Gastrointestinal : These diseases included gastritis , duodenal ulcer , gall bladder disease and spastic colon
- Gastritis – fifteen patients suffered from gastritis , the symptoms included pain , nausea , vomiting , flatulence , burning . The pain was variously described as dull heavy aching or spasmodic . The pain was often associated with nausea and vomiting . when the patient suffered from bilious attacks , the vomit was of food ,mucus and bile , head aches were common with bilious attacks being dull and heavy or migraine affecting either right or left frontal areas . Flatulence and burning were often relieved by eructation which were either bland or sour and bitter tasting.
Examination – in all cases tenderness of the pyloric antrum was present with spasm and in many muscular rigidity was found , flatulence , distesion also present in several patients .
- Duodenal ulcer –One patient suffered from duodenal ulcer , she complained of typical ulcer symptom with pain , flatulence and burning . the pain was relieved with food and antacids .
Examination- There was tenderness and rigidity of duodenum .
3) Cholecystitis : There was one case in the series . she suffered from pain in the epigastrium and in the right hypochondrium . the pain was dull ,aching and colicky in nature and was associated with nausea and vomiting .
Examination : Tenderness of the gall bladder and flatulent distension of the stomach were present .
4) Bowel –The bowel function varied , the action in many was sluggish or costive and one patient suffered from diarrhoea with excitement . Although one patient did not complain of any digestive disturbance it was found on routine examination that there were tenderness and rigidity of the stomach suggesting a diagnosis of gastritis of pre-ulcer state .cardiovascular disease .
In advanced stages of cancer debility , supervenes , associated with congestive heart failure , in one patient there was evidence of chronic myocarditis with dysphonea
,marked cyanosis and hypertension . In a second case Raynaud’s phenomena were present with extreme pallor and coldness of feet , diminished tibial pulses arterial
spasm of tibial arteries and pain in calves on walking even 100 yards .
Blood pressure: Blood pressure readings are normally variable even in healthy individuals . and the variation is often affected by emotional stress . In these series of 16 patients , 10 were found to be always with in normal limits e.g, anxiety ,grief , but became normal with relief of tension e.g, 152-114 with tension and 136-84 when relieved . In one case the blood pressure was persistently raised . This patient had been under severe emotional stress associated with melancholia . grief from unhappy love affairs and nursing her patients in their illness . The tension had persisted for a prolonged period with very little “let up”and this was reflected in her BP readings which showed little variation e.g, 182-120 , 186-120 . she also suffered from chronic myocarditis and alcoholism .
Respiratory tract : In eleven patients there were symptoms of respiratory tract disease ,in two patients there were nasal catarrh and sinusitis . In four there was uncomplicated bronchitis , usually chronic although acute bronchitis did occur in one patient had suffered from TB chest twenty years before the out set of carcinoma . Finally in four patients the lungs were involved in the process of the malignant disease , none were of primary lung cancer . three were eases of metastases involving the lungs , two being secondary to breast cancers and one associated with laryngeal cancer . The fourth case was secondary to ovarian cancer ,causing severe pleural effusion .
The condition was considered to be megg’s syndroma .
Head ache : Head ache was not a frequent symptom met with only five patients were affected by head aches considered severe enough for complaint in four , the site of pain was frontal , either right or left and some times alternating from side to side , the fifth patient had vertex head ache . In four patients the head ache were associated with digestive disturbances with gastric pain , nausea and vomiting . The pains were often aggravated by emotional disturbances . In one case , the type of pain occurred at a site of previous injury of skull ,the type of pain varied , being described as dull , aching , throbbing of shooting . In three cases migraine was diagnosed .
Endometritis : only one patient suffered from endometritis , this patient eventually suffered from uterine cancer , which a hysterectomy was performed .
Alcoholism : one patient was confirmed alcoholic for many years and also suffered from severe hypertension and chronic myocarditis .
