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VOLUME 20, NUMBER 41
OCTOBER 12, 1973
DURHAM, NORTH CAROLINA
CANCER-
Waging Battle Against
America’s No. 2 Killer
THROUGH THE EYES OF A SURGEON—Desphe two decades of p)rogress in cancer
drug research, most cancer victims find their best hope is still in the watchful eyes and
steady hands of the surgeon. Here Dr. Glenn Young Jr., professor of general and
thoracic surgery, operates on a patient with massive cancer of the esophagus. (Photo
by Jimmy Wallace)
This year 15,000 people in North
Carolina will find out that they have
cancer. Only one-third of them will be
alive five years from now.
Across the nation, cancer is our No. 2
scourge, eventually killing one of every
seven persons.
Recently the federal government
launched a major drive to try to change
these statistics through intensified
research and clinical trials. Duke is one of
11 regional centers throughout the nation
designed by the National Cancer Institute
to lead in this drive.
The goal of the centers include
disseminating the latest information on
cancer treatment to physicians in the
region and providing a hub for a sweeping
cancer screening program, a cancer
surveillance system and a rehabilitation
program.
But perhaps the most important task
of the centers is research, for the basic
weapons in the cancer fight are still
lacking—knowledge of what causes cancer
and what will cure it.
"The real need is for a lot more basic
information," said Dr. Wolfgang Joklik,
chairman of the Department of
Microbiology and Immunology. "The
idea is prevalent that there is a great deal
of information in the ivory towers that is
not being used—that we could cure cancer
if we would just get together all this
esoteric information and put it to
practical use.
"Unfortunately, that's just not so," he
said.
Today there are four basic approaches
to the treatment of cancer. They are
surgery and radiation and the two newest
approaches, chemotherapy and
immunotherapy. The latter two involve
the use of drugs either to kill a tumor or
to stimulate the body's own defense
against a tumor.
But despite the progress in drug
research in the past 20 years, the primary
treatment for most of the 100 different
diseases called cancer is still surgery or
radiation.
There are two stages of tumors for
which surgery is the primary treatment.
Neutron therapy, a promising form of
treatment for some cancerous tumors,
will become available for use this month
by physicians at Duke and two other
North Carolina nnedical institutions.
The treatments will be the first
available in the eastern United States, and
the program will be only the second if its
kind in the country.
Administered at the Naval Research
Laboratory cyclotron in Washington,
D.C., the treatments will be coordinated
in this state through Duke, the University
of North Carolina at Chapel Hill and
North Carolina Baptist Hospital in
Winston-Salem.
Dr. Patrick Cavanaugh, chief of
therapeutic radiology at Duke, was
among those primarily responsible for
getting the program started.
The therapy, which also will be
available for use by physicians in six
other eastern states and the District of
Columbia, utilizes a type of radiation
called fast neutron beams created by a
cyclotron to irradiate and destroy
cancerous tissue much as X-rays and
gamma rays are currently used for such
treatments.
Previous studies have shown that
neutron radiation is significantly better
than other types of radiation in
controlling or destroying some types of
localized tumors.
Funds totaling more than $1 million
from the National Cancer Institute are
supporting the extensive research and
clinical studies. In the first year more
than 200 patients may receive treatments
at the cyclotron.
To carry out the program, therapeutic
radiologists, biologists and physicists at
several universities, laboratories and
hospitals including Duke have formed a
cooperative organization called
MANTA—the Middle Atlantic Neutron
Therapy Association.
Cavanaugh, who is a member of
MANTA, said that a Duke physics
graduate, Richard Theus, is one of those
mainly involved in operating the Naval
Research Laboratory cyclotron.
America has assigned a top priority
to the conquest of cancer. The
National Cancer Institute has chosen
Duke as the site for a Comprehensive
Cancer Center, one of the regional
facilities that will lead the all-out
effort to conquer this disease.
This is the first in a series of four
articles by Miss Yvonne Baskin,
medical writer in the Office of Public
Relations, exploring the status of
cancer research and treatment, with
particular emphasis on work under
way at Duke. This article deals with
surgery and therapeutic radiology.
Subsequent articles will examine
chemotherapy, immunotherapy and
research with viruses.
Neutron Therapy Becoming Available
Stage 1 is when the cancer is still
confined to the site of origin. Stage 2 is
when the cancer has spread only to the
nearest lymph glands.
"If there is any evidence the tumor has
gone beyond that point, the tumor is no
longer operable," said Dr. William W.
Shingleton, director of Duke's
Comprehensive Cancer Center and chief
of the division of general surgery.
Using breast cancer as an example,
Shingleton said 65 to 70 per cent of the
women operated on for Stage 1 breast
tumors survive for at least five years. This
can't be called a real cure, however, since
the cancer could recur 10 or 15 years
later.
If the cancer has spread from the
breast to the lymph nodes under the
arms, Shingleton said, the five-year
survival rate after surgery is cut to 35 to
40 per cent.
Patients with tumors in the body
cavities, such as stomach and lung
cancers, have an even lower survival rate
because these tumors are often not
detected until they have reached the
nearly inoperable stage. The five-year
survival rate for patients who undergo
surgery for lung cancer is only 5 to 10 per
cent.
Approximately half of all cancer
patients undergo radiation, either in
hopes of a cure or for relief of some of
the suffering that accompanies cancer.
Often the radiation treatment is in
combination with surgery.
One problem with radiation treatment
has been that the most commonly used
types of radiation—x-rays, gamma rays,
electron beams—cannot produce the
desired chemical changes and kill the
cancer cells unless the cells contain a
sufficient amount of oxygen. Tumor cells
often do not contain much oxygen.
"There are many people who are
treatment failures because me radiation
did not kill all of the cancer cells," said
Dr. Patrick Cavanaugh, chief of
therapeutic radiology. "The radiation
therapist used the maximum amount of
radiation which the normal tissue around
the tumor could tolerate, but the cancer
cells didn't have enough oxygen for the
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