ENCORE #109! – *AN UPDATE!!!* on HOLD ON THERE BABA LOUIE!” – Exercise “reduces cytokines in adipose tissue” might be PURE HYPE!

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in June of 2012...

And now, the original post PLUS AN UPDATE, seven years later...

Doctors harp on exercise.

Despite the harping – or in my case, perversely because of it – I avoid exercise like the plague.

Even so, as I read more and more sites promoting the “exercise makes you better if you have breast cancer” meme, I found that almost none of them give any kind of evidence as to WHY exercise fights cancer and promotes healing.

So I dug into the sites and finally found some evidence supporting this wild, “Do this one weird thing…” kind of meme. This week, it’s number:

1)                  Increased levels of pro-inflammatory factors and decreased levels of anti-inflammatory factors have been linked with increased cancer risk. Physical activity might reduce systemic inflammation alone or in combination with reduction in body weight or composition through reducing inflammatory cytokines in adipose tissue.

What are pro and anti-inflammatory factors?

Let’s start with CYTOKINES and let me warn you, even researchers are still a bit fuzzy about these molecules, which explains the “might” in the paragraph above. We’ll take this subject as a “details at 11” kind of thing – it’s changing every day, but TODAY and to the best of our knowledge, we can say that we’re pretty sure that cytokines are small molecules that are given off by numerous cells and are used to communicate with each other. Cytokines are a large and diverse family of molecules with many jobs. One thing we are pretty sure they do to control the immune system – that collection of white blood cells and chemicals that spring to work when you’re hurt or sick and the body has to fight off an infection. The line between cytokines and hormones is also pretty blurry but PROBABLY, cytokines come from lots of places and there are only set amounts in the blood – though that amount can leap up during trauma or infection. Hormone levels are steady. Many cells produce cytokines. Most hormones come from specific glands (adrenal, pancreas, etc). Also, while usually specific, some cytokines act like hormones to have an effect on the entire body. Last of all, some cytokines act outside the immune system and affect the development of the human body.

As to breast cancer, at least one cytokine affects both the presence of and severity of breast cancer: “In a study published in the January 15th issue of Cancer Research…researchers showed that activation of the CXCR4 [cytokine] receptors [on the cancer cells] resulted in increased tumor growth and metastasis…and less dependent on estrogen for continued growth…to become metastatic and resistant to endocrine therapy…[in] A second study published in the current issue of Surgery…authors reported that all benign breast tissues had no detectable CXCR4 levels, whereas all 101 breast cancer patients showed at least some level of this cytokine receptor.  Of these breast cancer patients, 79 had low levels of CXCR4 and 22 had high levels of CXCR4.  These high CXCR4 levels were linked with increased breast cancer recurrence and worse chances of survival…overexpression of CXCR4 cytokine receptors is linked to worse breast cancer outcomes…blocking this pathway might become a valuable breast cancer treatment for patients overexpressing this cytokine receptor.”

The big “might” up above has given breast cancer, cytokines and exercise a high level of interest. The third reference below cites a study that, as of my referencing of it, was still recruiting participants.

So – I’m going to label THIS particular aspect of exercise and breast cancer as a big MAYBE, LET’S WAIT AND SEE. So don’t go spreading the word that exercise reduces cytokines and decreases breast cancer.

Nobody knows enough yet to say one way or the other.

Update: Not so fast!

Seven years later, there seems to be some evidence (in mouse research) that exercise can mitigate cytokine effects on cancer. I’ve condensed the abstract of the study referenced below. In essence it says, “Biological aging is associated with progressive damage accumulation, loss of organ reserves, and systemic inflammation…which [may lead to] a wide spectrum of chronic diseases, including several types of cancer. In contrast, aerobic exercise training (AET) reduces inflammation, lowers all-cause mortality, and enhances both health and lifespan…Lifelong, voluntary [mice who were trained to regular] wheel-running [experienced much less] age-related declines in…motor coordination…[and experienced]…partial protection against sarcopenia, dynapenia, testicular atrophy, and overall organ pathology…chronic elevation in…cytokines…was…[greatly reduced]…circulating SPARC [a protein in the body that,] when it accumulates, causes…“tissue fibrosis, nephropathy, retinopathy, and non-alcoholic fatty liver disease, while [when it’s removed] protects against the same…”…malignant tumours were also completely absent in [exercising mice], whereas they were present in the brain (pituitary), liver, spleen, and intestines of sedentary mice. Collectively, our results indicate that early-onset, lifelong running dampens inflammaging, protects against multiple cancer types, and extends healthspan of naturally-aged mice.”

