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
