Metastatic Breast Cancer: Liver Cancer

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…

This is not a cancer you hear about frequently, though it is third worldwide after lung and stomach in the number of deaths each year. It is uncommon in the United States with three fourths of all cases diagnosed in Southeast Asia, Mozambique and South Africa.

It is one of the least common of the metastatic breast cancers with bone cancer being 70% of the metastases and brain cancer being 10%. The remaining 20% are distributed between liver, lung and non-specific systemic diseases.

Metastatic breast cancer-caused liver cancer can show up as a significant weight loss, jaundice (getting yellow skin – this condition is sometimes seen in newborns (our son was jaundiced at birth)), and elevated liver enzymes (Inflamed or injured liver cells leak higher than normal amounts of Alanine transaminase (ALT) [This enzyme causes certain reactions to happen in the body that provide for cell energy and brain signal transmission] and Aspartate transaminase (AST) [which helps in the formation of the amino acids used to make several different body proteins such as hemoglobin], into the bloodstream). Other symptoms of MBC are abdominal pain, loss of appetite, fevers, nausea, sweats and vomiting. In some cases, there are no symptoms.

Tests that may be done to diagnose liver metastases include a CT (Computer Assisted Tomography) scan of the abdomen, liver function tests (to check for the elevated enzymes mentioned above), MRI (Magnetic Resonance Imaging) of the abdomen, PET (Positron Emission Tomography) scans or ultrasound of the liver

Pain from this kind of liver cancer responds to chemotherapy and analgesia. Doctors can also try radiation therapy to relieve pain and shrink the cancers.

How well you do depends on the location of the original cancer and how much it has spread to the liver. As recently as January of 2011, doctors have added a new treatment to the arsenal: Resection (removing parts of the liver affected by the cancer) of breast cancer liver metastases paid off in a survival benefit in patients with chemotherapy-responsive, estrogen receptor (ER)-positive primary tumors, according to data from a retrospective chart review.

“Although the cases were small in number, they are relevant in the context of changing views about cancer that metastasizes to the liver…I think there has been a [dramatic change in thinking] over the past 10 years or so, where it has been realized that this surgery can lead to long-term survival…I don't think that was recognized previously…I think there has been something of a nihilistic attitude toward breast cancer metastasis to other organs in the past…Generally incurable, most liver metastases from breast cancer are treated with chemotherapy or hormonal therapy,” said Daniel E. Abbott, MD, of the University of Texas MD Anderson Cancer Center in Houston. “I think this information is most valuable when people are willing to counsel patients and make the tougher decisions about who should and should not have surgery and then let patients make informed decisions.”

References: http://www.breastcancer.org/treatment/surgery/new_research/20110123.jsp

http://en.wikipedia.org/wiki/Metastatic_breast_cancer

image: http://www.hpblondon.com/liver-tumours/index_files/fdg_pet_scan.jpg

Metastatic Breast Cancer: Lung Cancer

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…

Some fifteen years ago, my wife’s mother passed away from lung cancer.

A child of her times, she smoked often and heavily for a number of years while raising four children, then quit – long before I met her.

Diagnose with lung cancer in 1994, she took chemotherapy, went into remission and finally succumbed to the disease in (I think – and my wife will correct me!) 1997.

Her disease was DIFFERENT than the type of lung cancer that can flare up after a woman (or rarely a man) is treated initially for breast cancer. Lung cancer after breast cancer is most often caused by BREAST CANCER cells that have invaded other organs and therefore are called metastatic breast cancer. 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.” The medical use for "shift of disease from one part of the body to another" dates from 1660s in English.

“Metastatic cancer to the lungs is the spread of cancer from another region of the body to the lungs. The place where cancer begins is called the primary cancer. For example, if breast cancer spreads to the lungs, it would be called breast cancer with metastasis (spread) to the lungs. In this case, breast cancer would be considered the ‘primary’ cancer.”

Symptoms that would lead doctors to believe that the breast cancer had metastasized to the lungs are similar to those of “regular” lung cancer and would be warning signs that a person would need to see their doctor as soon as possible. They include: a cough that persists over time, or does not go away with treatment; coughing up blood, difficulty breathing (due to decreased airflow by a tumor obstructing the large airways or spread through the lungs); wheezing (caused by the interference of airflow through an airway obstructed by a tumor); pain in the chest, back, shoulder, or arm (when a lung tumor presses on nerves around the lungs); repeated lung infections such as pneumonia or bronchitis; hoarseness; and lastly, lung cancer CAN have no apparent symptoms and only appear  when a chest x-ray is done for another reason.

As well, “general symptoms” of lung cancer can sometimes present with vague concerns such as fatigue, weight loss, loss of appetite, and even depression can be a symptom of lung cancer as well as many other conditions.

Treatment for cancer metastatic to the lungs is usually determined by the primary cancer, or origin of the cancer. Systemic therapy (chemotherapy, biological therapy, targeted therapy, hormonal therapy), local therapy – which might include surgery or radiation therapy), or a combination of these treatments. The choice of treatment generally depends on the size, location, and number of metastatic tumors; the patient’s age and general health; and the types of treatment the patient has had in the past.

