Day 254 - 22 May 96 - Page 45


     
     1        endothelia lining may be disturbed in some way or another.
     2
     3   Q.   Yes.
     4        A.  But there has to be some precipitating factor for there
     5        to be an abnormality.
     6
     7   Q.   You were proposing atheroma as the origin of the sequence
     8        which leads to the damaged endothelium, as I understand it?
     9        A.  I was, my Lord, because, as I understood it, Professor
    10        Crawford was talking in terms of heart disease and then
    11        went on to draw a parallel between the processes in heart
    12        disease and the processes in cancer.
    13
    14   Q.   That is one problem and that has been canvassed so far.
    15        But we are now on to, as I understand it, a high fat diet
    16        leading to a stickiness which I assume is either on the
    17        lining of the blood vessel or on the cancerous cell itself,
    18        as a result, presumably, of a high level of fat in the
    19        blood stream.
    20        A.  There is certainly no evidence that a high fat level in
    21        the blood stream will increase the stickiness of cancer
    22        cells.  My understanding, although I would have to say I am
    23        not an expert in the field, is that the fat level per se
    24        will not affect the endothelium, it will cause changes
    25        within the wall, which then secondarily will give rise to
    26        changes in the endothelium.
    27
    28   Q.   Just pause a moment.  Then we are back to your liver and?
    29        A.  Lung.
    30
    31   Q.   Lung.
    32
    33   MS. STEEL:   Just so we have covered it all, there is also the
    34        suggestion that if you had a high saturated fat diet cancer
    35        cells migrating from the primary tumour would find it
    36        easier to lodge and stick to the lining of the lymphatic
    37        system.  We dealt with the blood vessels.  What about
    38        that?
    39        A.  Well, I would like to know the mechanism by which this
    40        would happen because you do not see atheroma changes or fat
    41        deposition in the walls of vessels other than in arteries.
    42
    43   Q.   Leaving aside about atheromas, and just talking about the
    44        cancer cells migrating, whether or not they would find it
    45        easier to lodge and stick in the lymphatic system?
    46        A.  There is no reason that I can think of why they should,
    47        in these circumstances.
    48
    49   MR. JUSTICE BELL: Just cast your mind over it.  I suppose one
    50        proposition may be -- I do not know if it is what Professor 
    51        Crawford is putting forward -- is that the cancer cells 
    52        themselves have become stickier because they have been 
    53        circulated in blood which is carrying more fat in it and,
    54        therefore, when they get into the lymphatic system, they
    55        adhere there in circumstances where they would not adhere.
    56        Now, as an oncologist, does that mechanical sense or not?
    57        A.  I am afraid it does not, my Lord.
    58
    59   Q.   Can you give me a simple reason why?
    60        A.  No.  I think what we have broached on is a topic which

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