So there you go. NOT A TREATMENT FOR HUMANS, but evidenced by the newest research.

Reference: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0210863

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

BREAST CANCER RESEARCH RIGHT NOW! #66: Surprising SUPER Star Spokeswoman!

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Every month, I’ll be highlighting breast cancer research that is going on RIGHT NOW! Harvested from different websites, journals and podcasts, I’ll translate them into understandable English and share them with you. Today:

We’ve seen her in several favorite movies like Failure to Launch, The Blind Side, Midnight in Paris, in the big hit TV series lBig Bang Theory, as well as hearing her voice (albeit unknowingly) in Charlotte’s Web.

Actor Kathy Bates, I discovered today, is also a spokeswoman and lobbyist for the Lymphatic Education & Research Network (LE&RN.)

“Kathy Bates has successfully battled ovarian cancer since her diagnosis in 2003. In September 2012, she revealed via Twitter that she had been diagnosed with breast cancer two months earlier and had undergone a double mastectomy. In 2014, at the New York Walk for Lymphedema & Lymphatic Diseases, Bates announced via pre-recorded audio that, due to the double mastectomy, she has lymphedema in both arms. At that time, Bates became the National Spokesperson for the LE&RN and has been actively involved in lymphedema and lymphatic disease advocacy. On May 11, 2018, Bates led advocates in a Capitol Hill Lobby Day to garner Congressional support for research funding. The next day, May 12, Bates addressed supporters at the first-ever DC/VA Walk to Fight Lymphedema & Lymphatic Diseases at the Lincoln Memorial. She was awarded the 2018 WebMD Health Heroes ‘Game Changer’ award for her role in raising awareness of this chronic lymphatic disease.”

What does that mean, having a spokesperson? How can that make a difference?

In 2016, WBUR reporter Carey Goldberg interviewed Dr. Michele Berman, co-author of the book, "Reimagining Women's Cancers: The Celebrity Diagnosis Guide To Personalized Treatment and Prevention." She and her husband, Dr. Mark Boguski, run CelebrityDiagnosis.com. In that interview, after discussing the then-new Angelina Jolie diagnosis of a rare form of breast cancer and her double mastectomy, Goldberg asked, “So ultimately, the moral of this Angelina effect story is...?”

 Dr. Berman said, “Celebrity stories are really double-edged swords. They can be very helpful. They can be very educational. But if the information given is just put out there on its own, without appropriate commentary by people who know what they're talking about, people can get wrong ideas. They can go looking for cures where there may not be any; they can go looking for testing where they may not need it.

“It's obvious these celebrities are not doing this to cause anyone harm. Their intentions are very good. But their story just doesn't always necessary translate to other people's stories. The message got out; people learned some more, which is a good thing. But the message didn't necessarily target the people who were most at risk.”

Honestly? I can’t add anything more to this. So there you go!

Resources: https://en.wikipedia.org/wiki/Kathy_Bates, https://lymphaticnetwork.org/news-events/category/news-sub, https://www.aacrfoundation.org/Celebrity-Diagnosis/Pages/kathy-bates-lymphedema-breast-cancer.aspx, https://www.wbur.org/commonhealth/2016/12/16/angelina-celebrity-cancer

Image: https://www.gannett-cdn.com/presto/2019/01/31/USAT/3f32fab6-16b9-4c13-b64d-e229e4ff5ce2-bates.jpg?width=540&height=&fit=bounds&auto=webp

ENCORE #108! – Neulasta – What’s It DO???? (Plus some new thoughts…)

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry appeared in November of 2011.

Though I talked very briefly some time ago about what the various chemotherapy drugs that my wife was treated with were “for”, I never really went into any kind of detail.

Now that chemo is “over”, I wanted to explore what some of the long-term and lasting effects of the treatment are. Because she reached that time – what with the odd numbing of her upper lip, the incision pains, swollen ankles and dry skin, I’d like to know which of those things is chemo-derived and which ones are not.

So we’ll g0 here next:

What’s “neulasta” and what does it do?

Chemically, “neulasta” is N-(3-hydroxypropyl)methionyl, 1-ether-alpha-methyl-omega-hydroxypoly(oxyethylene). Complex. Lots of chemicals.

But what’s it DO?

