Before reading this chapter please start with:
WOB is optimal
Breast cancer will serve here as cancer prototype.
History of untreated breast cancer
Localized disease: A woman feels a small lump in her breast which gradually grows. The skin above the lump becomes rough, slightly red, and swollen As tumor grows, the skin above it becomes thinner. It is damaged and a wound is formed . Gradually the wound becomes deeper and discharges more and more pus. The infection spreads and turns into sepsis.
Systemic disease: As tumor grows it sends metastases to regional lymph nodes, and to remote organs. Even minute tumors may send metastases and some times metastatic cancer is diagnosed before the tumor itself was detected.
1. Carcinoma in situ: Generally benign.
2. Localized: Tumor is confined to the breast.
3. Regional: Metastases invade regional lymph nodes.
4. Systemic: Metastases spread into remote sites.
The purpose of staging is to estimate disease severity. In each stage the disease burden is heavier. Medicine postulates that cancer starts as a localized tumor. First it spreads to local lymph nodes. Then it enters blood circulation and metastasizes. Staging is supposed to illustrate how cancer progresses.
However, cancer does not progress this way! Most cancers send micro-metastases before being detected clinically, and by the time of diagnosis they are already systemic. Which is documented by epidemiological studies of localized cancers. Most patients whose localized tumors were removed (mastectomy), die from systemic disease.
Apparently cancer is detected "too late". Medicine instigated therefore two procedures: Mammography which detects tumors somewhat earlier, and adjuvant chemotherapy, which is supposed to eradicate micro-metastasis. Both are controversial.
Beware of Mammography
Cancer is more than just a tumor
Cancer is even more systemic then medicine would like to consider. It is manifested by three characteristics:
2. Cachexia, manifested by weight loss and wasting
3. Para-neoplasia, manifested by hormonal and CNS (central nervous system} changes.
Medicine claims that tumor causes the other two manifestations. As tumor grows it secrets toxic substances which cause cachexia and para-neoplasia. Yet it might be otherwise. Cancer may start as a sub-clinical cachexia, and para-neoplasia, accompanied by a tumor.
Many clinical studies published during the first half of the previous century suggest that this might be so. First, there appear some "non-specific" changes, which are initiated by para-neoplasia while the tumor is detected somewhat later. Many patients lose weight. Cachexia may antedate tumor appearance. In some patients who died with extreme cachexia , autopsy revealed only a small tumor. Blood coagulation changes may antedate pancreatic cancer. These and other observations initiated a flurry of tests for cancer proneness. Like reduced nerve conduction, usually measured in the leg, which is some patient is followed by cancer. Or, tests for mood changes. Already Galen observed that women with "black bile" were prone to cancer. What these doctors failed to realize and medicine does not accept is that all these individuals already had cancer, only their tumors were hidden.
proceeds through the following phases:
From its very beginning, cancer is manifested by para-neoplasia and cachexia. Initially they are subtle and generally overlooked. Like weight loss which accompanies many conditions. With time para-neoplasia and cachexia become more and more pronounced, yet then they are regarded as toxic maniestations of chemotherapy.
Cancer is a systemic disease
To a modern physician this may sound like an oxymoron, since a tumor is all that is to cancer, no tumor means no cancer! Medicine lacks some simple concepts that would allow it to examine a putative system-ness of cancer. And yet cancer is as systemic as arteriosclerosis. In the same way as myocardial infarction or CVA are localized manifestations of systemic arteriosclerosis, tumor is a localized manifestation of systemic cancer.
Medicine is puzzled by the fact that small tumors remain generally unnoticed. While all other diseases are more or less painful, cancer starts as a painless disease. Which medicine regards as unfortunate, since tumor ought to be removed as soon as possible. Enormous effort is invested in early detection. Healthy patients have to be examined periodically with sophisticated equipment. When tumor is detected they are told that despite feeling healthy, they are not.
Indeed, they are healthy, since WOB does not complain . A silent WOB indicates that it controls cancer and does not need any assistance. Which sounds like a heresy. Medicine hastens to remove any tumor and applies chemotherapy to eradicate its remnants. Yet most patients are not cured, which is attributed to the fact that the tumor was detected too late.
In reality one cannot cure a systemic disease with a localized treatment. Take arteriosclerosis which is manifested by a (localized) myocardial infarction. In the same way as curing the heart does not cure arteriosclerosis, tumor removal cannot cure cancer !
