Cancer

The battle against cancer

Discoveries, innovation, and hope for quality of life.

A cancer diagnosis means, first and foremost, one thing: chaos. Fear and uncertainty spread among patients and their families. Above all, it is essential to seek treatment from competent doctors and carefully consider conditions and options to find the best treatment for the patient. It can be either an individual treatment plan or palliative care.

Cancer is a change in the body's naturally existing cells. Healthy cells in the body grow, develop, and divide without problems, and death is regulated. In the case of cancer, this structure is missing; the cells divide uncontrollably and form a tumour [1]. Malignant tumour cells penetrate deeper and deeper into adjacent tissues, i.e., neighbouring organs and lymph nodes, multiply, and destroy their surroundings.

The result of the spread is often metastases. Metastases are secondary tumours, i.e., malignant tumours formed due to the spread of tumour cells to another part of the body. Malignant tumours can affect all aspects of the body. Statistically, malignant tumours most commonly form in the breast in individuals with female reproductive organs and the prostate in individuals with male reproductive organs. Lung cancer and skin cancer are in second place[2]. In 2020, just over 45,000 cases of cancer were diagnosed - that's 123 cases per day.

Life with and after a Cancer Diagnosis

Cancer is not just a medical condition; it is a journey that takes us through an emotional rollercoaster, filled with challenges and triumphs. In Denmark, cancer patients face unique aspects of this journey, from diagnosis to treatment and the subsequent healing process.

• The Reality of Diagnosis: Hearing the words "you have cancer" changes everything. Danish cancer diagnostics are characterized by advanced medical technology, but it is also a time when the patient's emotions and concerns are taken seriously. The Danish approach focuses on providing patients with clear information and support from day one.

• The Path of Treatment: Denmark offers state-of-the-art cancer treatment, and cancer patients have access to some of the newest and most effective treatment methods. The holistic approach also includes psychosocial support, integrated into the patients' treatment plans.

• Unity and Support: Being part of the Danish healthcare system means having a network of professionals and support groups at hand. Cancer patients in Denmark experience a high level of care and encouragement, from the medical staff to their own communities.

• Life After Cancer: The journey doesn't stop after treatment. In Denmark, there is a focus on rehabilitation and support to return to normal life. Patients are closely followed, and aftercare is provided to handle the emotional and physical challenges that may arise after survival.

• The Importance of Awareness: While treatment is progressive, awareness and prevention remain crucial. The Danish healthcare system emphasizes educating society about symptoms, screening, and lifestyle choices to reduce the risk of cancer.

While the challenges are real, there is also a strong sense of unity and hope. The Danish approach to fighting cancer is a story of courage and a reminder that even in the darkest times, light can be found in community.

Cancer Diagnosis

Cancer is often diagnosed through screening, but in other cases, it is discovered incidentally during a medical examination. Some patients contact their doctor due to symptoms suggesting a tumour. Such cancer symptoms can include lumps in the breast, frequent vomiting, neurological changes, or difficulty breathing. However, tumour diseases are often asymptomatic for a long time, so it takes a while to identify the symptoms. Therefore, competent doctors who take their patients' complaints seriously and examine them thoroughly are needed.

If there is suspicion of a malignant tissue change, imaging procedures such as ultrasound, X-ray, computed tomography (CT), or magnetic resonance imaging (MRI) are suitable for obtaining initial indications, depending on which part of the body is affected. The next step is for the doctor to take a tissue sample to confirm the diagnosis. This can be done on many organs without surgery. With an endoscope, the body's cavities and hollow organs (e.g., intestines, stomach, bladder, or lungs) can be examined under visual control, and a tissue sample can be taken. In harder-to-reach places, the tissue sample (biopsy) is handled differently. Either doctors puncture the organ through the skin with a needle or remove the tissue during surgery. The sample is analysed in the laboratory to determine whether the tumour is benign or malignant.

The Different Stages and Their Significance

Oncologists classify cancer into different stages to better assess and monitor the disease's status and its development. Different scales can be used to classify the disease. Each type of cancer has its particular staging system. This means that stages do not represent the same for all types of cancer.

The most widespread classification scale is the system from the International Union Against Cancer[3] (Union Internationale Contre le Cancer, or UICC). The classification tool, called the TNM scale, stands for tumour, node, and metastasis. The following aspects are assessed:

Size and spread of the primary tumour → T

Are there local or adjacent lymph node metastases? → N

Are there distant metastases present? → M

Behind the letters are numbers that reveal details about the tumour. The so-called grading indicates how aggressively the cancer develops, i.e., how dangerous it is classified. The scale divides malignancy into four levels:

T1-4 indicates the size of the node

N0-3 indicates how widespread the spread to lymph nodes is

M0-1 indicates whether there is spread (metastasis) to other organs

If a node is, for example, designated 'T1, N0, M0', it means that it is tiny, has not spread to lymph nodes, and has not spread to other parts of the body. The lower the number, the less the disease has spread.

Can Cancer Be Cured?

When it comes to the chances of curing cancer, both the stage at the time of diagnosis and the type and aggressiveness of cancer cells play an essential role. Cancer tumours detected early can, in the best case, be surgically removed and require no or only a few additional treatments.

If the cancer is more advanced, treatment becomes even more difficult. In such cases, patients, together with their oncologists, must weigh whether they will choose drug-based cancer treatment or palliative care.

