Cancer Doesn't Care - Pelorous

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Group Activities One Family’s Story Chai is experienced in establishing and running groups which meet the needs of our clients, and complement and enhance the one-to-one counselling and therapies we provide. As we are responsive to client suggestions new groups are often formed. All clients are welcome to attend a group – even if they just want to try it once or know that they cannot attend regularly. Art Workshop In the weekly group our clients are astonished at their own achievements, even if they have never attempted to paint or draw before. With guidance from professional artist Linda Sharpe and her volunteers, clients learn and release new talents, enjoy tea and cake, and often make new friends. For the last 3 years Chai’s Rosh Hashanah card has been designed by a group member, and last year a vibrant calendar was produced using their paintings – with their kind permission of course. They are already planning next year’s calendar! Bereavement Group* This group is run by professional counsellors for our clients who have sadly lost their partner. Within the group our clients are safe to express their feelings in a supportive and empathetic place. Breast Buddies* Breast Buddies, facilitated by our professional counsellors, is specifically for women with breast cancer. It meets on the first Thursday of each month and group members have an opportunity to get and give support, as well as gather information in a safe environment. Laughter Yoga Laughter Yoga is a combination of self-triggered laughter and yoga exercises which increases the amount of oxygen in your body. The resulting feelings of health and energy change the physiology of the body – so you start to feel happier. You don’t even need a sense of humour, just a willingness to laugh! Laughter Yoga is.... that you start to feel happier. Meditation Our highly-experienced facilitator uses visualisation to promote positive feelings through deep relaxation. Many clients who have practised visualisation in the session frequently use it in their daily lives, and find it a very helpful aid to reducing stress and relieving anxiety. Pilates Pilates is a form of exercise which uses small, controlled movements with an emphasis on core stability to strengthen and tone the body. It is able to help reeducate the body, promoting flexibility, postural alignments and musculo-skeletal balance. Pilates assists in relieving stress and tension while providing physical fitness and a sense of wellbeing. Chai has pilates classes on Mondays and Thursdays, with classes for beginners and advanced beginners. Post Breast Surgery Exercise Group* Regular arm exercises performed soon after breast surgery will regain and maintain joint flexibility and muscle strength, and decrease scarring. Neck and shoulder discomfort due to muscle tensing to protect the wound can be alleviated with regular, planned exercise. Exercises are important during, as well as after, radiotherapy which can cause tightening of the shoulder. This group is led by one of our Chartered Physiotherapists who provides group and individual guidance and advice. The group is suitable at any time after discharge from the hospital. Wednesday Afternoons On alternate Wednesday afternoons, our clients and our enthusiastic team of volunteers, enjoy a range of activities from cards to games to quizzes. Some clients come regularly just to enjoy the company, conversation and refreshments. Four times a year our Wednesday afternoons welcome professional entertainers. Yoga Our expert yoga teacher has been practising for over 20 years. Her class is suitable for all levels – with individual attention given, and can help to reduce stress and assist the body to improve its health and wellbeing. Sandra “It was around Pesach a year ago that I first noticed the lump in my breast. Although I went for tests straight away, it wasn’t until the summer that it was decided that the lump should be removed. By this time I had Grade 3 breast cancer. This was a terribly confusing time for me, and for my husband Ian. I felt a huge pressure to be ‘brave’, to carry on as normal and most importantly to ensure my children did not notice any changes in my role as their mummy. My family and friends were marvellous, but Ian sensed that I needed specialised, expert support. He made the call to Chai. Since being in touch with Chai last September, I have been receiving counselling, massage and reflexology at the centre in Hendon and also in my own home. Chai has been my haven, allowing me to show the side that I can’t show at home, and giving me the support and strength to continue my battle. Ian & Ruthie “It hasn’t been an easy year for us. Shortly after Pesach last year my mother passed away, and then Sandra was diagnosed with breast cancer. Our children have always been Sandra’s main concern. They are very sensitive to their surroundings – and can always tell when their mum needs a cuddle! They seem to be coping well, however Sandra’s cancer and the side effects of her treatment meant she hasn’t always been able to be there for them. Chai helped us think through how and what we told the children. My mother-in-law Ruthie has been so supportive and is amazing with Sandra and the kids. She finds it really hard to watch Sandra suffering, so she has also been going to Chai for regular counselling. And, I know Chai’s door is always open for me too. Chai’s services have made the world of difference to Sandra, and I am truly grateful that she has a space where she can focus on herself, without having to worry about the rest of us.” “My family and friends were marvellous, but Ian sensed that I needed specialised, expert support. He made the call to Chai.” *All groups are available to anyone affected by cancer, 18 20 years of cancer support in the community be it patient or family, except where specifically indicated. 20 years of cancer support in the community 19
