About 18 months ago a woman sat in front of the mirror at the ACT Cancer Society’s wig library in a small room at Canberra Hospital.
She was trying on a grey wig.
“”But my hair was blonde,” she said. “”Haven’t you got any blonde wigs.”
“”I’m sorry,” the society’s attendant said. “”No. There’s not much here. You can get one made through the hair shop in the foyer.”
“”I know, but I can’t afford it.”
She seemed defeated. Depressed.
My wife, Lynne, and I quietly retreated. There was no point in staying. Lynne had blonde hair, too. She also was to start chemotheraphy for cancer that week.
The prospective loss of her hair concerned her almost as much as progression of her disease. As with nearly all women and children the threat of hair loss was a great psychological barrier at a time she was assaulted physically and emotionally by the disease. It is an enormous attack on her self-esteem.
With children, it can be isolating, especially if the peer group is hostile, as kids can so often be.
This is why several police agreed to be cropped: to empathise with child cancer patients so they did not feel so isolated. Cropping then became a method of fund raising for cancer research.
I’m sure Kate Carnell and members of the police force mean well in having their heads shaved and will do good by doing so, but there is a harder side to chemotheraphy than hair loss.
I’m sure Mrs Carnell as a pharmacist is aware of it and sensitive to it, but the wider public may not be. It is not like going to a barber having your head shaved and the hair growing back and living happily ever after.
Chemotheraphy is often a last-line treatment for cancer. For cancers of the blood and lymphatic system it is often the only treatment. It the great majority of cases it means total loss of hair, not just on the head, but all over the body. And there are other worse side-effects.
Chemotheraphy means treatment with chemicals. The chemicals are poisons. They kill cancer cells. The trouble is that they also kill healthy cells.
Research into chemotheraphy is directed at finding chemicals, or combinations of chemicals, that attack cancer cells and leave healthy cells alone. But nothing completely selective has been found.
The trouble is that cancer cells are very similar to healthy cells. Their DNA is same and the proteins within them and on their surface are almost identical. It means that our immune system which attacks foreign bodies (like viruses and bacteria), leaves cancer cells alone.
Because cancer cells are so similar to ordinary cells, anything that poisons them is likely to poison ordinary cells, too. The main difference that cancer cells have is that they divide and multiply in an uncontrolled way. Ordinary cells, on the other hand, divide and multiply in a controlled way, just replacing worn-out cells.
Chemicals in chemotheraphy, therefore, are directed precisely at this difference between ordinary cells and cancer cells _ the quick replication of cancer cells.
So chemotheraphy chemicals tend to attack cells that replicate quickly. Which ones are they? Not only cancer cells but also all the healthy cells in the body which in the ordinary course of events do a lot of replicating. Hair is growing all the time, for example. It grows from the base, of course. The cells in the hair follicles tend to get replaced very frequently. In that respect, they are like cancer cells. When the chemotheraphy is introduced (usually by intravenous drip) it kills the cells in the hair follicles and the hair slowly falls out.
It also hits other quickly replicating cells, like the whole of the digestive tract, especially the mouth, the skin and fingernails.
Damage to the digestive tract can be very uncomfortable. Mouth ulcers and diarrhoea alternating with constipation are common. So are mouth infections like mouth thrush.
Fingernails get brittle. Skin gets chapped.
More importantly, the chemicals kill white blood cells and so lower the body’s immunity to attack from colds, flue and other disease.
The body does not like the chemotheraphy. It is a poison. The body’s reaction is to vomit the poison out. Nausea is almost inevitable.
But a lot of research is directed at treating these side-effects. New drugs are being developed all the time. They are not in the realm of “”New Cancer Breakthrough” but they make patients’ lives much better.
And there are constant trials of new cocktails of chemicals that are more effective in attacking the cancer cells or less damaging on healthy cells.
The chemicals are various formulas of the inorganic non-metallic poisonous elements fluorine, chlorine and phosphorous. And some come from plants or are synthetic versions of compounds from plants. Different combinations are used for different cancers, because they are all different. Indeed, they can be seen as different diseases with the common attribute of uncontrollable cell growth.