“Neulasta”, is a special protein that’s based on sugar (an oligo-saccharide, meaning that the molecule has only a few small units, in this case a sugar ) that’s attached to a protein to form a glycoprotein.

The glycoprotein is a very important part of a cell wall – the cells that are being targeted are white blood cells. The white blood cells are also called neutrophils, granulocytes and stem cells and are the main part of the blood that destroys microscopic body invaders like bacterial infections, viruses or other germs. The glycoproteins help the white blood cells recognize the germs.

Neulasta makes the marrow in bones produce more white blood cells to replace the ones killed by Cytoxan, Adriamycin and Taxotere (which I talked about esrlier) while they are busy killing cancer cells that are growing out of control.

The “colony” in the “colony stimulating factor” is the white blood cells in the bone marrow.

So – “neulasta” is injected just under the skin and gets into the bloodstream. It goes along until it reaches the bone marrow where it forces (also known as “stimulating”) the growth of new white blood cells to take the place of the older ones killed off by the chemicals in chemotherapy.

Side-effects? Sure. Any one of us who’s seen the Red Devil injected in his wife, mother or girlfriend knows what I’m talkin’ about here. With stuff like THAT going into a human body, to expect NO side-effects would be the crazy thing! There are “minor effects” – did any of the researchers experience any of these symptoms? If they had, would they have called the effects “minor”? – of the injection, things like hives; difficulty breathing; swelling (face, lips, tongue, or throat) as well as bone pain; pain in your arms or legs; or bruising, swelling, pain, redness, or a hard lump where the injection was given.

More serious side-effects (though according to the test trials, these rarely happened: sudden or severe pain in your left upper stomach spreading up to your shoulder; severe dizziness, skin rash, or flushing; rapid breathing or feeling short of breath; signs of infection such as fever, chills, sore throat, flu symptoms, easy bruising or bleeding (nosebleeds, bleeding gums), loss of appetite, nausea and vomiting, mouth sores, or unusual weakness.

My wife didn’t seem to experience any of the side-effects. In fact, though we expected WORSE, the chemotherapy (while horrible in its own right) only threw us a few curves. Because of the neulasta injections, she didn’t seem to catch any sort of germ at all and stayed (on the chemotherapy scale of things in our “new normal” world) pretty healthy.

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There are other thoughts I’ve had about the use of neulasta (pegfilgrastim) and I might look at those soon. As for the use of the drug in conjunction with chemotherapy, as with all things produced by the “Big Pharma” industry, the price of an injection of neulasta while remaining roughly the same at roughly $6000, has stimulated (pardon the pun) some competition from a new product, Udenyca. It’s on the market currently and costs less as long as you use a “coupon” (can you “clip coupons” for your cancer treatment now?) reducing the cost of an injection to $4000…from a starting point of $20,651…) This competition MAY be explained by the experimental use of neulasta in treating arthritis…

Hmmm…

For further thought: https://www.sciencedirect.com/topics/neuroscience/pegfilgrastim

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

GUY’S GOTTA TALK ABOUT…Alzheimer’s #23: Catharsis and Lingering Thoughts

Dad’s diagnosis of Alzheimer’s stayed hidden from everyone until I took over the medical administration of my parents in 2015. Once I found out, there was a deafening silence from most of the people I know even though virtually all of them would add, “My _____ had Alzheimer’s…” But there was little help, little beyond people sadly shaking heads. Or horror stories. Lots of those. Even the ones who knew about the disease seemed to have received a gag order from some Central Alzheimer’s Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this part of my blog…

You don’t have to read past this because it is, if I do say so, something of a downer. As I am writing this AFTER I wrote the words below, I realize that there was something cathartic about it…So if you DO read past this, don’t blame me for not warning you…

Yesterday afternoon, I drove past the senior residence where my parents spent the final years of their lives.

Amazingly, nothing had changed.

Amazing to me, but not to anyone else, because there are only a few of us for whom the entire world changed when Dad passed away almost 3 months ago.

I make jokes with my wife sometimes, saying, “Oh! I have to out to see Dad!” We both laugh, but deep down inside of me…I don’t feel anything.

My dad and I; in fact my parents and I, to be truthful, had an odd relationship. They were 1950s distant – not that they slept in different beds like Ozzie and Harriet or Ricky and Lucy Ricardo, but they ascribed to the 1950s dictum that you raise your kids then ignore them after they get married (except for obligatory seasonal family get-togethers and visits to see grandchildren).