Colorectal <strong>Cancer</strong>: Mr Daren Francis How common is bowel cancer? Bowel cancer is the third most common cancer in the UK. Each year 35,000 people in Britain are diagnosed with cancer of the colon or rectum. Unlike certain other cancers bowel cancer can often be cured. The mainstay of treatment is surgery however chemotherapy and radiotherapy are playing an ever more important role. New treatments are being introduced all of the time making survival even more likely. One thing we know for certain is that the earlier bowel cancer is diagnosed the greater the chance of cure. How does it all start? The colon and rectum is lined with millions of cells which over a person’s lifetime shed and are then replaced. The replacement of these cells is very strictly controlled and regulated by genes. If this process is faulty in any way then the growth of these cells becomes abnormal and leads to the formation of a polyp. This polyp is the first step towards cancer. Polyps Once the polyp has been formed it starts to grow. From a tiny bump on the lining of the bowel it increases in size. This can occur over many years and some polyps remain benign throughout life. However approximately one in ten polyps will turn into a cancer. As a rule of thumb the larger the polyp the more likely that it will be cancerous. We are less concerned about polyps less than 1cm in size. We know that the majority of all the cancers of the colon and rectum start as benign polyps and if removed early enough prevent cancer developing. Polyp to <strong>Cancer</strong> – the process In some polyps the growth pattern becomes so disordered and fast that the cells become unrecognisable as polyp cells and become cancer cells. This is the first part of the change from a benign polyp to a malignant or cancerous polyp. As the cancer advances it starts to grow into the wall of the bowel and can invade the blood stream, lymphatics and nearby structures. When this occurs it is referred to as an invasive cancer. Once this has happened, the cancer can potentially “metastasise”. This means it can spread to organs far away like the liver and lungs to form secondaries or metastases. The cancer does this via the blood stream or the lymphatics. The importance of early diagnosis and screening Put simply the earlier the cancer is detected the better the chance of cure. As the cancer gets larger it invades more deeply and the chances of it spreading increase. Not all people have symptoms of bowel cancer which is why the Government has introduced the national bowel cancer screening programme. Screening gives the opportunity of picking up polyps or cancers when they are still curable. This programme is offered to all people aged between 60 and 75. It involves a simple stool test which is carried out in the privacy of ones own home. The symptoms of bowel cancer The process of the polyp turning into a cancer can take between 5 and 10 years. Early on in this process there are very little in the way of symptoms. The symptoms which develop later such as bleeding, change in bowel habit, episodes of diarrhoea and constipation are also common to other bowel disorders such as piles and irritable bowel syndrome making the diagnosis in some circumstances quite difficult. When a bowel cancer gets bigger it can sometimes lead to severe abdominal pain and even block the bowel which requires emergency treatment. In some cases bleeding from the bowel can go unnoticed and after a period of time the patient will become anaemic. How is the diagnosis made? Sometimes the doctor will be able to make the diagnosis by examining the abdomen or performing a rectal examination. If there is any doubt tests are needed. The most commonly used tests are: Flexible Sigmoidoscopy – following an enema to clear the bottom part of the bowel a telescope is inserted to directly inspect the lower half of the bowel. Colonoscopy – this test requires the bowel to be cleaned the day before the test using powerful laxatives. Again it is a telescope but on this occasion the entire large bowel is examined to check for polyps and cancers. This test is normally carried out with sedation as it can be a little uncomfortable. CT pneumocolon scan – this is an X- ray test and again requires the bowel to be cleared with powerful laxatives the day before the examination. A tube is not passed through the bowel but air is inflated to allow the bowel to be examined. It is good at detecting problems but unable to treat any polyps. The advantage of the flexible sigmoidoscopy and colonoscopy is that if there is a polyp or a growth in the bowel it can either be completely removed at the same time or a biopsy taken. The best test for each individual patient is selected by the