Sunday 4 February is World Cancer Day, an annual initiative to support those living with cancer and to promote funding and research into all forms of the disease. With an older population and huge advances being made in treating many other diseases, the overall rate of cancer incidence is rising. That means that while only a few years ago our lifetime risk of developing cancer was around one in three, it is now considered by Cancer Research UK to be around one in two.
The good news is that with improvements in cancer diagnosis and treatment, more people are also surviving the disease. The rate of some cancers is dropping dramatically, for instance lung cancer, as a result of the reduction in smoking, although the rate of reduction in men is offset somewhat by a gradual increase in the rate among women, due to the later uptake among women.
Today’s news has reported that for the first time deaths from prostate cancer have overtaken deaths from breast cancer. While advances in breast cancer management are not at the detriment of other cancers, this does demonstrate that where financial resources and political will exists, there is significant potential to reduce the mortality from cancers.
Does that therefore mean that those suffering from less common cancers are at a disadvantage through lack of funding into their specific disease? Research shows that some cancers are funded at a far higher level than others. When the level of overall funding is measured against years of life lost from cancer, some cancers do fare better, the ‘winners’ being breast cancer, prostate cancer and leukaemia. Other types of cancer such as pancreatic and uterine cancers are far worse off.
Cancer involving the spinal cord is another of the poorer performing cancers in terms of funding. It can arise either as a primary cancer within the spinal cord, or as metastasis from another location in the body. As a result of the presence of the tumour causing compression on the spine, patients can experience debilitating effects, including severe pain, weakness, changes in sensation, loss of bladder and bowel control, and loss of sexual sensation/function.
This is sometimes manifested as Cauda Equina Syndrome (CES), where the nerve roots at the base of the spine are compressed. Among most people CES is a little known condition, and while it is routine for doctors to be trained in spotting the signs, it is still common for the red flags symptoms to be missed. Back pain, when combined with loss of sensation, particularly around the ‘saddle area’, genitals and anus, or altered sensation when passing urine or faeces, should prompt swift examination and in most cases should lead to a rapid MRI scan to determine the cause of the symptoms.
It is most common to see CES as a result of intervertebral disc rupture, which tends to lead to a more rapid onset of symptoms, but there can be other causes, including tumours, along with haemorrhage, injections, or spinal surgery. Once the Cauda Equina has been compressed for a period of time, the damage is often irreversible, and while the onset of symptoms from tumours can be more gradual, it is still essential that treatment is sought and in many cases emergency surgery is required.
Early surgical decompression will often treat the debilitating symptoms, and even in cancer patients when treatment can only be palliative, avoiding the distressing effects of CES is still extremely important.
Philippa Luscombe, a partner in the clinical negligence team who is part of the CES specialist group at Penningtons Manches, commented: “All cancers have the potential to impact people’s lives in numerous ways and World Cancer Day is an important initiative to keep cancer in the public consciousness and to encourage funding. We should however ensure that the less common cancers do not get left behind in the competition for funding.
“There are still far too many cases of delayed diagnosis of CES in all its forms but increased funding is likely to bring increased awareness. As soon as breast lumps in women, or testicular lumps in men are noticed, our minds turn to the possibly of a cancer diagnosis and we should also be as alert to the signs of CES which can help prevent a potentially devastating condition.”