Every cancer patient may think about why they have cancer. I am no exception. Understanding the reason could prevent cancer recurrence or help prevent other cancers from occurring. Cancer patients are prone to have cancer repeatedly. I have treated a 48-year-old woman who had suffered from five types of cancers on eight parts of her body.
All cancers are the result of genetic mutations. In specific cases, factors that induce gene mutation are difficult to determine. The World Health Organization declared that 40% of cancers are preventable as a whole. Recognizing the possible causes of cancer will help prevent cancer and reduce cancer recurrence.
Genes are inherited, so we cannot change our own genes. My mother died of liver cancer, had I inherited the cancer causing genes from her? It’s too late now to confirm this as my mother had no pathological examinations carried out on her liver so there were no tissue samples left for me to be able to do genetic and molecular analysis. Secondly there’s no literature that can show genetic evidences of cholangiocarcinoma.
The current president of the United States National Institutes of Health, Francis Collins, a chief expert of the Human Genome Project cited “the 15th family” in his book Language of Life. A patient named Dolly at forty-eight years old was diagnosed with breast cancer. Ten years later two of her three daughters Janet and Lucy followed her steps. Almost at the same time, Dolly's sister Matilda, known in the family as Mattie also suffered from breast cancer. Mattie had three daughters, two of them died of breast cancer before they were thirty years old, the other one also suffered from ovarian cancer. Afraid of having the same fate Mattie’s third daughter chose to have a prophylactic mastectomy. On October 30, 1992, more than 20 family members gathered at the Collins counseling center and received genetic tests. The results showed that the BRCA1 gene on chromosome 15 had mutated. Later, Dolly and Mattie’s niece suffered from breast cancer, the other nephew suffered from esophageal cancer, and Mattie also suffered from ovarian cancer, while her son died of colon cancer…The next generation of those people who carry this mutant gene have a 50% probability of inherited mutation. Others in the family may also suffer from cancer, they are under the health surveillance of a specialized agency.
It’s been established that breast and ovarian cancer already have a strong hereditary causal link. Many other cancers are also highly heritable, such as retinoblastoma and colon cancer. There is a rare familial adenomatous polyposis where patients have countless small colon polyps from childhood, almost all develop into colon cancer around the age of forty. In order to avoid such tragedies it’s necessary to do a prophylactic colectomy. Another type of highly hereditary colon cancer is called hereditary nonpolyposis colon cancer, these patients carry MLH1, MSH2 and MLH3 mutations. 60% of these patients will have colon cancer while 30% will have uterine
cancer. Currently it’s advocated that patients who had colon cancer before the age of fifty should receive routine MLH1, MSH2 and MLH3 genetic tests. Once the mutation is found, family members are required to do the same test. If it is positive, family members should undergo colonoscopy every year from the age of twenty. For women, they should undergo an annual endometrial biopsy sampling. Those women who do not want children can undergo a prophylactic hysterectomy.
About 10% of pancreatic cancer patients have genetic background. We are currently researching a cancer prone family. An old lady from Jiangsu province (No.7 in Fig. 2) came to our hospital. She was eighty-nine years old and suffering from pancreatic cancer. In the previous twenty years she had suffered from colon, rectal and uterine cancer. The colon cancer successively occurred in the ascending colon, transverse colon and descending colon. Further inquiry found that ten of her family members had had gastric cancer, duodenal cancer, colon cancer, liver cancer and lymphoma. Among them, colon cancer was most prevalent. As well as the patient herself, there were five more colon patients (Fig.2). With reference to medical literature there is no precedent example of such a cancer prone family. We have already obtained blood samples from this family and a costly genetic analysis is in progress.
Figure 2 The specific condition of the cancer patient’s families.
The red ones represent cancer patients, there are eleven cancer patients in total including: (a) Gastric cancer, (2) Duodenal cancer, (3) Gastric cancer, (4) Liver cancer, (5) Colon cancer, (7) Colon cancer in 1977, Uterine cancer in 1982, Transverse colon cancer in 1989, Descending colon cancer in 1996, Rectal cancer in 2003(all already received surgery), Pancreatic cancer in 2007,(8)Colon cancer,(17)Colon cancer, (23) lymphoblastoma, (25) Colon cancer, (26) Colon cancer.
Neurofibromatosis is a highly heritable cancer, about one in 3,000 people suffer from this disease, which is mainly a large number of pigmented spots on the skin, commonly known as “coffee spots”, and a large amount of nodular lumps mostly on the head, face, neck, and chest. Tumors can be large, if they grow on the face. Famously, John Merrick known as the ‘Elephant Man’ presented trunk-like changes to the face. The family members of these patients tend to have a similar disease.
In 2006, we treated one young boy and girl in Malaysia. The girl’s mother and younger brother had also had the disease. In 2007, we treated a 32-year-old man from Hunan Province. His tumor on head, face, neck and chest weighed as much as 20 kg and his mother and sister also had similar symptoms. After we removed the huge ‘super-tumor’ announced by Reuters and the Associated Press, the American television channel National Discovery broadcast the treatment procedure in 50 minutes and praised it as “groundbreaking surgery” and “innovative success.” With the help of the Chinese Academy of Sciences, Guangzhou Institute of Biology, we have successfully tested the patient and his family members’ genome and found the locus of NF1 genetic mutation. The success of the “Human Genome Project” created extremely favorable conditions to uncover the secrets of a variety of cancers. With the application of advanced sequencing it has been possible to spend less money to determine each patient's genome. The language of life, DNA and its sequencing has allowed us to master our own future. We should revel in this trend and enjoy the benefits of scientific achievements.
Among various genetic mutations, the detection technology for the BRCA1 gene along with later discovered similar BRAC2 mutations has already been popularized.
● It’s suggested that women carrying this gene mutation must regularly consult experts about the risk of breast cancer and ovarian cancer. Checks should include screening with mammography or MRI scan, ovarian ultrasound and serum CA125 determination. Women regularly consult experts about the risk of breast cancer and ovarian cancer, including mammography or MRI scan, ovarian ultrasound and serum CA125 determination etc.;
● Women who have gone through childbirth and do not want any more children could consider having the prophylactic oophorectomy, removing the oviduct at the same time which would reduce the possibility of ovarian cancer to zero.
● Those women with serious psychological burden could receive prophylactic oophorectomy and then the breast reconstruction surgery.
● Those men who carry BRCA1/2 mutant genes have a higher possibility of prostate cancer and pancreatic cancer, and should receive close medical observation.
● Not all carriers of the mutant genes will have cancer, so although on one side, we should maintain high vigilance, on the other we should have a calm approach towards it.