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Archive for cancer

Nov

Am I really a cancer survivor?

Posted by: lynn | Comments (1)

Cancer survivorship is big on my mind this week as I’m writing a story on the topic for work. I call myself a cancer survivor. I had melanoma in 2001. Two tumors: one was small, a black fleck on the border of my right areola, the other big, deep and ugly on the inside of my right forearm. The second one was the worry–it had grown through all the layers of skin and fatty tissue.

I have souvenirs: a tiny white fleck of a scar on my breast, a half-dollar-sized, keloided scar on my right forearm and a long thin scar in my right armpit. And my life, and my daughter, as well. I mustn’t forget about those gifts.

When I tell people I am a cancer survivor, they expect me to spin a tale about my chemotherapy treatment, or radiation therapy, or immune therapy–like Izzy on Grey’s Anatomy. They want to hear about my triumph over lost hair, and uncontrolled vomiting. They want to know about my suffering. I can’t tell them about those things, because I didn’t endure them. My cancer was cured with surgery.

And because my only suffering was fear of death, having a major operation when I was 25 weeks pregnant, I feel like a fraud. Like I’m almost a cancer survivor, but not quite. My oncologist has told me I was very lucky, because thick melanomas are more likely to spread to the lymph nodes and beyond. My pregnancy may have somehow contributed to the lack of metastasis. He’s right. I was lucky on so many fronts, and I’m grateful.

But as I’m writing this story, I also feel ashamed, like I’m trying to cash in on some sympathy chit that cancer survivors get, but that I don’t quite deserve. I wonder if other cancer survivors who were lucky enough — like me — to need only surgery to cure them feel the same way. Are they ashamed, too, that they didn’t suffer? Do they feel guilty that they survived?

Recently, I’ve thought about not calling myself a cancer survivor anymore. If someone points out my scar, I could say I’m someone who had a tumor that was removed and all is well. However, like those survivors whose treatment caused more suffering than mine did, I harbor a strong fear in the pit of my stomach that melanoma will come back. About 60% of stage IIb melanoma survivors are still alive 10 years later. When can I stop worrying? Ever? My grandmother died from breast cancer at the age of 82 that was initially treated when she was in her late 40s.

I know these are questions that plague other people who’ve had cancer. In that, we’re the same. Is worry of recurrence enough, though, to make me a legitimate cancer survivor? And why do I need to call myself part of that group at all?

Sounds like a topic for therapy.

Categories : cancer

Comments (1)

Jul

Sometimes TMI is TMI

Posted by: lynn | Comments (2)

At work, I’m writing an article for my magazine about cancer stem cells. My center has a large stem cell research program, and a big focus is on the idea that cancer tumors are run by these CSCs.

Normal cells check in with themselves regularly, fix what’s fixable and kill themselves if the damage can’t be fixed. Evidence: get a sunburn and watch your skin peel off. New skin grows in because there are stem cells slowly dividing and making little twin daughter cells to rebuilt what you’ve lost.

The theory is that stem cells–which keep your tissues regenerating and therefore alive–divide slowly and live long. That means they can accumulate genetic damage from all the carcinogens we’re exposed to in the air, the water, our food. If they get enough genetic damage, they give rise to what we call cancer–which is cells that divide very quickly and out of control. Cancer cells lose their ability (or to personify, their desire) to kill themselves when they are broken.

CSCs have been identified in blood cancers like leukemia and in some solid tumors. Almost every organ in our bodies is lined with epithelial cells, and epithelial cell cancer is one of the most common types, regardless of what part of the body it hits–breast, pancreas, liver, mouth, skin.

CSCs, it’s hypothesized, keep the tumor growing, invading and spreading into new places. Traditional cancer treatments, like chemotherapy and radiation, target fast-dividing cells. CSCs are slow-dividing cells. And they also make up less than 0.1% of a solid tumor’s bulk. That means about 1 in 10,000,000 cells would be a CSC. So chemo and radiation doesn’t kill them, and they live on to make new tumors in close-by and distant places.

CSCs can be thought of as generals in a war. There aren’t very many of them, they hang at the back, and send in the troops to invade. They build the armies. And when the shit hits the fan–at least in Hollywood movies–they tend to hide out until things cool down.

It’s possible that CSCs are able to change hats to evade treatment. Most cells don’t survive the bloodstream, because they get filtered out by the lymph nodes. But CSCs seem to be able to change into a different type of cell that makes them super scuba divers with special tools they use to drill their way into other tissue. Lymph nodes are the first place cancer usually spreads to, so if CSCs–the pioneers of new tumors–get caught in this filter, they can start new tumors there. The liver is a common site of metastasis, and guess what, the liver’s a big old blood filter.

I have to note that some scientists don’t believe any of this. But skepticsm is what makes science science. And data. Data is king.