At least that’s the way it was for me until my parents reached their declining years. I didn’t go shopping with my mom or to sporting events with my dad. We hadn’t shared those things while I was growing up, so we didn’t share those things when I was older. I rarely socialized with my parents outside of familial obligations…until their decline reached a point where they needed me to transport them and start to keep track of appointments and take them to the hospital and intervene in their medication dosing regimens.

By then, there was no time left to have fun. By then, I assumed the role of caretaker (though I have no idea if anyone other than my wife and daughter had any idea how invested I was in that. The answer was so deeply that my life became little more than work and parents.) Even when they moved to the senior care facility I started this essay with, and there were people there to care for them, I was constantly on call. After my mother passed away, I was literally on-call as I was the child who lived closest to the facility. For the two years following Mom’s passing, I went to the place at least once a week – to reset the TV, get groceries (even though they provided meals and snacks, Dad never wanted to depend on that. He always kept soda, milk, cereal, crackers, cookies, and candy…uh…handy.) Toward the end, the milk would sit until I had to throw out an untouched bottle and everything but the soda and candy went uneaten.

Honestly? I felt as if I were taking care of strangers and then a stranger. That made it even more uncomfortable when Dad would tell me that I was the only one he could count on; or that I was his only friend…

Why did it make me so uncomfortable? Because, horrible person that I am, I didn’t care anymore. It took my breath away when I realized that I actually may not have EVER cared. I’d felt misplaced in my family since adolescence; an outlier with little or no interest in the things that consumed the others. My family and I camped, wrote, biked, traveled, read, gardened, and not a single one of us ever joined a sports team – except my son ran track in eighth and ninth grade. We had no “equipment closet” (filled with smelly hockey equipment, usually!) because I couldn’t have cared LESS about sports. Religion was important  to me, too (it became important to my siblings later in their lives. It was important to me when I was a teenager and served to accentuate my weirdness. By the time I started college, I rarely spoke with any of them. I continued to live at home, drive to college, and work, but in every way, I was just a “lodger”.

And suddenly I found myself filling the role of intimate (in more ways than one…) for my parents. I may very well be processing that for a long, long time…

Image:  http://az616578.vo.msecnd.net/files/2016/06/25/6360242025150255191939281878_Alzheimer-disease-patients.jpg

Easter Saturday Reflections EIGHT Years Since I Started This Blog

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

Four hundred and ten posts, two hundred and sixty weeks.

Good Friday was last night.

Why do they call it good? Strangely enough, the best explanation I have ever heard or seen popped up on Friday on my niece’s Facebook post in the form of a comic strip drawn by legendary artist, Johnny Hart, creator of the strip “B.C.” and co-creator of the strip, “The Wizard of Id”:

This is the only reason such a day, such a celebration could be called “good”.

Seven years ago, my daughter and I were talking about Good Friday on the way to the service and back. She observed that this was the only specifically Christian Holy Day that the secular world has been unable to coopt. We decided that there’s no way that such an event could be made cute or represented by cuddly animals, people in costumes or from which candy companies might not spin adorable commercials or bunnies laying chocolate eggs. Any attempt to “cute-i-fy” Good Friday is doomed to failure by the nature of the day.

It’s grim. Gruesome. Dark. It’s all about torture and execution.

Outsiders – those who don’t know of, believe, or otherwise acknowledge Christianity – find it offensive and inexplicable; perhaps even insane. “Why would you possible want to remember the horrific execution of your rabbi and teacher?”

Last night I was reminded again that the events leading up to the execution of the Christ are NOT about the failure of God to accomplish His mission on Earth. The crucifixion was NOT a backup plan and a bad one at that.

The events prior to Good Friday were an exhibit  of everything that is rotten in Humanity and a display of ample proportions of exactly why it needed forgiveness and saving.

The infant Jesus was born a slave to an empire both global and cruel. His birth sparked the slaughter of hundreds of other innocent newborns by decree. His life exposed the tedious, unremarkableness of thirty years of growing old in an ancient world and the loss of his father during adolescence; his three years of ministry exposed him to corrupt government, avarice and greed, ridicule by the intelligentsia, betrayal and abandonment by friends, public adulation turned mockery, lies, a corrupted justice system that did not represent slaves; gambling and drug abuse.

What does this have to do with my wife’s breast cancer? One night, I was shamed by His suffering because I have for some time now begged and challenged Him to explain, “Why have you made me suffer so?”