specialist as not all the tests are appropriate for everyone. What happens after the diagnosis is made? Once the diagnosis of bowel cancer is confirmed the decision making process regarding your care is made by a team of specialists known as a multidisciplinary team (MDT). Further tests are organised including blood tests and special scans. This enables a full assessment of the primary bowel cancer and in addition the extent of spread. This allows for the planning of the most appropriate treatment. Treatment does depend a lot on the location of the cancer as there is a difference in the initial treatment of colonic and rectal cancers. Rectal cancers The planning of the treatment of rectal cancer is slightly different from colonic cancer as radiotherapy aimed at the cancer can shrink the tumour before surgery and improve cure rates. Following radiotherapy, surgery can then remove all of the tissue surrounding the cancer and leave none behind. This is known as a total mesorectal excision or TME. After the tumour is removed it is cut up and looked at under the microscope to decide if any further treatment like chemotherapy is needed. This is dependant on how far into the bowel wall the tumour has invaded and if it has affected any of the lymph glands which have been removed at operation Colonic cancers After the tumour has been assessed most colonic cancers are treated by surgery in the first instance. The surgery allows removal of the tumour and the lymph glands surrounding it. The specimen which has been removed is then looked at under the microscope and again the level of invasion through the bowel wall is assessed along with the number of lymph glands that are affected. This allows the planning of any post operative chemotherapy. With early cancers sometimes surgical removal alone is all that is necessary. Consequences of surgery With most cancers of the colon, after removal of the affected section the ends of the bowel can be joined together again. However with some cancers of the rectum (which are very close to the anal canal) it is not possible to leave enough rectum so as to allow the bowel to be rejoined. In these cases a colostomy is formed. This is an opening of the bowel onto the abdominal wall to allow the passage of stool after the rectum has been removed. What happens after recovering from surgery? The key to planning the treatment after surgery is the final histology of the specimen which has been removed. This is looked at under the microscope and the need for any chemotherapy decided by the MDT on a number of factors specific to the individual case. The role of chemotherapy is to improve the chances of cure. The specialist team continues to follow up patients with regular blood tests and scans. Advanced bowel cancer In some cases the cancer has spread to other organs and cure is not possible. In these cases sometimes surgery is not appropriate. On these occasions chemotherapy and radiotherapy play a major role in the treatment. These modalities can be very effective in controlling symptoms and prolonging life but careful consideration has to be taken to select a treatment which balances the side affects and the benefits gained. Implications for the family When people are diagnosed with bowel cancer at a young age (40 – 50 years) or when bowel cancer is very common within a family it could be because there is an inherited genetic abnormality. The risk of other members developing bowel cancer is assessed and they can be advised to undergo regular colonoscopies starting at a young age. The future and research The treatment for colorectal cancer continues to improve all of the time. Screening has meant earlier detection and endoscopic removal. Laparoscopic or keyhole surgery is allowing much smaller incisions and quicker recovery following surgery. Larger tumours are being shrunk with specific chemotherapy and radiotherapy to allow surgical removal. Liver and lung surgery is now possible for selected patients who have developed metastases with a view to cure. People with inoperable cancer are living with the disease as less toxic and more effective chemotherapies are developed. We continue to make people aware to watch for potential signs through various methods to make it easier to identify cancer at an early stage. Mr Daren Francis MBBS, MD, FRCS Daren Francis is a consultant surgeon at Barnet and Chase Farm Hospitals NHS Trust where he provides a Colorectal, Laparoscopic and General surgical service. He also works privately from Spire Hospital Bushey, The Garden Hospital and The Kings Oak and Cavell Hospital. For more information please visit Daren’s website: www.darenfrancis.co.uk 20 20 years of cancer support in the community 20 years of cancer support in the community 21
Page 1 and 2: Cancer doesn’t care 2010 Issue 5
Page 3 and 4: My Personal Reflections over the pa
Page 5 and 6: increasing demand. We also have sat
Page 7 and 8: Breast Cancer: Prof. Michael Baum &
Page 9: Growth of our Services: Elaine Kerr
Page 13 and 14: Q&A with Sir Ralph Kohn FRS and Lad
Page 15 and 16: Cancer Genetics - The Jewish Perspe
Page 17 and 18: Chai Promise Chai Promise, launched
Page 19 and 20: Lighten the load - One stress you c
Page 21 and 22: All proceeds to Chai Cancer Care ww
Page 23 and 24: Appealing to the Appetite: Healthy

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