disguising hair loss and looking good. Some people find it comfortable to wear a hat or scarf, others prefer to wear a wig. Some financial assistance is available from the public hospitals and the private health funds to help purchase wigs.
Look Good.... Feel Better is a programme to help you counter-act the effects of physical changes in your appearance due to your treatment. In a two hour workshop you can learn to use make-up and hairstyling with wigs and other accessories as well as having a lot of fun. Contact The Cancer Council South Australia for further information.

Your digestive system Nausea and vomiting are side effects associated with some chemotherapy drugs, which may start from a few minutes to several hours after receiving them. If sickness is likely to occur with the drugs you are having, or if you have experienced this reaction, there are anti-sickness drugs (antiemetics) which your doctor can prescribe. These are usually very effective. To help to reduce nausea:
Avoid eating or preparing food when you feel sick. Eat only a light meal before your treatment; for example soup and dry biscuits. Eat several small meals each day and chew the food well. Drink whatever non-alcoholic fluids you prefer. Some people find soda water, dry ginger or weak tea refreshing. Avoid rich or fatty foods. Drink as much fluid as possible before your treatment. After treatment you may find it easier to drink small amounts more often than to have large drinks. Eat cold or slightly warm food if the smell of hot food causes nausea Some people find that using relaxation techniques helps to fend off or reduce their nausea.
The lining of the digestive system may be affected by some chemotherapy drugs and this may cause diarrhoea. More rarely, you could become constipated. To help to reduce the problems of diarrhoea and constipation:
Drink more fluid. Eat small snacks rather than large meals. If you have diarrhoea, eat less fibre and avoid raw fruits, cereals, vegetables, milk and milk products until it is cleared up. If constipation occurs, increase your intake of fibre, raw fruits, cereals and vegetables. Prune juice and hot drinks can often stimulate bowel action. See your doctor if problems persist - medications are available to ease problems.

Mouth care Some chemotherapy drugs can cause a sore mouth or small mouth ulcers. Good oral hygiene will help to minimise problems and if mouth ulcers become infected, treatment can be given to help clear the infection.
Clean your mouth and teeth gently every morning, evening and after each meal. Remove and clean dentures every morning, evening and after meals. Rinse mouth after removing dentures. If toothpaste stings or brushing makes you feel nauseous, try a mouthwash of bicarbonate of soda instead. Dissolve 1 teaspoon of bicarbonate in a mug of warm water. Use dental floss, with care, daily.
If you have a dry mouth it may help to:
Sip fluids frequently, especially water, and eat moist foods; Keep your lips moist by using vaseline or lip balm. If your mouth is not sore, eating fresh pineapple chunks can help to keep it fresh and moist.
Discuss any dental problems with your doctor and when visiting your dentist let him know you are having chemotherapy. Undergoing dental work during treatment is generally not recommended.