He hadn’t answered my plea until that night five years ago when He said, “I can’t explain that, Guy. But I can say that I have been with you in that suffering because I understand suffering. I understand despair. I get you. That’s why I haven’t cast a lightning bolt in your direction for your impertinence. I understand, as few others can, your suffering, and I’ll stand by you and answer what questions I can. Look at your blog – lots of answers there. Not ‘the answer’, that won’t come until we can talk face-to-face; but you got a lot of them. See you later, bud.”

I know this isn’t about breast cancer exactly; I suppose I pulled a Johnny Hart on you all. Be that as it may, my prayer is that you might find some answers to your suffering. If you can’t find answers, then I’d be happy to talk with you. Just leave me a comment and I’ll reply…

Image: https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjztqes950z_sxbwketq2UVlRYHUmdAq_4HCNMkgKSdAmCBAR2EIgz-qPP61G60TUi_Gt2JFKsUvpAteXDB4Fs1pM6TME6rh4qXybBOdfKdZ9fxAgCohO-k-9DyQVeiEWB5yNvJ_gtBim4/s1600/good-friday-cartoon-bc.png

ENCORE #107! – The NEXT Five Years – Anastrazole!!! What’s It DO???

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…That was four years ago – as time passed, people searching for answers stumbled across my blog and checked out what I had to say. The following entry first appeared in December of 2011.

All right – the mastectomy is done (not OVER, there are still deep emotions attached to that surgery that will never “disappear”). The chemotherapy is done (same thing there: deep emotions and memories that will be carved into my mind forever). While it’s never completely gone, the gut-wrenching worry has passed.

What now?

For the next FIVE years, in addition to some cosmetic surgery, checkups and maintenance, there are more DRUGS. Specific to breast cancer is the one I’ll talk about today: anastrozole (say it, “an-AS-troe-zole”).

Chemically, this is called 2,2'-[5-(1H-1,2,4-triazol-1-ylmethyl)-1,3-phenylene]bis(2-methylpropanenitrile) – it’s the picture you see above.

But what’s it DO?

In a nutshell it slows down the production of estrogen in a human body (BTW – men make estrogen, too, just not as much as women do. Women make testosterone, just not as much as men do).

So?

Estrogen, which at puberty initiates the maturation of a woman, causes among other things, the increased growth of the cells in the breast. This estrogen comes from the ovaries and is a totally normal response to a person growing up. Estrogen levels in the blood increase during every menstrual cycle – which means it stimulates the growth of breast cells.

Estrogen doesn’t just stop affecting the woman after puberty. “…life-long exposure to estrogen…plays an important role in determining breast cancer risk…the number of menstrual cycles a woman has, and hence the length of exposure to estrogen during her lifetime, affects her risk for breast cancer.”

So every time a woman has her period, estrogen travels through the blood. The molecule of estrogen affects cells in the body – but only certain kinds of cells like the ones found in the breast and uterus. These cells have “keyholes” in their walls that are called estrogen receptors. The estrogen and the estrogen receptor hook together to make a single molecule that enters the nucleus of the cell. Once it locks on the cell’s DNA, it directs it to do many things. Among the things it tells the cell to do is GROW.

You know by now that cancer happens when cells grow totally out of control. So every time the breast cells get a message from the estrogen, they grow. Breast cancer is the out-of-control growth of breast cells stimulated by estrogen.

Anastrazole BLOCKS estrogen from giving its message to breast (and other) cells. On the website listed below, the author states: “…the medication is directed at preventing recurrence [of cancer] other than just in  breast tissue….The American Society of Clinical Oncologists stated recently: ‘To lengthen disease-free survival and lower risk for [cancer] recurrence in nearby tissues or distant tissues…’”

So in a single sentence – Anastrazole blocks estrogen from giving its message to cells that like to take up estrogen and start growing wildly.

References: http://envirocancer.cornell.edu/factsheet/general/fs9.estrogen.cfm , http://www.medhelp.org/posts/Breast-Cancer/Why-Arimidex-Anastrozole-after-bilateral-mastectomy/show/1314813

Image: https://c2.staticflickr.com/6/5527/10893068965_1d328e8f71_b.jpg

GUY’S GOTTA TALK ABOUT…Breast Cancer #45 ****! Bone Cancer In A Friend, AGAIN

From the first moment my wife discovered she had breast cancer, there was a deafening silence from the men I know. Even ones whose wives, mothers or girlfriends had breast cancer seemed to have received a gag order from some Central Cancer Command and did little more than mumble about the experience. Not one to shut up for any known reason, I started this blog…

I know, I know, RIGHT after I say that there’s nothing else to say, something happens…not with the love of my life, but with a friend of ours.

