I was reading an article the other day about Wilko Johnson. He’s quite a guy, is Wilko. Guitarist with Dr Feelgood… Major influence on Punk…. Star of Game of Thrones… Wit and raconteur…. Let’s face it. The guy’s a bloody legend.
Now, depending on your point of view, Wilko is either very unlucky, or very, very lucky and his story helps to give some insight into the way that doctors diagnose cancer and consider treatment options.
Wilko was diagnosed with pancreatic cancer in 2013. Now, pancreatic cancer is a nasty, nasty disease. And the reason why it’s so nasty is that it is asymptomatic – it doesn’t cause symptoms.
Other diseases can produce symptoms very early on in their development, eg. testicular cancer. A testicular lump forms very quickly after the onset of the disease and, as long as you do something about it as soon as you find it, it can be treated before it develops too much. That’s why the success rate for treating testicular cancer is so high.
But pancreatic cancer is the opposite. It doesn’t produce any symptoms in its early stages, so the patient doesn’t even know it’s there. As the cancer grows and spreads, they might start to get a bit of a sore back or stomach, but it won’t seem that serious. Over time, the pain increases, so the patient finally goes to the doctor. But by then, it is often too late. By the time that the symptoms become serious enough for the patient to seek medical help, the disease has spread so far that it is virtually untreatable. That’s what happened to Iain Banks. And Bill Hicks. And Patrick Swayze. And, er, Hayley from Coronation Street.
So, when Wilko was diagnosed with pancreatic cancer, the outlook was bleak. His doctors estimated he had 10 months to live. Surgery wasn’t a realistic option and chemotherapy would give him, at most, an extra 2 months.
Wilko’s response was extraordinary. Rather than complain, or rage against the hand he’d been dealt, Wilko simply accepted it and decided to spend his remaining time doing what he did best – playing music. He recorded and released a new album, then embarked on a Farewell Tour, playing night after night all across the country, to say goodbye and to thank all of his fans. And he decided to keep going until the very end. Except something odd happened: the end didn’t come. He just kept going.
Eventually, one of his fans, who happened to be a doctor, began wondering how he was managing it and referred him to pancreatic specialists at Addenbrookes Hospital. After a series of tests and consultations, the team came to the conclusion that Wilko’s tumour was treatable after all, albeit with a low chance of survival.
But….how can this be? How could the original diagnosis have been so wrong? Well, the first thing to remember is that, as I’ve mentioned previously (in No Cure For Cancer…?), the word “cancer” is not the name given to one, single disease. It is an umbrella term for many diseases, which all produce similar symptoms ie. uncontrolled cell growth. Now, all cancers might have similar symptoms, but the important point is this: why is the cell growth out of control? What is causing it to happen?
If you remember back to No Bootees, you’ll remember that I explained that cell growth and division was controlled by a huge number of signals produced inside cells – which I grouped as Stop! and Go! signals. You’ll also remember that I explained that cancer arises from a surplus of Go! signals and that the behaviour of a tumour depends on the type of Go! signals being produced. Now, this is also true when you are trying to tell one type of cancer from another. Different cancers will produce a different pattern of Go! signals, this can be what separates one disease from another. So, when doctors are trying to diagnose which type of cancer a particular patient has, they will look at many factors: (a) What organ did it originate in? (b) What cell type within that organ did it originate in? (c) How has the tumour grown and spread? (d) What Go! and Stop! Signals are the tumour cells making (which they will call “Markers”). Now, different types of cancer might originate in the same organ, grow in similar ways and have similar Markers, therefore, quite often, identifying which particular type of cancer an individual patient has can be tricky.
Also, remember that each patient is a unique individual. Therefore, as the tumour arises from the patient’s own cells, if the patient is unique, then so is the tumour! Each patient’s disease is a unique case. And each patient’s disease will have its own individual response to treatment. That is why you can get two patients diagnosed with the same disease, at the same stage, in the same organ, on the same day; one of whom makes a full recovery while the other only survives a few months. Taking all of this into account then, how the hell do doctors decide what to do?
Well, the decisions taken will be based on probabilities. Tumours arising from a certain cell type, in a certain organ, producing a specific pattern of Markers (ie. Go! and Stop! Signals), are likely to progress in a certain way and are also likely to respond to specific treatments in a similar way. Therefore, the doctors will take all of these factors into account before deciding on the course of action which is likely (note, LIKELY) to produce the best results for the patient. There are no absolutes – just probabilities.
So, in Wilko’s case, this is what his original consultants did. They reviewed all of the evidence – where the tumour was located, how big it was, what markers were present, how it was likely to progress – and came to the conclusion that he had a pancreatic adenocarcinoma – the most common type of pancreatic cancer, which is responsible for 75% of cases.
And when his case was re-examined, the review team did exactly the same. But the difference was, this time they had some additional information, namely how the tumour had changed in the 12-ish months since the first diagnosis. This led them to re-assess the original diagnosis and they decided that Wilko’s tumour wasn’t a pancreatic adenocarcinoma, but a much rarer (and more slow-growing) disease called a pancreatic neuroendocrine tumour. This also allowed them to revise the likelihood of surgery being successful.
Now, the prognosis still looked bad. The tumour was so extensive that he was only given a 15% chance of surviving the operation. Despite that, Wilko decided to go ahead, given that a 15% chance of survival was better than 0%. He underwent nine hours of surgery to remove the tumour – which also involved removal of his pancreas, spleen and parts of his stomach and intestines. And against all the odds, he survived.
So, now Wilko has been given a second chance. As I said at the start, you could either consider him very unlucky to have undergone all of this, or very, very lucky to have been given the re-diagnosis. Either way, it’ll be interesting to see what he does next.
So, in tribute to the mighty Wilko Johnson, let’s give thanks to his recovery by watching him in his pomp. More power to your elbow, sir!
Take it away Wilko……
AG McCluskey (2015). Feelgood … Feel lucky Zongo’s Cancer Diaries