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Notes and References Notes and References Cancer Poetry: An Introduction 1. Paul Muldoon, Horse Latitudes (New York: Farrar, Straus & Giroux, 2006), p. 106. 2. Margaret Knowles and Peter Selby (eds), Introduction to the Cellular and Molecular Biology of Cancer, 4th edn (Oxford: Oxford University Press, 2005), p. ix. 3. Heart attacks have certainly been more frequently the subject of comedy and exaggerated speech than cancer. 4. This is according to Cancer Research UK (http://www.cancerresearchuk. org/cancer-help/about-cancer/cancer-questions/how-many-different-types- of-cancer-are-there, accessed 18 December 2012). However, Lauren Pecorino states that ‘Over 100 types of cancer have been classified’ (Lauren Pecorino, Molecular Biology of Cancer: Mechanisms, Targets, and Therapeutics (Oxford: Oxford University Press, 2012), p. 2). 5. It is equally difficult to find cancer represented explicitly in prose fiction before the 20th century; tuberculosis was written about much more fre- quently. There is a possible allusion to cancer in Tolstoy’s novella The Death of Ivan Ilyich (1886), but in 20th-century prose fiction, cancer appears either literally, metaphorically or both in Arnold Bennett’s novel Riceyman Steps (1923), Edith Wharton’s story ‘Diagnosis’ (1930), Thomas Mann’s novella The Black Swan (1954) and Aleksandr Solzhenitsyn’s Cancer Ward (1967). 6. Since age is the biggest risk factor for cancer, and life expectancy is higher, the incidence of cancer is higher today. Paul Scotting writes that before 1800, life expectancy was around 40–45. In developed countries, life expectancy has increased to around 80: ‘Our bodies now provide the necessary time for cancer to develop and so it has become one of the most common causes of death’ (Paul Scotting, Cancer: A Beginner’s Guide (Oxford: Oneworld, 2010), p. 6). 7. Wilfred Owen, Poems, ed. Jon Stallworthy (London: The Hogarth Press, 1985), p. 117. 8. A similarly indiscriminate disease, influenza, would claim tens of millions of lives in the pandemic of 1918–20. 9. Leonard M. Franks and Margaret A. Knowles, ‘What is cancer?’, Introduction to the Cellular and Molecular Biology of Cancer, pp. 1–24, at p. 1. 10. Nicholas James, Cancer: A Very Short Introduction (Oxford: Oxford University Press, 2011), p. 1. In 2000, cancer was diagnosed in 10 million people world- wide, and caused 6.2 million deaths. 11. Naomi Allen, Robert Newton, Amy Berrington de Gonzalez, Jane Green, Emily Banks, and Timothy J. Key, ‘The causes of cancer’, Introduction to the Cellular and Molecular Biology of Cancer, pp. 25–44, at p. 25. The authors cite the World Health Organization in 2003. 12. James, p. 5. 199 200 Notes and References 13. James, pp. 8–10. 14. Pecorino, p. 10. 15. In developed countries, due to better nutrition and more plentiful protein, puberty occurs earlier than in the past, while greater use of contraception and more plentiful education mean that pregnancy occurs later. 16. Smoking is responsible for causing more than a dozen types of cancer, including over four in five cases of lung cancer (according to Cancer Research UK (http://www.cancerresearchukorg/cancer-info/healthyliving/ smokingandtobacco/smoking-and-cancer, accessed 18 December 2012)). 17. Allen et al., Introduction to the Cellular and Molecular Biology of Cancer, pp. 33–4. 18. Allen et al., Introduction to the Cellular and Molecular Biology of Cancer, p. 41. This risk can be recessively determined (two defective copies of the same gene, one inherited from each parent), or dominantly determined (one sin- gle copy of the defective gene from one parent). 19. James, p. 24. 20. James, p. 25. 21. Regardless of carcinogenic factors, there is a relatively fine line between a healthy cell and a cancer cell. Scotting writes that ‘The frequency of muta- tion resulting accidentally from the imperfect nature of DNA replication is about one mutation in any given gene in every 10,000,000 (107) cell divisions’ (Scotting, p. 26). If the human cell contains – at a conservative estimate – around 21,000 genes (ordered in 23 chromosomes), there will be abnormalities in 40 to 60 genes, or in other words, as James puts it, there will be 40 to 60 typographic errors in the library of 23 approximately 1,000-page books that make up the human genome (James, p. 76). 22. Franks and Knowles, Introduction to the Cellular and Molecular Biology of Cancer, p. 3. The more highly differentiated a cell is, for example, if it is a muscle or nerve cell, the less likely it is to be able to divide. 23. Sonia Lain and David P. Lane, ‘Tumour suppressor genes’, Introduction to the Cellular and Molecular Biology of Cancer, pp. 135–55, at p. 137. 24. Apoptosis is the phenomenon of cells self-destructing when they are no longer necessary. 