Your doctor will carry out regular tests to assess the effects of the chemotherapy on your cancer. These may include x-rays and scans which can show any reduction in the size of the cancer. Frequent blood tests will also be carried out. Some cancers produce specific chemicals which can be measured in the blood; variations in the levels can indicate the success of your treatment. Abnormal cells may be found in the blood, for example with the leukaemias, and regular samples will be examined to monitor what is happening. Chemotherapy can also affect the bone marrow, and result in a reduction in the normal level of cells in the blood (the blood count). This is not uncommon. A blood test is carried out before each treatment to check your blood count and occasionally your next treatment may be delayed if your bone marrow needs extra time to recover. Blood samples or urine can also be used to measure the function of internal organs such as the liver and kidneys. Other tests may be carried out if the drugs being used are known to be associated with specific adverse effects. Depending on the results of your tests, your doctor may want to modify your treatment plan. The dosage may be reduced if you are experiencing severe side effects or impaired function of the immune system or other organs in your body. Alternatively, your doctor may want to change to other drugs which may have fewer side effects or to produce a more effective response.
Helping yourself Even though chemotherapy can cause unpleasant side effects, some people will still manage to lead an almost normal life during their treatment. Even if they feel unwell during the treatment courses, many people find they recover quickly between courses. Other people decide that they want to cut down on some of their activities and take life more slowly for a while. What is important is that you do what you like, within the limits of comfort. There are also many ways in which you can smooth the course of your treatment and help yourself. Doing things for yourself will help you to feel more in control of your disease and treatment. Try to plan your time so that you can still do things that are important to you. Remember that rest and relaxation are also important to help your body recover. Realistic goals are more likely to be achieved. Enjoy your social life but don't be too tough on yourself.
When you go for treatment Unfortunately, going for your treatment is not usually a quick in and out. You may have to wait for blood tests or X-rays, the results of your tests, to see your doctor and for the pharmacy to make up your drugs. There is also the time it takes to actually receive your drugs. Listed below are some of the methods other people have found helpful to deal with the waiting times. Everyone is different so choose whatever you think might be useful for you.
Take a close friend or family member with you to keep you company and remind you of anything you want to find out. Prepare beforehand a list of the questions you want to ask your doctor, nurse or any other person involved in your treatment. Take a walkman so you can listen to your favourite music or an interesting radio programme. Learn a relaxation or self hypnosis technique to help with the anxiety of waiting for tests and results and receiving your treatment. If you are having treatment in a large hospital, ask if there are volunteers who can help you to find the different departments for your tests or sit with you to keep you company. Take a book, newspaper or crossword to occupy your time. Talk to other people who are also waiting for treatment and share experiences. You may pick up useful hints on dealing with side effects, but do check these with your doctor or nurse before using them. Remember that other people might be having very different treatments.

Chemotherapy is usually given as several courses of treatment, each of which may last from a few hours to several days or longer, depending on the drugs given. The total number of courses you have will depend on how well your cancer is responding to the drugs. It may take several months to complete your treatment. Your doctor will take several factors into consideration when planning your treatment. Most important are:
the type of cancer you have; where it is situated in the body; how far it has spread, if at all; your age and general health.
The frequency of your treatments and the total length of time it takes will also depend on several factors including:
the type of cancer you have; the drugs you have been prescribed; the response of the cancer cells to the drug(s) during treatment; any side effects the drugs may cause.
If you want to keep working during your treatment, you might like to ask your doctor if your treatment times can be fitted in with this. Treatment can also sometimes be delayed to fit in with special occasions you wish to attend or to allow you to go away on holiday. Your doctor will be happy to explain your own treatment plan to you. If you have any questions, don't be afraid to ask.

Cancer is a disease of cells, the building blocks of the body. Normally, all cells divide and reproduce themselves in an orderly and controlled manner, allowing your body to grow and to heal after an injury. In cancer, the process gets out of control and abnormal cells may multiply to form a lump or tumour. The growth of this primary tumour can damage other tissues and interfere with the normal function of the body. Cancer cells are malignant and can break away from a tumour and spread to other parts of the body via the bloodstream or lymphatic system. If they settle and produce new tumours, these are called secondary growths or metastases. Benign tumours do not behave the same way as cancer cellsbut also need medical attention. The word 'cancer' can also be used when cells multiply abnormally but don't form a lump or tumour. This happens when the blood-forming cells are affected, producing leukaemia. Many cancers can be successfully treated, especially if detected early. The main methods for treating cancer are:
surgery - removing the cancer from the body; radiotherapy - using high energy radiation to destroy cancer cells; chemotherapy - using drugs to kill cancer cells; adjuvant treatments - a combination of any of the above.
Chemotherapy may be used together with surgery and radiotherapy as a precautionary treatment in case some cancer cells remain in the body. Chemotherapy is the primary treatment for some cancers, such as those of the blood forming organs and is also used if there has been spread of a cancer to other parts of the body.

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