In addition to the surgical removal of the tumour or metastases, chemotherapy and radiation are usually the means chosen to treat cancer. The treating oncologists individually determine the sequence of treatment. In some cases, reducing the tumour’s size using medication or radiation before removing the affected tissue during surgery makes sense. In other cases, the opposite approach may be more promising - the goal is to destroy any remaining cancer cells with subsequent chemotherapy.

What does chemotherapy and radiation[4] mean? A brief overview:

Chemotherapy: During chemotherapy, shortened to chemo, patients receive one or more drugs at specific intervals (cycles) to combat cancer. Patients receive the chemotherapy drug(s) for one or more days, followed by a break for recovery. There are usually four to six such treatment cycles. The drugs are called cytostatics and are administered as tablets or infusions through a port catheter.

Cytostatics disrupt the cancer cells' division cycle and, thus, destroy them. The drug does not distinguish between malignant cells and normal tissue. Still, the effect on cancer cells is more noticeable because they divide faster and are more susceptible to chemotherapy. Side effects of chemotherapy include nausea, vomiting, hair loss, and severe pain.

Radiation therapy: Radiation therapy is a locally acting treatment - it only destroys cells in the irradiated area. The effect of ionising radiation or particle radiation damages the cells' genetic material, stops cell division, and causes the cells to die. As a result, the malignant tumour becomes smaller or disappears altogether.

Radiation therapy also damages healthy body cells. In most cases, however, the cell’s repair systems can repair the damage. The ability is more pronounced in healthy cells than in malignant cells, so healthy cells regenerate while cancer cells die and are eliminated by immune cells. To enable this process, radiation therapy is also given at multiple intervals. The sessions are called fractions.

There are different forms of radiation therapy: internal radiation and external radiation. Not all forms of radiation therapy are suitable for all types of cancer, so the oncologist decides the most appropriate treatment. In external radiation therapy, patients lie on a bed under a radiation apparatus. The most modern technology allows for precise irradiation of the affected organ. Internal radiation is called brachytherapy, where the radiation source is placed directly on the tumour. This allows irradiating the tumour with a relatively high dose while sparing the surrounding tissue as much as possible.

What Impact Does Medical Cannabis Have on Cancer?

The suffering of cancer patients is often so severe that the effect of conservative medicine reaches its limits, or they must be administered in such high doses that the side effects become a new problem. Medical cannabis can be a supportive treatment in some of these cases with far fewer undesirable side effects. Some of the cannabis side effects are even quite desirable:

Serious illnesses often lead to depression. In a study of cannabis as medicine for nausea and vomiting associated with medical cancer treatment[5], researchers found that cannabis' mood-lifting effect was a thoroughly desirable side effect.

Cannabis for nausea and vomiting during chemotherapy

Since chemotherapy, which works throughout the body, also disrupts cell division in healthy tissue, cancer patients suffer significantly from the side effects of the cytostatic drugs.

The appetite-stimulating effect of cannabis can help patients alleviate nausea and vomiting. In the study mentioned above, cannabis treatment was significantly more effective in relieving patients' symptoms than conventional medicine[5].

Cannabis as a pain reliever

Cancer patients often suffer from severe chronic pain due to their illness. Conventional pain relievers are not sufficient to relieve the symptoms, and opioids are often the only effective remedy. However, taking these drugs usually has side effects that patients find very uncomfortable. Several studies[6] suggest that cannabinoids may be effective against severe chronic pain, especially nerve pain (neuropathic pain). In comparison, the side effects of cannabis (such as dry mouth or drowsiness) appear to be better tolerated.

Cannabis in palliative care

Cancer cannot permanently be cured, and therefore, palliative care is an essential part of treating cancer patients. Palliative treatments should make the remaining time as comfortable as possible for patients. The focus is no longer on healing but on the quality of life. Optimal pain management is crucial, as is relief from nausea and vomiting, loss of appetite, depression, and neurological conditions such as seizures. Recent research[7] has shown the benefits of cannabis in the palliative treatment of tumour patients in several studies.

Criteria for the Prescription of Medical Cannabis

The responsibility for medical treatment with cannabis always lies with the treating doctor. Therefore, it is the doctor who determines whether a patient should be treated with medical cannabis.

According to the cannabis guidance from the Danish Medicines Agency:

• Relevant approved marketed drugs should be tried before attempting treatment with medical cannabis.

• Cannabis should not be used for children and young people under 18 years of age due to a lack of knowledge about long-term effects, including cognitive development.

• A doctor can prescribe a maximum of one month's supply on a prescription.

• Doctors, as a rule, should not treat with medical cannabis outside their area of expertise.

Furthermore, the Danish Medicines Agency has approved a few patient groups and indications, including nausea and vomiting during chemotherapy, for the use of medical cannabis as a patient in Denmark. You can read more about relevant indications for prescription here.

References

1. Kræftens Bekæmpelse: Hvad er kræft? - Kræftens Bekæmpelse (cancer.dk)

2. Kræftens Bekæmpelse: Hvor mange får kræft? - Kræftens Bekæmpelse (cancer.dk)

3. Sundhed.dk: Brystkræft, fakta - Patienthåndbogen på sundhed.dk

4. Region H: Medicinsk kræftbehandling (rigshospitalet.dk)

5. Tramèr, M. R. et al. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ 323, 16 (2001).

6. Cannabis and Cannabinoids (PDQ®)–Health Professional Version - NCI. https://www.cancer.gov/about-cancer/treatment/cam/hp/cannabis-pdq.

7. Doppen, M. et al. Cannabis in Palliative Care: A Systematic Review of Current Evidence. J Pain Symptom Manage (2022).