After she got a “clean bill of health” and the doctors said that the cancer was in remission, they discovered multiple lesions of bone cancer scattered through her body. For a second, I’m going to ENCORE! The post on bone cancer from December 2011:

But just what IS bone cancer and why did she get it?

The cancer, while it can certainly occur by itself, is what is called metastatic breast cancer. It happens when cancer cells from the breast escape into the blood stream or the lymph system and invade MORE new flesh.

Bone cancer is the most common form of metastatic breast cancer (MBC) – 70% of MBCs are of this ilk – the other 30% is made up of brain cancer (10%) and lymph, lung and liver cancer. Let me emphasize here that these cancers are NOT the peculiar type of cancer cells that initiate these diseases in people who have never had breast cancer. These cancers are BREAST CANCER cells that have invaded other organs and therefore are called MBC. The word “metastatic” was used in the 1570s and comes from the Greek metastasis which means "transference, removal, change.” The roots are meta which means “over, across” plus the word histanai which means “to place, cause to stand.” Literally, “to cross over to another place to stand”, the medical use for “shift of disease from one part of the body to another” dates from 1660s in English.

Bone cancer caused by the invasion of breast cancer cells into the bones can first show up as back, bone, or joint pain lasting more than two to three weeks that seems to be getting worse; numbness or weakness in a particular part of the body; a change in bowel or bladder activity, such as problems with incontinence or not being able to urinate or have a bowel movement. This may be a sign that the nerves in your backbone are getting pinched by the cancer.

As well, blood tests can reveal a buildup of calcium or tumor markers (special proteins in the blood) like CEA (carcino-embryonic antigen), CA (cancer antigen) 15-3 or CA 27-29 that suggest the cancer might be in the bones. Calcium build up might also show up in a routine bone scan. These tests are NOT usual and are typically ordered only if the symptoms appear.

Metastatic bone disease (MBD) caused by invading breast cancer often behaves in a “mixed osteolytic (destroys bone cells) and osteoblastic (causes abnormal growth of bone cells) manner”. Bone destroying or bone growing MBD occurs because the different cancer cells give off chemicals that interfere with the naturally occurring cells in the bone and cause bone destruction, new bone formation, or both. MBD weakens the affected bones, people with the disease are prone to fractures. Broken bones caused by MBD are termed "pathological fractures."

The most common treatment options for MBD include radiation and medications to control pain and prevent further spread of the disease, and surgery to stabilize bone that is weak or broken. By killing the cancer cells, radiation relieves pain, stops the tumor from growing and can prevent the bone from breaking. Radiation can also be used to control the cancer after surgery to fix a broken bone.

MBD is a systemic (body-wide) problem and radiation therapy may be use just to lessen symptoms and pain in more advanced cases, or to completely destroy disease in the affected bone.

Different cancers respond differently to radiation. Several types of radiation therapy are available. Local field radiation is the most common type of radiation used to treat MBD in which radiation is directed at the metastatic tumor and the immediate adjacent tissue. Entire bone segments or multiple bones can be targeted by local field radiation, depending upon how many areas are affected by the disease. This usually results in complete pain relief in 50% to 60% of cases and partial relief in more than 80% of cases. How well MBD responds to radiation depends on many things, including cancer type (for example, breast cancer typically responds very well to radiation, while kidney cancer does not), and where the tumor is located.

Pain usually begins to subside in the first 1 to 2 weeks, but maximum relief may take several months. Therefore, pain medication is prescribed throughout the radiation treatment course.

OK, enough textbook talk.

The upshot has to be that while it’s treatable and manageable, it must be demoralizing in the extreme. To have been told “it’s in remission!” and then to hear, “Oops. It’s back…” has to come close to crushing the spirit.

So…I know that I usually stay away from religious stuff, but in this one case, I’m going to ask anyone who reads this to hold this friend of ours up in prayer, or unconditional positive regard, or meditate on this woman’s pain that it might be removed or lessened, send positive energy, hold her in your thoughts, empathically absorb her pain then wring it out of your mind (?) …anything that works for you when you are considering the pain of another.

Thank you.

Resource: https://www.mayoclinic.org/diseases-conditions/cancer/in-depth/cancer/art-20044575

Image: http://wrex.images.worldnow.com/images/23784252_SA.jpg