Tag Archives: staging

Ice Picks

I had a call from my oncologist’s office: I need to come in tomorrow to talk about the test results.  That means the CT scan results were turned around very quickly… and it doesn’t bode well that we need to meet immediately to discuss the results. 

I’m doing everything I can to hold it together – especially since Georgia is home with me today – but basically I’m a mess.  Axel came home during Georgia’s nap time and found me upstairs, lying on our bed.  He just put his arms around me and told me he loves me.  He had to go back to work, and now I can hear that Georgia is awake, so I have to snap out of this paralysis and back into life with my little girl, but I feel like I’m in a trance watching someone on the outside go through the motions while on the inside I’m frozen in fear.

Keep those ice picks handy.

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A Cancer Primer

A friend of mine recently told me that when I talk about cancer, she gets a little lost in all the medical terminology and references to different kinds of treatments.  It’s a slippery slope, and I can see now that I have slid it. To make amends for my spouting of esoteric mumbo jumbo, herewith, a Cancer Primer:

 

Cancer Strong contender for Most Terrifying Word in the English language; also known as the C-Word, the Darth Vadar of disease, and “the little word with the big stink.”  Meaning: A disease that involves abnormal or uncontrolled cell division.  Basically your good cells get overtaken and/or crowded out by bad cells.  This doesn’t happen because you did something wrong, no matter what anyone including that nasty little voice in your head tries to tell you.

Metastatic Breast Cancer (Also, “mets” in cancer-lingo.) The scary, hairy, foul-breathed boogeyman of breast cancer. It means your breast cancer has spread to other parts of your body. But it is still called “breast cancer” no matter where it goes (bones, organs, lymph nodes…) Imagine you are Turkish, and you visit Newfoundland for some whale watching or, God forbid, turbot-fishing. You are still Turkish.  You are not considered Canadian just because you came to Canada for the fish.  OK, so perhaps this analogy is a bit obscure.  What I’m saying is, it’s not that your breasts have travelled to your liver, but that the invading cells are the offspring of the original trouble-makers. When this happens, they just add the M-Word to the C-Word and voila! Your C-Word gets cranked up a few stages (see “Staging” below.)

Biopsy This is when they physically extract suspicious cells from your body and send them to a lab for questioning under a microscope. They have lots of different kinds of biopsies, some of which are less unpleasant than others, but eventually you’ll get an answer. Oh yes, you’ll talk, little cells… You’ll sing like little cancerous canaries…

Pathology  The specific nature of your disease as defined by the characteristics of your cancer cells.  Some breast cancers are related to hormones, some are not; some breast cancer cells have certain proteins on them, others do not.  The lab identifies exactly what the cells are made of so the oncologists know whether to use the medical equivalent of numchucks or molotov cocktails.  All breast cancer cells are stupid jerks, you don’t need a microscope to see that.

Radiation I think everyone has a basic idea of what happens with radiation – you nuke the cancer.  In a localized, laser-beam sort of way. Check out “radiation” in the tags for more details.

Chemotherapy Ah, notorious chemo: the bald-making, sick-making, cancer-killing drug therapy. Actually, not all chemotherapies make you bald and many are much improved in the sick-making department too. They’ve come a long way, baby.  And they’re not all administered by IV drip, either – some (like my capecitabine) are pills.  Think of chemo like an army that goes in and wipes out everything good along with everything bad, with the intention of rebuilding the good stuff later (this usually works better in chemotherapy than in Bush Administration foreign policy.) The somewhat arbitrary attack plan explains hair loss; if chemo drugs are designed to attack fast-reproducing cells – like cancer cells – they’ll knock out hair cells too. Hair loss can be an incredibly devastating, psychologically debilitating, massive downer. You look in the mirror and see “cancer” looking back.  On the upside, people will give you their seat on the bus and eventually, the hair grows back. 

Targeted Therapies These newer cancer treatments are less arbitrary than chemo, and more targeted to the specific cellular stuff happening with certain cancers. For example, they may work in conjunction with chemotherapy to deliver the toxic drugs directly to the cancer cells (smart-bombing) or they may be designed to prevent the tumour from developing the blood vessels it needs to feed itself and grow.  Let’s all just take a moment here and be collectively creeped out that tumours develop blood vessels and feed themselves.  Seriously. It’s gross. It’s like something from a Ridley Scott movie.

