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Cellular Cancer Therapy, part 8
Carcinomas of the endometrial lining of the uterus occur less frequently than cancer of the cervix and comprise 2% of the cancers found in women.
Pathology. There are two types: the discrete tumor, a mass which may or may not be polypoid and in general is exophytic; and the diffuse tumor which affects the whole cavity with a pale fragile covering of tumoral tissue that exudes mucous and blood.
Diagnosis. Pelvic bimanual exploration, concentrating on adherence, uterine growth, masses, asymmetry and fixation can be used for diagnosis. Postclimateric bleeding may occur, but this may be due to a carcinoma of the cervix.
Treatment. We use Donatian Therapy.
Prognosis. Prognosis in general is quite good for an endometrial carcinoma. A tumor that disseminates slowly and a female population that consults as soon as the first symptoms appear are definite therapeutic advantages for the doctor. Two—thirds of the patients consult their doctors with localized carcinomas. We have achieved a 60% rate of cure in 30 patients with this form of malignant neoplasia.
Carcinoma of the Derinal Velamen (? Vellosidades corionicas)
We have only treated two patients with this neoplasia and both were cured with the use of methotrexate in addition to Donatian Therapy.
The Incidence of this type of cancer has increased in recent years and now comprises more than 5% of all cancers in women.
Pathology. According to Abell there are 4 histologically distinct types that deserve attention here: tumors originating in (1) the germinal epithelium, (2) the germinal cells , (3) the specialized cells and (4) the non-specialized stroma.
1) Tumors of the Germinal Epithelium. According to San Martino there are 5 subclasses:
a) Serous Tumors. These represent 40% of ovarian tumors, half are malignant, the other half benign. They occur bilaterally, are very invasive and destructive.’ Examples are: serious cystadenoma, serous papilloma, malignant cystadenocarcinoma and serous papillar carcinoma.
b) Mucinous Tumors. These are not as common as the serous type. They are multicystic and reach very large proportions. We have always believed that these were teratomas and that their mucinous cells represented metaplastic intestinal epithelium. They are less malignant than the previous type. Representative examples are: mucinous cystadenoma and mucinous cystadenocarcinoma.
c) Endometrial tumors. Cystadenoma and cystadenocarcinoma. These are less malignant.
d) Brenner’s Tumors. These can come from: 1. Residues of Walthard cells, 2. Metaplasia of the germinal epithelium and 3. Metaplasia of some previous mucinous tumor.
e) Mixed tumors. In general these are solid and not classifiable.
2) Tumors of Germinal cells. There are three types:
a) Disgerminomas. Malignant tumors found in girls.
b) Teratomas. The most frequent is the dermoid cyst.
c) Mixed tumors.
3) Tumors of the specialized stroma
a) Tumors of the granulous capsule (? teca). These secrete estrogens and the major types are those of Setoli and arrhenoblastomas. Tumors of the Sertoli cells produce estrogen in women; tumors in the Leydig cells produce testosterone.
b) Arrhenoblastomas produce hormones, predominantly masculine ones, that virilize women, though we have treated patients in whom the arrhenoblastomas produced progesterone with subsequent hyperfemininization.
4) Tumors of the non-specialized stroma. The most common is the peritoneal pseudomyxoma, which is nothing more than the proliferation of encysted mucin on the peritoneum.
Diagnosis. Up until now, 75% of the patients with ovarian carcinoma reach an incurable stage by the time they are diagnosed. Diagnosis of this type of tumor is very difficult; exhaustive bimanual pelvic examination, and x—rays are useful. We have found that with the use of the Oncodiagnosticator, correct diagnosis has increased to 95% when the symptoms have not yet appeared, and the patient still has a 90—100% chance of a definite cure. The most common type of ovarian carcinoma, the serous tumor, averages 25-50% cures.
CANCER OF THE VULVA AND THE VAGINA
In the polystratified squamous epithelium of the vulva and vagina squamous or epidermoid tumors may appear. These are practically the same as those described for cancer of the skin.