The only encouraging thing about chemotheraphy side effects is that because it effects quickly replicating cells, the body can repair itself reasonably well because quick-repairing parts are attacked. Hair grows back. The mouth and digestive tract are also quick repairers and white blood cells replace themselves fairly quickly. Ask a blood donor.
Chemotheraphy is usually used in three ways: as a primary treatment; as what is called adjuvant (or additional) therapy; and as last-line treatment.
The other treatments for cancer are surgery (cut it out), radiation (burn it), hormone treatment (cut off its protein nourishment), and treatments outside traditional western medicine (meditation, acupuncture and herbal).
Chemotheraphy is usually used as a primary treatment for cancers of the blood (lukaemias) and lymphatic system (Hodgkin’s disease). When cancer is growing in fluid it is, obviously, impossible to use surgery and difficult to use radiation.
The success rate for chemotheraphy for some of these cancers in children has improved markedly in the past decade, and is now at more than 70 per cent. And their hair grows back.
Chemotheraphy is used as adjuvant (or additional therapy) very soon after diagnosis in cases when solid cancers (prostate, breast, stomach, colon, bowel and so on) appear to have already spread or is likely to have already spread given the size or the original tumour. Typically, signs of spread will be seen in the lymph nodes (under the arms or in the neck, for example).
In these cases, surgery will be used to cut out the primary tumour, radiation be used to burn any residual cancer at the primary site and chemotheraphy be used in an attempt to mop up any cancer that may have spread elsewhere. Once again hair grows back.
Chemotheraphy, therefore, is a treatment that affects the whole body because it is chasing cancer that may be anywhere within the body.
It is also used as a last-line treatment when typically months or years after apparently successful first-line surgery, radiation and hormone treatment the cancer appears elsewhere in the body, often in the bones, liver or brain.
It is also used when a single very large tumour is found that must be shrunk before surgery can be used to cut it out.
Chemotheraphy can work in a perverse way. Oddly enough, it can be more effective against aggressive and quick-growing cancers than against slower, more benign cancers. This is because it hones in on fast-multiplying cells; it is most effective when cancer cells are more different from body cells.
Side effects vary between patients, but hair loss is almost universal for the common cancers.
It does not come off neatly, as in the barber’s shop. Rather it falls out slowly, starting about two or three days from the first treatment. Chemotheraphy regimes differ, but they usually involve a drip over several hours every three or four weeks (as an out-patient). The gap is necessary to allow the white blood cells to build up again.
It usually takes about two weeks for all the hair to fall out. It is very distressing and painful. Most chemotheraphy patients get satin pillowcases, because it hurts as it comes loose in sleep, even with a turban.
Lynne bought a wig. An expensive one. People even remarked on her fabulous new hairdo. It was synthetic because the natural ones have to be washed more frequently and styled to keep their bounce. She figured that after a coupled of months she had easily paid for it in saved trips to the hairdresser for cuts and styles. So she bought another wig for variety. And to keep her morale up, which was important.
But we could afford it. Many can’t.
Cancer patients do not want to look different, or awful and hairless.
So not all the money raised should go for research. Present patients need help as well as future ones.
But the research dollar is important. It is important to seek other more effective ways of treating cancer.
A leading cancer specialist Lynne attended said chemotheraphy was barbaric and next century people would view it with amazed horror. He had high hopes for genetic work to splice out genes that were markers for cancer.
Also on the table is a range of work to trigger the body’s immune system (its killer T-cells) to attack cancer cells. This is done by introducing a synthetic antigen to the body. At present it only works in mice, so there is a way to go yet.
The new treatments will avoid the hell of chemotheraphy. The vomiting in the night. The hair on the pillow. The loss of appetite, strength and will. The feeling sick most days and wondering whether it will be worth it. The new treatments might also stop total baldness being a marker for cancer.
(Incidentally, you don’t have to join head-shaving exercises to give to cancer research or to help existing patients; you can quietly send a cheque to the ACT Cancer Society. 159 Maribyrnong Ave, Kaleen. 2617.
Alas, Lynne’s chemotheraphy was last-line treatment and did not work. Her hair never grew back.