References: http://lungcancer.about.com/od/symptomsoflungcance1/a/symptomslungca.htm

http://www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic

image: http://www.topcancernews.com/images/1/CancerMetastasis.jpg

Metastatic Breast Cancer: Bone Cancer

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…

We just got news this week that a “cancer friend” of ours had a bone scan, and after an extended time of treatment, she is cancer free!

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.

While bone cancer is the most common – 70% of metastatic breast cancers 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 metastatic breast cancer. 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.” 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.

For our “cancer friend”, the treatment has been effective and with the pain greatly reduced, we are planning to actually meet for the very first time for dinner over the holiday season!

References: http://www.breastcancer.org/symptoms/types/recur_metast/where_recur/local.jsp , http://orthoinfo.aaos.org/topic.cfm?topic=A00093

Image: http://www.meddean.luc.edu/lumen/meded/Radio/curriculum/Harrisons/Oncology/mets5b.jpg

Man Cancer and the Orchiectomy

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…

So this week I got the news that two good friends of mine have cancer. One has colon cancer and will be undergoing a colECTOMY (ecto = Greek for “to cut out”) during the Christmas season.

The other is twenty-some years younger than me. He was diagnosed with testicular cancer and had a radical orchiectomy after which…well, we don’t know because they are in the specific diagnosis part of his New Normal. He said he’d let me know because I pray well for biological specifics – I can see the parts of the body that are affected – cancer, breaks, dislocations, flu. I am a great prayer for healing of body parts as well as for restoring the heart and mind.

At any rate, some time ago, my wife asked “Why do so many people have breast cancer?” I marshaled statistics in this post: http://breastcancerreaper.blogspot.com/2011/06/why-do-so-many-women-have-breast-cancer.html

The research led me to the statistics for other kinds of cancer – lung cancer, Liz’s mom died from this; blood cancer (leukemia), the son of close family friends; brain cancer, an old friend of mine died from this at 30; skin cancer, my sister, brother and sister-in-law have this; there are others with other cancers that I don’t care to enumerate at this time.

Testicular cancer has increased by 60% in the past 25 years. Why? Right now no one knows the answer, it just…has.

A student of mine, after we talked about why my wife’s hair all fell out during chemo. I talked about how the chemicals target fast-growing cancer cells – and kill the fast-growing hair cells “accidentally”. She then went on a rave about how we should make drugs that ONLY target cancer cells…and that got me to thinking.

Are all cancer cells created equal? Or are they egalitarian? Is testicular cancer the same as breast cancer? Brain cancer? Lung cancer? Skin cancer?

Questions – and today…no answers. Just more questions that I’m going to try to answer in the future…

Image: http://www.tc-cancer.com/images/img-cancer-cell.jpg

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…

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: anastrazole.

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 ANYWHERE IN THE BODY 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: http://www.3dchem.com/imagesofmolecules/arimidex.jpg

A Big Hairy Deal

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…

It’s been my experience that men don’t usually care that much about their hair. It’s also been my experience that hair is VERY important to women.

That’s why the most obvious result of chemotherapy – alopecia – has such a profound impact on women and the men who love them. Women who lose their hair are OBVIOUS to everyone who looks at them. They are noticed; they stand out in public in a way a bald man will never stand out. We admire it even – Kojack, The King of Siam, Captain Jean-Luc Picard are all heroes and we don’t even notice their shiny heads. But bald cops, Queens and starship Captains would be so odd that most of us wouldn’t even remember the rest of the record, reign or voyage.

As men with wives, girlfriends and mothers who will or who have lost their hair because of breast cancer, we stand in an unusual place.

We have to be honest encouragers.

“Honey, how does this wig look on me?”

“Is the scarf the right color for my skin?”

“If I wear a baseball cap every day, will you still think I’m sexy?”

“If I don’t wear anything on my head in public, will you be embarrassed?”

The first response to each question is initially: “It looks fine, dear”, “It looks fine, dear”, “Of course I will”, “Nothing you could wear or not wear would embarrass me”.

The problem with the response is that our loved ones are our loved ones and a diagnosis of “stupid” does NOT go hand-in-hand with a diagnosis of breast cancer. They know when we are patronizing. I learned the hard way not to patronize my wife. When she asked one of the questions above, I had to take my time and think. I had to consider my answer not because I wanted to be right, but in order to battle the deep-seated desire to avoid inflicting any more pain on a person worn out from the constant fight against cancer.

So I studied her as she modeled the wig, scarf, hat or bald pate.

Honestly responding, I gave my opinion. When it was honest, it gave her FEEDBACK and while the ultimate choice was still hers, she most likely felt that my response – especially before her hair started to grow back – was honest and another data point in her effort to decide what to wear that day.

Ultimately, I could do nothing more important that to be consciously HONEST!

Images: http://i536.photobucket.com/albums/ff323/MSBrady78/charpics/picard.jpg

Neulasta!!! 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…

Hey! I'm back! And yes, I WAS in Portland, Oregon during Occupy Portland! I DID see the marchers and took pictures of them and watched them...occupy Portland for several days...and now, back to our regularly scheduled blog:

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).

Looks like the picture up top. 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 above) 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.

References: http://en.wikipedia.org/wiki/Pegfilgrastim, http://www.drugs.com/neulasta.html,

Image: http://molecules.gnu-darwin.org/html/00150001_00175000/164419/164419.png