Such a twisted logic is applied by medicine to other diseases as well. Like diabetes mellitus. It ignores the myriad processes operating in diabetes, and focuses on one, hyperglycemia. Diabetes is a hyperglycemia which has to be reduced. Yet hyperglycemia treatment generally fails to cure the disease, since patients end up with kidney failure and retinopathy.
In both diseases, clinicians face an unpleasant phenomenon, resistance to treatment. In diabetes it is manifested by insulin resistance, and in cancer, by a resistance to chemotherapy. It may seem as if the two phenomena have nothing in common. After all insulin and chemotherapeutic agents are distinct and unrelated. However what counts is not the substances themselves, but WOB's reaction to treatment. Since resisting it, treatment of both diseases is harmful. Treatment is justified only if given in accord with WOB.
Homeostasis in Diabetes
Like cancer, diabetes proceeds through the following phases:1. Pre-clinical. Hidden hyperglycemia.
All along diabetes evolution WOB maintains homeostasis .Blood glucose rises in small steps between which it remains constant. Prior to each change WOB elevates the glucose set point to a new value which determines the current blood glucose level. Following insulin injection blood glucose drops, to raise again when insulin is catabolized. It will always return to the level specified by the set point which shows that WOB controls carbohydrate metabolism in health and in disease. It maintains hyperglycemia since the body needs it. What medicine regards as a pathological hyperglycemia, is regarded by WOB as a normoglycemia. For yet unknown reasons, elevated blood sugar is vital to the body, and ought not be regarded as pathological.
In the long run, hyperglycemia damages small blood vessels and impairs blood flow to tissues. Despite this, WOB continues to raise blood sugar. Apparently the rising blood sugar is so vital to the organism that it is ready to suffer secondary damage. Which poses a challenge to treatment. By lowering blood sugar, it prevents secondary damage, yet somehow harms the organism. Adequate therapy is therefore a compromise between the potential damage of hyperglycemia and WOB's needs. Medicine rejects this notion. In order to prevent secondary damage, blood sugar is lowered to normal values. The possibility that hyperglycemia might be vital to the organism is rejected. Which is the main reason for insulin resistance. By making insulin resistant, WOB protects itself against a wrong treatment.
In order to adequately treat a disease, we ought to find out what drives it. Infectious diseases are driven by microbes. What drives diabetes? Medicine postulates that diabetes results from a disturbed carbohydrate metabolism manifested by a faulty glucose-receptor. Yet this view violates the optimality principle presented in the second chapter. All components of a disease have a purpose whose meaning may elude our understanding. We cannot ignore that it is WOB which maintains an elevated blood sugar, and since WOB operates optimally hyperglycemia is vital.
Homeostasis in Cancer
The same arguments apply to cancer. All along its evolution WOB maintains homeostasis. Tumor grows in small steps between which its size remains constant. WOB controls the tumor load. Prior to each change it elevates the tumor-load set point to a new value, which determines its size. Following chemotherapy tumor shrinks, and when chemotherapy ends WOB replenishes its mass. It will always return to the level specified by the set point. Like hyperglycemia in diabetes, the growing tumor is required for yet an unknown reason. What medicine regards as a pathology, is created by WOB and is vital to the organism. . .
In the long run, tumor harms tissues, and causes secondary damage. Despite this, WOB continues to raise the tumor load. Apparently the growing tumor is vital to the organism, and it is ready to suffer secondary damage caused by it. Which poses a challenge to treatment. Tumor removal prevents secondary damage, yet somehow harms the organism. Adequate therapy is therefore a compromise between the potential damage by tumor and WOB's needs. This view is utterly rejected by medicine, and so is also any suggestion that a tumor might be vital to the organism. Which is the main reason for the mounting resistance to chemotherapy. By making the tumor resistant, WOB protects itself against a wrong treatment.
Similar considerations may have convinced Hippocrates to propose the following: In his 38th aphorism (section VI) he writes: It is better not to treat those who have internal cancers since, if treated, they die quickly; but if not treated they last a long time.
No doubt that the above arguments will shock any physician. Yet they reveal a new dimension in medicine, optimality. The organism operates optimally in any condition. We all know that the organism maintains homeostasis (homeorhesis). What is less obvious that this is the best under circumstances. The organism is extremely complex and sophisticated. We shall never be able to grasp how it optimizes. All we need is to understand are its messages, which will direct our treatment for the benefit of the patient.