So there are cancer researchers all over the world now working on understanding how these rare CSCs do what they do. There are others who are taking old cancer drugs off the shelf and testing them against CSCs in animal models of cancer. And at my center (and elsewhere), they’re finding drugs that are killing tiny distant metastases. One of our scientists just got positive results on a first-in-man drug trial for head and neck cancer that targets a certain pathway these generals may use to direct the troops. And there are others working on developing new drugs to target CSCs.

The good news is these targeted therapies rarely have unbearable side effects. Why? Traditional chemo kills all rapidly-dividing cells. And what cells are fast dividers? Your stomach lining. Your hair. Your skin. So as the drug is poisoning the cancer cells, it’s also poisoning your normal cells, making you throw up and your hair fall out. It’s like setting off a nuclear bomb to kill your enemy and you wind up killing your neighbors too. Targeted therapies work on very specific doorways and pathways and processes that cancer cells use to live and conquer, leaving the normal cells alone.

Likely, if you get cancer in a couple of years, you’ll receive a targeted therapy that’s designed for your tumor’s exact gene problems, a CSC targeted therapy, and lower doses of traditional chemo to “debulk” the tumor.

This is good news, right? Where’s the TMI that’s TMI for me?

It’s possible that it only takes one CSC to start a new tumor. Or maybe 7, or 31. CSCs could send off pioneers well before a tumor is big enough to be detected, let alone treated. And CSCs can go dormant, like sleeper cells in spy movies, ready to jump into action when the time is ripe.

This can explain recurrence. The cells that survived are likely adapted to the treatment used the first time, so they will be harder to kill. And some scientists think that CSCs have a mechanism that pumps out foreign substances; they certainly can pump out dye used to stain cells, one of the ways these little suckers are identified in the lab.

Eight years ago I had Stage IIIa melanoma. My tumor was huge, 2.75 mm thick (a tumor of 1.5 mm can kill you). It was all the way through the fatty tissue on my right forearm. I had it removed surgically and the pathologists said the margins were clear, meaning no melanoma cells in the edges of the tissue they removed. However, CSCs were just a theory then. There was no test to see if there were CSCs in the lymph nodes they removed.

Which means I can have sleeping melanoma cells in my body right now. And they can decide to wake up and start a new tumor somewhere I can’t see, like my liver, my lungs or my brain. And I won’t know it until it’s too late to do anything.

That’s too much information.

To think that just 1 cell out of the trillions in my body could kill me prematurely, painfully and with much suffering, is more than I needed to know. It’s bad enough that I see my oncologist on campus several times a month, and when I go in for checkups he shows me this line graph of survival for my stage of melanoma. Eight years out, and I still have a 40% chance of dying from this stupid disease — a disease I gave myself by attempting, year after year, to make my pale skin tan. A disease of vanity.

I’m not going to linger on this idea of a rogue cell waiting with a bomb in my body. But writing this story, I’ve had to stop and think about it a few times. OK, often. OK, constantly. And I don’t know what to do with this information. At all.

As intellectually stimulating as my job is, translating science into stuff normal people can understand, this line of work is scary for a cancer survivor. Hopeful, because I also see the overwhelming volume of work being done to understand this most complex of killers. But scary nonetheless.

Categories : cancer, work

Comments (2)

Jun

Michael Jackson, Farrah and my hosta

Posted by: lynn | Comments (3)

Today at work I was escorting a TV journalist to interview my cancer center’s expert on anal cancer when he told me that Michael Jackson had a heart attack. We happened to be hurrying through a heavy rainstorm, me holding my floral umbrella over his unprotected camera. This was the second storm of the day. The first included 70 mph winds that forced rainwater under the doors and flooded our research center. (the storm’s significance comes later in the post … patience!)

“Yeah, he had a heart attack. But it’s unconfirmed that he’s dead.”

I put it out of my mind as he interviewed our doctor about the disease that took Farrah’s life.

public service announcement

Anal cancer is rare, just 5,700 cases in the US each year, compared to about 150,000 cases of colorectal cancer. The good news is that 90% of people survive. However, anal cancer has such a stigma because, well, it happens in your anus–a taboo body part if there ever was one–and it’s becoming associated more and more with HPV, the virus better known for causing cervical cancer. That makes anal cancer a sexually transmitted disease, just like cervical cancer and — with growing likelihood — head and neck cancer. Epidemiologists estimate that about 80% of adults have a strain of HPV, which rarely has any symptoms and cannot be avoided by using condoms.

You can catch HPV from vaginal sex, anal sex, oral sex and possibly even kissing someone with an active oral infection. In my mind, that means it’s imperative that girls AND boys be vaccinated against this disease.

I could be Farrah next. Or you could. So watch for these symptoms: bleeding and a mass. Many people mistake a mass for a hemorrhoid. Be safe and see your doctor, because while it’s embarrasing to talk about your butthole, it’s better to be embarrassed than dead. As I said, if caught before it spreads, anal cancer is quite curable with chemotherapy and radiation therapy, and there are new clinical trials for targeted drugs that may be even more effective and with much fewer side effects.

