The riddle of the cancer relapse

Cancer relapse or the 'Cancer Sleeper Cell' are oh-so-reassuring (NOT!). I read this article and paid attention to it - through all five pages. So they are now trying to figure out if cancer has its own stem cells. But they haven't quite figured it out yet. They are trying. They have been working in this area since at least 1974 - so in 36+ years they still aren't sure.

On one level its quite interesting and almost exciting that they are looking at cancer down at the cell level to see which ones are stem cells - capable of regenerating themselves. They are this deep into cancer biology that they are looking at it cell by cell, detail by detail. They can define different kinds of cells and know which ones they should treat differently.

On the other hand, its been more than 36 years so this must be quite a conundrum if it is yet to be resolved. Why is it so complicated? I don't know. They, meaning the researchers, don't know. Yet. Even going back to the ancient Greeks, they aren't sure. Is cancer what the Greeks called 'black bile'? Or is its secret hidden in the idea of a cancer stem cell?

All of this adds up to the cancer relapse riddle. Why do some relapse or recur and others not? Did the combination of surgery, chemotherapy, radiation, and hormone therapy get rid of every cancer cell in my body? They aren't sure. Just because a tumor has disappeared visually, that we can detect, we don't know if it had stem cells that could lead to recurrence. And there is no time limit on recurrence. What if they go dormant for years and then return.

Thyroid cancer is a relatively slow growing cancer. So if there are thyroid cancer stem cells, and they grow slowly, how long will it take them to be detectable. It is my understanding that current medical technology such as a CT, MRI, ultrasound, or Xray can only detect down to approximately half a centimeter. In a pathology lab, after that something is removed from your body - whether by biopsy or surgery, they can see into the cell but they have to have found it before they can take it out.

How fast do things grow? I had a breast MRI and they indicated a 'suspicious area' that they wanted another look at in six months. At the six month mark, it was a 0.7 cm tumor (benign that time).

Well, we can't run off for tests monthly and have to assume the best - if necessary, go read Candide and learn about the 'best of all possible worlds' and get some optimism. The cancer relapse is still a riddle and we have to live with it.

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The M word

In cancer there are two nasty words no one wants to hear. The R word - recurrence - and the M word - metastases. The R word means it came back. The M word means it spread to other parts of your body. Quite often you get these words together as cancer often returns in another body part.

However there are some people who are diagnosed initially with metastatic cancer meaning they have a primary tumor or tumors and it is also found in other body parts. For them a cancer diagnosis is a double whammy. Not only do they have cancer, they have in multiple areas where it needs to be treated. It means (in my non medical mind) that it is in your system and you need to be treated systemically, not just locally as with an early stage cancer. And the treatment and the scrutiny will continue for the rest of their lives.

At the initial diagnosis, when cancer is found they test to see if they can find the cancer anywhere else. If they do, that's the M word.

The sad thing with metastatic cancer is that very little research is done in this area. I think the percentage of breast cancer research that focuses on metastatic breast cancer is somewhere around 4%. That is extremely low. Wouldn't it make sense that to look for not just the cause of cancer but why it spreads or returns? I have several friends who are in this boat.

Any time a person living with cancer goes back to the doctor, particularly to the oncologist, all we are thinking as well go 'no M word, no R word, no M word, no R word, no M word, no R word...' over and over again. Tell me I have a bleeding ulcer, a broken leg, degenerating back discs, gall stones, kidney stones, lymphedema, benign anything. But not the M word and not the R word and I am happy.

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All the fun out of life

So after cancer, life goes on and you return to a new normal - you can never go back to being normal, your are now a zebra. After chemo, your system once again appreciates food, your hair returns, and life goes on. And now they say if you drink, you are more likely to have your breast cancer return.

What if life is a tiny bit more stressful than it was in the past and you appreciate that dinner glass of wine a bit more. But now you can't have it. Here's the choice: (A)don't have wine and feel more stressed because your cancer might return or (B)have wine and feel less stressed because you are slightly relaxed about if your cancer will return. Do you want A or B? (Actually, how about (C) have no cancer in the first place?) They are taking all the fun out of life.

Anyway today I am off to visit a college friend. (I was going to say an old friend but we aren't old.) She and her husband live on a lake. I said I can't kayak or canoe but she offered to tow me with her kayak while I float in an inner tube. That could be quite enjoyable.

Actually today my back is not happy. I woke up in the middle of the night and then I tried lying on my side to get back to sleep and ended up in excruciating pain... But I have drugs and will still be able to float.

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