Habit can send cancer patient's chances up in smoke

Editor's note: This is the second in a series of columns about smoking cessation from medical professionals at Providence St. Mary Medical Center.

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As a medical oncologist, one of the first issues I think about when counseling a patient with cancer concerning choices and prospects for treatment is whether that individual is actively smoking.

I know from experience that people who choose to stop smoking greatly enhance their chances of getting a remission of cancer from treatment when compared to those who continue. The reasons are several.

Oncologists are just becoming aware of the dynamic nature of the interaction between a developing cancer and the host individual's body that contains the disease.

Oncologists are becoming aware that this relationship can be influenced on a day-to-day basis both positively for the purposes of treatment but also adversely from factors that untowardly affect an individual and weaken that individual's ability to counteract the growth of the cancer.

Treatment of cancer by itself is often no match for such a disease, but instead needs a continuous contribution from the individual to succeed.

These host cancer-resistance factors are centered around the immune system, which plays an ongoing and major role in helping our body control the progression of cancer.

When we take steps to strengthen the immune system, such as when an individual ceases smoking, we act to arm it with its normal anti-cancer abilities, which together with effective cancer treatment cancer then achieve and maintain a cancer remission.

An important corollary to this is that smoking cessation also acts to reduce chronic inflammation. Chronic inflammation is an inevitable consequence of smoking and harms the immune response to cancer by acting as a distractant to the system and helping to camouflage the cancer.

This serves to prevent immune cells from doing their job in ridding the cancer from the body. Chronic inflammation greatly helps the cancer by keeping the immune system preoccupied and off balance.

Smoking is the most common cause of environmental carcinogenesis. The hydrocarbon byproducts of tobacco smoke are potent aromatic chemicals that continually overwhelm the body's normal means of detoxification.

These chemicals act to promote cancers occurring throughout the aero-digestive tract, starting in the mouth, the pharynx, the esophagus, the lungs and then right through to the pancreas, the kidneys, the bladder and even the rectum.

Any of these mucosal surfaces that are touched by these hydrocarbons begins the transformation process to becoming a cancer. It is no wonder then that smoking accounts for nearly half of all the cancers that occur in this country.

These toxic smoke chemicals also contribute to a wasting of the body's normal nutritional resources such as vitamin stores that the metabolism uses to conduct normal metabolic activities.

Chronic tobacco exposure drains the body of its vitamin resources, which further weaken cancer resistance. No matter how much vitamin supplementation the smoker chooses to take, smoking sends those vitamins literally "up in flames".

When I counsel patients about smoking cessation, I like to use the metaphor of a firefighter coming to your house to put out a fire.

The first thing firefighters will do when they get to the house is to turn off the gas supply. The first thing an oncologist must do when treating a patient's cancer is use the same approach and provide resources for an individual to make that same choice.

Dr. James Cunningham is a medical oncologist and the medical director of the Providence St. Mary Regional Cancer Center.

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