Frequency. Approximately 5% of the cancers found in women are of this type.
Pathology. Carcinoma of the vulva generally grows slowly, as does a differentiated squamous tumor of the labia majora. It can appear as an ulcerating, papillar, or exophytic tumor. It may bleed and metastasize to the lymph nodes of the inguinal lymphatic network. Vaginal carcinoma develops as an undifferentiated carcinoma in the upper third of the vaginal arch.
Diagnosis. Diagnosis is very simple, the patient need only be observed. Any ulcer of some duration that bleeds or becomes purulent, when found in the interior of the vagina, should be considered cancerous until proven otherwise.
Treatment. We use Donation therapy and frozen cyto—ovulum (?),
The bladder has a transitional epithelium between the squamous and basal layers, so these tumors are quite homogeneous and make up 3% of the cancers found in man.
Pathology. Many tumors of the bladder seem to begin as papillomas or carcinomas of the first degree transitional cells. Histologically there are three recognized kinds of transition cell carcinomas:
1. Papillomas,
2. Differentiated Carcinomas,
3. Anaplastic tumors,
Diagnosis. The most specific sign is hematuria, which is macro or microscopic but the quantity is not related to the size of the tumor. The Oncodiagnosticator is our basic diagnostic tool, and subsequently, if the physician so desires, cytoscopy, which permits him to inspect all of the areas of epithelium in detail.
Treatment. When they are papillomas, fulguration is the preferred treatment. In the case of infiltrating tumors, we have only achieved some results with Donatian therapy (20% rate of cure).
Prognosis. Except for papillomas, prognosis is not very promising.
There are three types: tumors of the parenchyma, of the renal pelvis, and those of Wilms, in children.
Frequency. These make up 1% of human cancers and are three times more frequent in men than in women.
Pathology. 80% of renal Carcinomas are adenocarcinomas of the renal parenchyma, which originate in the cells of the proximal and distal collecting (?? contorneados) tubules. These have been named hypernephromas, and microscopically three varieties can be distinguished:
a) Diffuse papillary type,
b) Granulous cell type,
c) Clear cell type.
The group of the epidermoid tumors of the renal pelvis make up 10% of the renal tumors.
Wilms’ tumors comprise a large portion of the malignant neoplasias in children, and originate in embrionary renal tissue. In general they appear before the child reaches 7 years of age. They grow quickly, distend the kidney and its capsule, finally rupturing the perirenal tissues.
Diagnosis. Prolonged painless hematuria; hematuria in the case of carcinoma of the bladder is painful. With these tumors infection also occurs frequently as well as shivers and bouts of slight fever. Death comes from septicemia.
Wilms' tumors are usually diagnosed from the mass present in the abdomen, These tumors rarely provoke hematuria. First we use the Oncodiagnosticator and then excretory urography is the second best diagnostic technique, followed by (centelleografia ??) in the hands of a very experienced diagnostician. Arteriography has been shown to be very useful to determine the presence of renal masses and to distinguish between cysts and cancers, The former have no blood vessels, whereas the latter have many aberrant ones.
Treatment. We use Donatian therapy and cyclophosphamide, which is the cytostatic that we have most experience with.
This is almost only a disease of the elderly; 95% of those who have it are over 60.
Pathology. The hidden location and small size of the prostate make it difficult to discover this carcinoma. However, its macroscopic character helps clinicians in diagnosis, since the majority of these cancers originate in the posterior lobe, which lies flat up against the rectum. Almost all of these cancers are subcapsular. Therefore, almost all of them are found below the surface, easily palpated by an exploring finger. The prostatic capsule is made up of a dense cover of elastic conjunctive and muscle tissue. Outside this capsule, between it and the aponeurosis of Denonvilliers, there are many nerves and an extensive prostatic plexus of veins. These structures also succumb to the invasion of the carcinoma after it has invaded the capsule, and Batson’s vertebral venous system explains the frequent metastases that occur with prostatic carcinomas. Often the first metastases lodge in the bones of the pelvis, lumbar and femoral vertebrae, then the most common sites are the lungs, liver, aortic and mediastinal lymph nodes.