Rheumatoid arthritis :the interest in this patient lies in the fact that the rheumatoid arthritis followed several years after the malignant disease , five years after colectomy , she suffered from acute rheumatic fever which later developed the early phase of rheumatoid arthritis . Fortunately she recovered completely from arthritis and at present is clinically free of symptoms and signs of permanent damage to joints .
Sleep : The difficulties of sleep are always a problem in cancer cases . These sixteen patients all had difficult –ties with insomnia before and during the course of the disease . There were two principal causes for the insomnia
1.pain and discomfort 2. emotional disturbance .
pain and discomfort – these symptoms were present in all patients and could be very severe when the cancer was well developed , they were there fore very potent causes of insomnia.
Emotional disturbance and distress ,when a patient was under the influence of emotional stress e.g, anxiety , worry , fear apprehension , grief or resentment , then the resulting tension was a cause of insomnia which was difficult to relieve or eliminate , the severity of stress varied ,in most cases , it was severe although in some patients even a slight degree of stress could lead to severe insomnia , during the period of wakefulness physical symptoms could be aggravated e.g, head aches , pain of digestive disturbance such as gastritis or duodenal ulcer ,etc. thus a vicious circle was established associated with emotional stress and tension , insomnia and physical symptoms , head aches etc. the difficulties in treatment were bound up with attempts to break this vicious circle .
Psychological symptoms : From a study of the personality of the patients , one is able to appreciate the process of development of psychological symptoms . All patients were considered “nervous” or suffering from “nervous tension”, although each patient had his own pattern of reaction to a stress situation , in this study
broad groupings of the various types of reaction were found . they may be classified in three groups .
- In this group various forms of the fear reaction were found .
- Fears of the unknown death , dark and being alone.
- Anxiety and worry over various things –triffles ,work domestic and other personal relationships .
- Apprehension and anticipation about future events and want of confidence in work , business etc.
- Phobias , e.g, cancer phobia ,before the onset of cancer .
- In this group various form of depressive reaction appeared .
- Depression varied in degree from mild leading to a severe reaction to the point of melancholia , some even have had suicidal thoughts .
- Grief , varied in degree from slight to severe and profound often with a sense of acute loss of dear and loved ones . The depression was usually relieved by weeping , although some patients considered weeping a childish reaction and suppressed it frequently with an aggravation of the somatic illness .
- Nursing loved ones and sympathetic to others in illness , nursing loved ones imposed an increased strain- different from the impersonal attitude of a devoted nurse .
- In this group appeared those patients who showed an active aggressive
reaction to the stress situation , even to the extents of hostility.
- Anger –This was the reaction to
a stress situation which annoyed and
- Resentment —This was shown when reaction patient had sense of injustice resulting from the stress situation .
- Frustration ,reaction to a situation in which the patient felt he could not obtain his objective due to what he considered obstruction .
The emotional reactions to stress were never simple or confined to one type ,e.g, the fear or depressive reaction . The response of the patient was governed in part by the pattern of his personality and was often complex ,e.g, was composed of the fear and depressive reactions .
One patient was nursing her mother . She had a sense of fear and apprehension regarding the outcome of the illness . and also grief towards her mother in her
illness . A second patient was hurt by the actions of her fiancé . When she was jilted , she reacted by feeling aggrieved at the loss of her self-esteem and also resentment towards her fiancé because of being hurt and jilted , Operative treatment was performed on twelve patients with relief to all patients . Two patients were found inoperable , one carcinoma of the breast and one rectal cancer . Two patients refused operation , metastatic spread developed in five patients the period . after operation ,varying greatly . The shortest time was one year after operation and the longest 15 years . The liver and lungs were principally involved . 3 of the original
16 patients have already died . The period of post operative survival has varied , the shortest known being 2 years and the longest 15 years . This study has been concerned only with the presentation of the tacts of the somatic and psychological symptoms of the cancer patients . Prior to the onset and development of cancer from these facts it is possible to consider a hypothesis that cancer may be a stress or psychosomatic disorder associated with such stress stimuli as worry anxiety , fear , grief , resentment , etc, . It has long been recognized that the onset and development of cancer are comparatively gradual and insidious . The possible association of emotional stress with the onset of cancer may not be immediately apparent . It is there fore necessary that a detailed history be taken to include the early manifestations of emotional stress and to associate these with the parallel development of somatic disease . when these facts are available , it is possible to compare the origin of cancer and its links with stress with the criteria used to define a stress disorder .