25. Pecorino, p. 3. In 2011, in ‘Hallmarks of Cancer: The Next Generation’, Hanahan and Weinberg proposed a further two enabling characteristics, ‘genome instability and tumor-promoting inflammation’, as well as two emerging characteristics (there is evidence of their importance, but further research is required): ‘reprogramming energy metabolism and avoiding immune destruction’ (Pecorino, p. 3). See D. Hanahan and R. A. Weinberg, ‘The Hallmarks of Cancer’, Cell, vol. 100, no. 1 (2000), pp. 57–70, and D. Hanahan and R. A. Weinberg, ‘Hallmarks of Cancer: The Next Generation’, Cell, vol. 144, no. 5 (2011), pp. 646–74. 26. Some more terminology: epithelium (tissue-specific cells), and mesenchyme or mesoderm cells (supporting tissue cells): ‘Approximately 85% of cancers occur in epithelial cells and are classified as carcinomas. Cancers derived from mesoderm cells (e.g. bone, muscle) are called sarcomas, and cancers of glandular tissue (e.g. breast) are called adenocarcinomas’ (Pecorino, p. 2). The other two major groups of cancers are the lymphomas (arising in the lymph nodes) and the leukaemias (arising in the bone marrow). Notes and References 201 27. Terry Priestman describes how each of the three major kinds of cancer treat- ment ‘has its strengths and weaknesses. Surgery is very good if a primary cancer is still quite small and hasn’t spread. But it can’t be used for big cancers, or when there are multiple secondary cancers in different parts of the body. Radiotherapy is good at treating some primary cancers, and can often cover a wider area of tissue than it would be safe to remove in an operation, and it can help ease symptoms from some secondary cancers. Chemotherapy is fairly ineffective against most primary cancers (although the haematological cancers, the leukaemias, lymphomas and myeloma are an exception to this rule), but has a valuable role in preventing or treating the secondary spread of a cancer’ (Terry Priestman, Coping with Radiotherapy (London: Sheldon Press, 2007), p. 18). 28. United States National Cancer Act of 1971, http://legislative.cancer.gov/ history/phsa/1971, accessed 18 December 2012. 29. James, p. 3. 30. Nevertheless, 70 per cent of all cancers develop in people over 60 years old, so even if cancer were eradicated, the average lifespan might not be consider- ably longer. 31. Three types of radiotherapy are teletherapy (external beam therapy); brachy- therapy (a source of ionizing radiation is placed close to or inside a cancer; this is used in cervical and prostate cancer treatment); and systemic radio- isotope therapy (a radioactive substance is swallowed or injected; the isotope then concentrates in certain tissues or organs and irradiates them; this is used in the treatment of thyroid cancer). 32. Radiotherapy is not just curative, but can also be used to alleviate the symp- toms of terminal cancer. Since the treatment is targeted, side effects are localized – including hair loss and skin changes – apart from fatigue. 33. Pecorino, p. 13. 34. Franks and Knowles, Introduction to the Cellular and Molecular Biology of Cancer, pp. 3–4. There remains some reservation towards the principle of embryonic stem cell research, and at times active opposition to it, by the United States pro-life movement, which is associated with several Christian groups and, ironically, opposed to abortion and the termination of the long- term comatose and brain-damaged. 35. Barbara Ehrenreich, ‘Welcome to Cancerland’, Harper’s Magazine (November 2001), http://www.barbaraehrenreich.com/cancerland.htm, accessed 18 December 2012. 36. Jackie Stacey, Teratologies: A Cultural Study of Cancer (London: Routledge, 1997), p. 81. 37. Stacey, p. 64. 38. Titles rescinded by USADA (United States Anti-Doping Agency) on 24 August 2012. 39. Stacey, p. 12. 40. Lance Armstrong with Sally Jenkins, It’s Not About the Bike: My Journey Back to Life (New York: Berkley, 2000), p. 259. 41. Stacey, p. 12. 42. Ruth Picardie, Before I Say Goodbye (London: Penguin, 1998), p. 13. 43. Lisa Diedrich, Treatments: Language, Politics, and the Culture of Illness (Minneapolis: University of Minnesota Press, 2007), p. 68. 202 Notes and References 44. Stacey, p. 16. 45. Donald Hall, ‘The Third Thing’, Poetry (November 2004), http://www.poet- ryfoundation.org/poetrymagazine/article/146874, accessed 18 December 2012. 46. Harold Varmus and Robert A. Weinberg, Genes and the Biology of Cancer (New York: The Scientific American Library, 1993), p. 1. 47. Armstrong, p. 97. 48. Elisabeth Grosz, ‘Julia Kristeva’, in Feminism and Psychoanalysis: A Critical Dictionary, ed. Elizabeth Wright (Oxford: Blackwell, 1992), pp. 194–200, at p. 198. 49. Lawrence Goldie with Jane Desmarais, Psychotherapy and the Treatment of Cancer Patients: Bearing Cancer in Mind (Hove: Routledge, 2005), p. 60. 50. Robert Bor, Carina Eriksen and Ceilidh Stapelkamp, Coping with the Psychological Effects of Cancer (London: Sheldon Press, 2010), pp. 10–20. 51. Susan Sontag, Illness as Metaphor and AIDS and Its Metaphors (New York: Picador, 1990), p. 20. 52. Sontag, p. 65. 53. This tension is epitomized in Margaret Edson’s 1995 play W;t, when Dr Kelekian is explaining Vivian’s diagnosis: his statement that ‘“Insidious” means undetectable at an—’ is interrupted by Vivian, who insists, ‘“Insidious” means treacherous’ (Margaret Edson, W;t (New York: Faber & Faber, 1999), p.
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