Diagnosis. Meticulous digital palpation and transperineal biopsy using a Silverman needle can be used for diagnosis. In these cases, the Oncodiagnosticator is also of undeniable value.
Determining the level of acid phosphatase contributes to diagnosis. If it is high, it is a reliable sign; if it is normal, the possibility of neoplasia can be discarded. This was the first chemical proof of cancer described by Gutman.
We have shown, with the Oncodiagnosticator, the significant changes in two enzymes (??isozirnas) of serous lactic dehydrogenase, with relief from prostatic cancer.
Treatment. Donatian therapy.
This Is equivalent to the carcinoma of the ovary in women, but differs in that there is a greater relative abundance of the tissue in germinal cells; in the seminiferous tubules and a smaller quantity of stroma than in the ovary. Therefore, tumors of the testicle are tumors of germinal cells and show less diversity than those of the ovary. All of them are malignant.
Frequency. They are rare tumors and make up 1% of all carcinomas. However, they are important because they represent the largest number of cancers in men between the ages of 29 and 34.
Pathology. There are 4 classes:
Seminoma 40%
Embrionary carcinoma 28%
Teratocarcinoma 27%
Coriocarcinoma 2%
Non-germinal tumors 3%
Benign neoplasias practically do not exist in the testicle but when they appear they are of the type of capsular fibromas or Leydig cells.
Diagnosis. The patient, in general a young man, complains of a node on the scrotum. When the tumor reaches a medium size, it becomes painful. Occasionally, the metastases cause the first manifestations, such as pain in the lumbar region, fever, anorexia, vomiting, or the recent appearance of cough, without any other apparent cause.
To the touch, the typical testicle with a tumor feels hardened, heavy and does not feel pain. Often there is hydrocele and growth of the testicle. The tumors appear as shadows when backlighted, where the hydrocele is translucent.
Differential Diagnosis. These need to be distinguished from orchitis, hematoma and. hematocele. Testicular tuberculosis which affects mainly the epididymis and not the testicle and often manifests visible calcification in x—rays as well as the formation of beads along the seminal ducts.
Treatment. We use Donatian Therapy. The best prognosis we have achieved in patients with seminomas is 65% cured.
Grouping all the tumors of the mesoderm under the rubric of sarcomas yields an original heterogenous class. This is because the malignant neoplasias derived from muscle, fat, connective tissue, bones, and blood vessels tend to behave in surprisingly similar ways, in spite of the diversity of the tissues in which they appear.
Frequency. Sarcomas of the mesoderm make up about 1% of all cancers.
Pathology. Stout enumerates 18 different malignant tumors of the mesoderm. We will only mention the most common, since some of the 18 are seen once or never in the life of an oncologist. The common ones, in order of frequency, are:
Fibrosarcoma
Liposarcoma
Habdomyosarcoma
Synovial Sarcoma
Fibrosarcoma. This is the most common type. It comprises about 17% of all sarcomas and usually occurs on the extremities or the trunk of individuals whose age can vary from 30 to 6o. The majority of these tumors are well differentiated and almost all show reticulin fibers under the microscope. Fibrosarcomas typically invade local tissues making extirpation almost useless. They look encapsulated, but only have a compressed tissue which is a pseudocapsule.
Liposarcoma. This type never originates from a lipoma, it appears on its own. It can be of multicentric origin, and it feels firm, node-like but not as hard as a stone.
Rabdomyosarcoma. This is the third most frequent type of sarcoma and in general affects men, especially their extremities. Curiously, this type metastasizes by way of the blood vessels and never through the lymph ducts. The most disastrous are: the embrionary rabdomyosarcoma, a very malignant tumor that occurs in children, and the alveolar type of rabdomyosarcoma.
Synovial Sarcoma. These appear on the knee and ankle and originate in the articulary capsule, hut they rarely affect the synovial membrane of the joint itself.
Differential Diagnosis. These need to be distinguIshed from sebaceous cysts, lipomas, fibromatosis, mixomas, xantomas, and angiomatosis.