Staging This is when they measure your cancer and kind of rank how bad it is.  Not that anyone ever says “it’s somewhat bad,” or “it’s extremely bad.” They will just talk about how much it has spread, how big the tumour is, where it is in proximity to organs, etc.  Stage 0 cancer is called “in situ” and means it hasn’t moved one little bit, and Stage IV is the big M.  People sometimes also talk about “high grade” and “low grade” cancer. This is another measure of the likelihood of the cancer to move around or otherwise become a greater pain in the a**.  In addition, you’ll hear about things like “triple positive” or “double negative” cancers – this isn’t a measure of the extent of the cancer but of its nature (estrogen, progesterone or HER-2 positive or negative) so don’t let it freak you out.  

There are many more terms in the cancer lexicon – far, far too many – but that, I think, is enough cancer talk for one day.

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Carol’s Letters – Letter 1

The following is a letter written by a woman I know, updating her family and friends about what she’s going through with breast cancer.  Carol’s letters are written with a blend honesty, courage and humour as she navigates the sometimes bewildering and always surreal landscape of cancer treatment. I thought they should be shared.  She agreed to let me post them.  Here is one of the first, originally written in January 2009:

January 21, 2009

Subject: Update

 

Hi everyone,
It’s hard to know exactly where to start…One of the many things that I am learning is that each of my caregivers looks at my breast cancer in a slightly different way. The surgeon was primarily focused on locating and removing the tumor, infected lymph nodes and sufficient surrounding tissue to ensure that my margins were clear. His post-op report to me was that all of the nodes in my arm pit were removed and 5 of 15 nodes were infected, the 4.5 cm tumor and surrounding infected tissue were removed and the margins were clear. In addition to this, there was no metastases to other organs. All of this brought me to the diagnosis of stage 3A cancer.

The oncologist also has staged me as a 3A but they look at it a bit differently. What is the composition of the tumor/cancer, how aggressive was it and where could microscopic cells have spread to and what do I have to do to find those marauding cells and kill them so that we never have to deal with a recurrence?

We (Linda and I) met with the oncologist today at Princess Margaret (PMH). His interpretation was as follows:

-the tumor was large (4.5 cm)
-5/15 lymph nodes were infected (the cancer has learned to move)
-the tumor was very aggressive: Grade 3 (as he referred to the stages 1 thru 3: the good, the bad and the ugly…I had the ugly)

The “Grade 3” is important to him because it indicates the aggressiveness of the tumor, its ability to travel and, therefore, how aggressive he needs to be with treatment. Having said that, the cancer cells are Her2 positive and estrogen/hormone receptive, which is good news for treatment as they have drugs that can specifically target and bond to the receptors and prevent cancer growth.

What does this mean for my treatment? At PMH it would mean a standard protocol of 3 courses of FEC (the Google junkies may know what that means, this is a combination of 3 different chemo agents), followed by another three courses with Taxotere and Herceptin (approx 4 ½ months in total for chemo), followed by a year of Herceptin and 5 years of Tamoxifen. The radiation follows the chemo.

Where he threw us for a loop was in recommending that I go to St. Mike’s for treatment where they offer a different protocol – TCH. He feels this is my best treatment option, is the best treatment available and is currently the proven standard in Alberta and the US. This is available at St. Mike’s because they are combining this protocol with a trial with a drug called Avastin. But either way with this trial I get the TCH protocol which, in his opinion, is better than the FEC protocol currently available at PMH. The benefits of this are that I would receive the Taxotere and Herceptin at the very beginning – the “T” and the “H” of TCH (targeting the very essence of my type of cancer right away) and avoid some of the other more negative side effects of the FEC treatment protocol. Other than this difference the duration of this treatment is the same. After about 4 ½ months of treatment I would return to PMH for the radiation.

He was really quite firm that this was the bet route to go. PMH will also soon offer this treatment but they don’t have it yet (complicated to explain but I will if you want me to).

Long story short…I am going to see the oncologist at St. Mike’s, hopefully in the next few days, to discuss participating in their program. If for some reason I decided not to go that route, the doc a t PMH said I could go back to PMH and begin chemo there with no time lost. He did however say that he’d likely want to see a brain scan…to figure out if I was crazy for not going to St. Mikes…

That’s it for now. I’ll talk to each of you over the days to come but wanted to give you this basic info as quickly as I could.

Thanks for your support,
xo cw

 

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