1.It begins at a time of crisis in the patient’s life
2.It shows a time correlation with situations provoking stress in the patient .
3.It clears up when the stress situation changes for the better .
The illness begins at a time of crisis in the patient’s life , this suggests a sudden or rapidly developing stress situation and a reaction both psychological and somatic occurring either immediately or with in a short space of time . If this criterion is applied to cancer patients then it is not acceptable . The circumstances of these 16 patients were not comparable to the acute sudden and rapidly developing illness of the stress disorders suggested in the definition . In the cancer cases , the stress was not sudden and acute but slow , gradual and maintained over a long period , the patient’s health was not sudden attacked by acute stress , but gradually undermined
by slowly developing stress and somatic illness , this form of emotional stress has a cumulative effect over a period and ended with the development of cancer in such circumstances might be rationally considered a crisis , since the cancer appeared at the end of a period of prolonged stress . If this definition of the effective stress in the cancer patient is accepted , then it would fulfill this first criteria of a stress disorder .
It shows a time correlation with situations provoking stress in the patient , when the development of somatic illness in response to stress is followed in the cancer patients , then the time correlation is easily recognized . In the cancer patient’s in the early phase of their illness when the somatic disease was benign , the developing physical symptoms were aggravated under the influence of severe stress and relieved when the stress subsided and passed off it is important to note the association of constantly recurring emotional stress with somatic illness developing side by side . This is a criterion of other diseases which are already recognized as psychosomatic disorder , so that the development of cancer in these cases as a psychosomatic disorder is similar to other stress illness
The disease or illness clears up when the situation changes for the better . This criterion is most difficult to fulfill in cancer patients . Owing to the fact that in so few instances does cancer under go spontaneous regression and cure . There are some such cases reported , but in the majority of cases the pathological changes are irreversible even when the stress is relieved circumstances are favorable for improvement .
cancers that may be stress related :
At present the evidence is suggestive but it is certainly not proven scientifically that stressful events may be a contributory cause of cancer , The strongest evidence that stress full life changes can trigger certain cancers is for cancer of the colon , cancer of the rectum , breast cancer and lung cancer . How ever , it is very unlikely that this triggering effect of stress is only present for these cancers . The more likely explanations is that all cancers can be triggered by stress full changes and by the emotional change which is often associated with these stresses and that these four cancers and there fore have been more extensively studied by scientists than the less common malignant tumors .
How stress might trigger cancer :
Scientists are still piecing the clues together and at present the explanations of how stress may be a triggering factor in the appearance of a cancer should be regarded as speculative , extensive studies in certain well defined groups of individuals who are known to be under major stresses , such as among those who have had a bereavement and who do not adjust and remain in grief for an abnormally long period of time , have shown that their immunity often becomes depressed , so that they are more susceptible to various illnesses including cancer . this lowering of the immunity interferes with the normal capacity of the body to eliminate the occasional cancer cell which may be present in the body . this depression of the immune state allows the multiplication of these cells and as result a lump appears , say in the breast , which is then diagnosed as breast cancer .
STRESS MANAGEMENT IN A CANCER PREVENTION PROGRAMME
At present scientists cannot say with certainity that reducing one’s stress level will decrease the risk of developing a cancer , the evidence for this is mounting , suggesting that stress can be a trigger for the appearance of a cancer but the evidence is not nearly as strong as say for diet , smoking and inherited factors , nevertheless , I present some methods which may be useful in reducing your stress level , in the knowledge that if performed correctly , they can do you no harm , your life is likely to become more vital and enjoyable and as a bonus , your chances of developing a cancer or other illnesses may also be reduced .
Given that avoiding stressful situations cannot often be achieved , we turn to the many ways in which we can.