Diagnosis. The only method we use is the Oncodiagnosticator,
Treatment. We use Donatian therapy, so as to avoid amputation.
Frequency. These are considered rare, and even including the myeloma of the plasmatic cells as a sarcoma, their frequency does not even reach 1% of all cancers. These are more common in men than in women.
Pathology. The 7 most common sarcomas, and the tissues they occur in, are:
Osteosarcoma Bones, osteoblasts, osteoclasts
Condrosarcoma Cartilage, condroblasts
Tumor of the giant cells
Fibrosarcoma Connective tissue, fibroblasts
Myeloma of the plasmatic cells
Sarcoma of the reticular cells
Ewing’s Sarcoma
Osteosarcoma. This is the typical sarcoma. It is very malignant, and metastasizes from the beginning. It invades the epiphysis and the diaphysis, but never the articulatory space. There are 3 kinds: Parosteous Osteosarcoma, Central Osteosarcoma and Osteosarcoma from Paget’s Disease.
Diagnosis. There is always pain where there is a hone tumor. it is slight and intermittent in the beginning, persists and becomes continuous and more intense. The patient describes it as a sensation of electric shocks in the location.
Ewing's sarcoma in general differs from the other types in that it originates in the diaphysis of the large bones, has an unfavorable prognosis, and metastasizes almost from the beginning.
X-rays and the Oncodiagnosticator provide the information necessary for the diagnosis of sarcomas.
Differential Diagnosis. This needs to be distinguished from metastases to the bones of other primary tumors.
Treatment. We only use Donatian therapy and have achieved a rate of cure of 75% in 15 patients with sarcomas, where 4 were Ewing’s sarcoma.
The solid neoplasias of the lymph tissue can he grouped for convenience under the heading of lymphomas. All of the reticuloendothelial neoplasias especially the lymphomas and leukemias originate in pluripotential reticular cells. These are cells that produce erythrocytes, lymphocytes, monocytes, granulocytes, hystiocytes, platelets, fibroblasts, and osteoblasts.
Due to the fact that the lymphocytic and hystiocytic derivatives of the reticular cells serve principally to generate defenses against foreign antigens, neoplasias of these tissues involve and affect immunological systems of different kinds.
Frequency. Lymphomas make up 3% of all cancers, occurring slightly more frequently among men.
Pathology. The wide range of lymphomas is due to the variable degrees of differentiation of lymphocytes and hystiocytes from the primitive reticular cells, This is Cooper’s classification, which is the most complete and functional:
I. Hodgkin’s Disease
a. with a predominance of lymphocytes
b. with nodular sclerosis
c. with mixed cellularity
d. with lymphocytic weakening
II. Lymphosarcomas
a. well differentiated (nodular shape, lymphonns of the giant cells)
b. undifferentiated (lymphoblasts)
III. Lyrnnhocytic and Hystiocytic (mixed)
IV. Hystiocytic lymphomas (undifferentiated lym phomas
V. Burkitt's Tumor
Diagnosis. It is not easy to discover a lymphoma once it has begun to develop. Physical exploration has to be very meticulous to discover an abnormally large lymph node.
Biopsy is the most important diagnostic method for the definitive diagnosis of lymphomas. X-rays of the lungs, the large bones, and the spine will reveal lymphomas in about half of the patients that have them. Osteoblastic lesions suggest Hodgkin’s disease, while pure osteolytic lesions suggest lymphocytic lymphoma.
In general, lymphomas stem from an energic reaction caused by the alteration of the immunological system. Therefore the PFD test and others will give negative results.
Differential Diagnosis. Any illness that begins with a prominence on the neck and appears similar to Stage I of lymphomas.
Every lymphoma progresses in four stages: Stage I; only one lymph node or area of nodes is affected. Stage II; several areas of nodes are affected. Stage III; lymphatic tissues are affected above and below the diaphragm. Stage IV; Spread to non-lymphatic tissues.