/public service announcement

So here I am, talking about anal cancer and thinking about how beautiful Farrah was, how much fun she seemed to be when I was a kid. Of course, I was a HUGE Charlie’s Angels fan. My friend Linda and I played Charlies Angels for hours every weekend. I was always Sabrina, though. We had this binder full of photos of clothes cut from the JC Penny catalog, and we’d each choose an outfit for the day. We made very clever spy devices using gum erasers, sewing pins and thumbtacks. Our fathers cursed us repeatedly because we’d throw these tiny weapons like make-believe bombs, and they’d eventually run them over with the lawn mower or their car. I know for sure I gave my dad at least one flat tire. (Sorry Dad)

I also remember that iconic Farrah poster, which my friend Vivian had up in her room. I remember giggling because you could see her nipples!!!! And also spending hours on Vivian’s sister Michelle’s hair, rolling it in curlers to try to achieve that fabulous Farrah look on a 4-year-old.

I was thinking about how much Ryan O’Neal obviously loved her. I caught a tiny preview of his interview with Barbara Walters, and I thought, I hope that Steve loves me that much, because that is one devoted man, and that’s what every woman wants.

I was driving through the roundabouts in Lowry, a neighborhood just north of my house.And I turned on the radio to hear that Michael Jackson was confirmed dead. And so was the Farrah Fawcett death story. Because while Farrah was an icon, MJ was THE Icon.

The DJ played Beat It. And I started to cry.

I cried because Michael Jackson was so sad, and so damaged, and because he thought he was so ugly and unlovable, as my friend Meara just posted on Facebook. He was among the most successful people ever to walk this earth, was so loved and adored (and eventually vilified) by everyone but the most important person–himself. And I cried because he was Daddy to three kids: Michael Joseph Jackson, Jr., Paris Michael Katherine Jackson and Prince “Blanket” Michael Jackson II. Those poor children. I can’t even imagine what they will go through.

I was such a huge fan growing up. I played my Thriller album (my first album) hundreds of times, maybe thousands. I got in trouble in homeroom in 8th grade for singing PYT with other girls, because it was “too sexy for 8th graders to sing.” Yeah, I know, he was creepy in the end, and likely a child molester.

But as Elvis was to my parent’s generation, MJ was to mine.

He is on the shortlist of muscians who set the soundtrack for my adolescence: MJ, U2, Depeche Mode, Prince, the Cure, Howard Jones, Def Leppard. I can’t think of my freshman year of high school and the pom pon squad without thinking of our Beat It routine, one of the first pieces I ever helped choreograph. I saw MJ in concert at the old McNichols Arena in 1988, and the crowd booed because he didn’t play Man in the Mirror.

And I kept crying–not sobbing, but crying nonetheless, until I realized that traffic was being rerouted. Turns out the main street I live off is flooded with about 3 feet of water.

I took a circuitous way home and happily found that my basement is NOT flooded. However, I have about 3 inches of hail in my little garden and my hostas, my hibiscus and my hydrangeas (yes, my garden is sponsored by the letter H) are trashed. Trashed I tell you.

Today sucks.

So I’m sitting here, listening to the fourth major storm of the day thunder its way through Denver, drinking wine, listening to Thriller and mourning.

Raise a glass with me, wherever you are. To icons. (and to Mother Nature, and the Universe, operating in its infinite wisdom). I leave you with the lyrics to my favorite Michael Jackson Song. Sing it with me!

P.Y.T

Where Did You Come From Lady
And Ooh Won’t You Take Me There
Right Away Won’t You Baby
Tendoroni You’ve Got To Be
Spark My Nature
Sugar Fly With Me
Don’t You Know Now
Is The Perfect Time
We Can Make It Right
Hit The City Lights
Then Tonight Ease The Lovin’ Pain
Let Me Take You To The Max

[Chorus]
I Want To Love You (P.Y.T.)
Pretty Young Thing
You Need Some Lovin’ (T.L.C.)
Tender Lovin’ Care
And I’ll Take You There
I Want To Love You (P.Y.T.)
Pretty Young Thing
You Need Some Lovin’ (T.L.C.)
Tender Lovin’ Care
I’ll Shake You There

[Background]
Anywhere You Wanna Go

[2nd Verse]
Nothin’ Can Stop This Burnin’
Desire To Be With You
Gotta Get To You Baby
Won’t You Come, It’s Emergency
Cool My Fire Yearnin’
Honey, Come Set Me Free
Don’t You Know Now Is The Perfect Time
We Can Dim The Lights
Just To Make It Right
In The Night
Hit The Lovin’ Spot
I’ll Give You All That I’ve Got

Breakdown
Pretty Young Things, Repeat After Me
[Michael] I Said Na Na Na
[P.Y.T.'S] Na Na Na
[Michael] Na Na Na Na
[P.Y.T.'S] Na Na Na Na
[Michael] Na Na Na
[P.Y.T.'S] Na Na Na
[Michael] I Said Na Na Na Na Na
[P.Y.T.'S] Na Na Na Na Na
[Michael] I’ll Take You There