Treatment. We use Donatian therapy. Alkylating medications such as those that have already been mentioned at the beginning of this chapter can be used according to the dictates of the physician’s experience, during Donatian Therapy.
As common as the lymphomas, but less controllable, are the liquid forms of reticuloendothelial neoplasia called Leukemias. (The solid forms are the lymphomas.)
Frequency. Approximately 3% of all the malignant neoplasias are leukemias and this sickness accounts for 5% of the deaths from cancer. Leukemias are the most common types of cancer found in children and occur, in general, in the lymphoblastic form. Leukemias with blasts are always acute ailments while those with cytic forms (lymphocytic, mielocytic, etc.) are always chronic. Acute malignant ailments are those that cause death in less than 3 months. Chronic malignant ailments are those that permit up to one year of life.
Pathology. A simple classification of the Leukemias according to cell type serves our purposes. The degree of leucemic cell differentiation corresponds to the degree of acuteness or chronicity of the sickness, because the less differentiated the cells, the more acute the ailment.
I. Lymphocytic (48%)
a. acute lymphoblastic leukemia
b. chronic lymphocytic leukemia
II. Mielocytic Leukemlas (43%)
a. acute mieloblastic leukemia (in adults)
b. chronIc mielocytic leukemia (in adults)
III. Monocytic Leukemias
a. acute monoblastic leukemia
IV. Other diseases of the hemopoietic system
a. Guglielmo’s syndrome (erythroleukemia)
b. Plasma cell leukemia
c. Megacaryocytic leukeumia
The first typical alteration leukemia occurs in the bone marrow, the seat of hemopoiesis. The changes in the marrow often take the form of a hyperplastic pattern in normal cells. Leukemic hone marrow shows leukocytes that are so immature that they look like the primordial cells. An enormous number of these abnormal cytoblasts replace the normal hemopoietlc activity, and the phagocytic and immunitary mechanisms become practically destroyed. According to the type of leukemia, the rest of the reticuloendothelial system is also affected. Often, chronic lymphocytic leukemia produces lymphadenopathy and hepatosplenomegalia, manifestations that may persist for years. Rarely does lymphadenopathy occur with mielocytic leukemia, but there is splenomegalia. Sheets and blocks of leucemic cells infiltrate, replacing or displacing the normal organs, and in the tissues they obstruct capillaries and disorganize the lymph ducts. This affects the circulation of normal tissues, the general metabolism and oxygenation. It has been calculated that approximately one billion leucemic cells, with a weight of around 640 g, are necessary to destroy a human being.
Peripheral leukocyte counts can be either normal or low. Often patients with leukemia show leukopenia. Very high counts appear with chronic lymphocytic leukemia, reaching levels as high as 1 million leukocytes per mm3. Anemia may be absent in the first stages, but when it appears it is normocytic and normochronic.
Leucemic skin lesions occur frequently in many forms: red or purple papulae, furuncles, petechiae. Immunological deficits can result from the disease, from the medications used, or from both.
The lungs can be affected by leukemic infiltration and hemorrhage: the bronchi can be blocked and distal atelectasis produced with infection and pneumonitis.
Diagnosis. Leukemia may be suggested, but not diagnosed, by the case history and physical exploration. The leukemic patient often has bleeding gums, infiltration around the eyes, and signs and symptoms of anemia and peripheral or central nervous disorder. Habitually, the area over the sternum is hypersensitive. In patients with chronic lymphocytic leukemia, the only sign present may be lymphoadenopathy.
Treatment. We use Donatian Therapy. Our statistics for these cases are very limited, since we have only treated 5 patients with leukemia. All showed improvement but later died.
Common errors committed with leukemic patients. Some doctors still think that because leukemias are necessarily fatal, it is useless to treat them. Hyperuricemia can easily go unnoticed until there is renal insufficiency. Tumors of the pituitary and suprarenal tumors have only been briefly mentioned because, except for the adrenal carcinoma, the others are benign and only have repercussions for endocrinopathies which they cause by an imbalance of the organism’s hormonal system.
part 9