Understanding Lymphatic Metastases ... A Beginner's Primer

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Spread of Cancer through the Lymphatic System

(Summer 2011 - Reprinted from Cancer Quest / Emory University / Winship Cancer Institute  http://www.cancerquest.org )

The Lymphatic System


The lymphatic system plays an important role in controlling the movement of fluid throughout the body. Specifically the lymphatic system controls the flow of lymph, a colorless fluid containing oxygen, proteins, sugar (glucose) and lymphocytes (cyte=cell). Once they are formed in the bone marrow, lymphocytes circulate in the body and reside in lymphatic tissue including lymph nodes and the spleen, where they search for and await contact with their target proteins. The lymphatic system is a system of vessels (tubes) that is present all throughout the body. Like the more familiar circulatory system, the lymphatic system carries fluid, proteins and cells of the immune system.

Red blood cells are not found in the lymphatic system. The two systems (lymphatic and circulatory) are connected. The lymphatic system picks up fluid and cells from around the body and returns them to the circulatory system via ducts located in the neck/shoulder area. The fluid within the vessels is known as lymph. There are some similarities and differences between the (more well known) circulatory system and the lymphatic system.

Small lymphatic vessels merge into larger ones and these large vessels eventually empty into lymph nodes. Lymph nodes are kidney bean shaped tissues that are found in grape-like clusters in several locations around the body. Lymph nodes are sites of immune system activation and immune cell proliferation (growth). The fluid in this extensive network flows throughout the body, much like the blood supply. It is the movement of cancer cells into the lymphatic system, specifically the lymph nodes, that is used in the detection of metastatic disease.

Spread of Cancer Through the Lymphatic System

The lymphatic system is of great importance in cancer for several reasons:

• Cancer cells can spread (metastasize) by getting into the lymphatic system.
• Many cancer types are classified or staged by whether or not cancer cells can be found in lymph nodes close to the site of the original tumor. The logic is this: The lymphatic system is found all over the body so if cancer cells from a tumor have made it that far, they may also have traveled to distant locations.

When a cancer cell has moved through the blood or lymphatic systems or via direct contact to another location, it may divide and form a tumor at the new site. Metastatic tumors often interfere with the functions of the organs involved and lead to the morbidity and mortality seen in cancer.
The lymphatic system plays a crucial role in the metastasis of certain cancers. Lymphatic vessels are designed for entry and exit of immune cells, and are therefore easy for tumor cells to enter. In addition, the flow of lymph is quite slow, so there is little stress to harm cells.⁽¹⁾ Researchers originally believed tumor cells invaded the lymphatic system by eroding the vessel walls as the tumor advanced and metastasis would then occur by passive drainage. However, current evidence suggests the interactions between metastasizing cells and lymph vessels are much more active and complex, and specific interactions between the two are required.

The presence of metastases in lymph nodes near the primary tumor often indicates metastasis to distant organs, and is a significant prognostic indicator in many cancers. To assess the presence of metastasis to surrounding lymph nodes, physicians perform a lymph node biopsy. In this procedure, the lymph nodes are removed by surgery and are checked for the presence of cancer cells. Nodes are determined either positive or negative for cancer.

Because lymph drainage pathways from a tumor vary greatly between patients, even for the same area, up to 30% of tumors cannot be accurately predicted to migrate to specific lymph nodes. Improvement in lymphatic imaging and mapping are needed to ensure that metastasizing cancers are not accidentally missed. ⁽²⁾


The diagram below shows the lymphatic system


  

1. Kopfstein, L., and G. Christofori. 2006. Metastasis: cell-autonomous mechanisms versus contributions by the tumor microenvironment. Cell Mol Life Sci. 63:449-68. [PUBMED]
2. Shayan, R., M.G. Achen, and S.A. Stacker. 2006. Lymphatic vessels in cancer metastasis: bridging the gaps. Carcinogenesis. 27:1729-38. [PUBMED]

Routes of Metastasis

There are three primary ways tumors can spread to distant organs:

1. Through the circulatory (blood) system (hematogenous)
2. Through the lymphatic system
3. Through the body wall into the abdominal and chest cavities (transcoelomic).

The circulatory system is the primary route of spread to distant organs, while lymphatic vessels provide a route to local lymph nodes, after which metastases often travel through the blood ⁽¹⁾ While the circulatory system appears to be the most common route, the extent of lymphatic versus hematogenous spread appears to depend on the origin and location of the primary tumor.⁽²⁾ For example, bone and soft tissue tumors (sarcomas) spread primarily through the blood, while melanoma, breast, lung and gastrointestinal tumors spread through the lymphatic system.⁽³⁾ Transcoelomic spread is fairly uncommon, and appears to be restricted to mesotheliomas and ovarian carcinomas.⁽⁴⁾

In order for tumor cells to gain access to lymphatic or blood vessels, tumors need to promote the growth of these vessels into and around the tumor. Growth of blood vessels is called angiogenesis, and growth of lymphatic vessels is lymphangiogenesis.

1. Bacac, M., and I. Stamenkovic. 2008. Metastatic cancer cell. Annu Rev Pathol. 3:221-47. [PUBMED]
2. Gerhardt, H., and H. Semb. 2008. Pericytes: gatekeepers in tumour cell metastasis? J Mol Med. 86:135-44. [PUBMED]
3. Kopfstein, L., and G. Christofori. 2006. Metastasis: cell-autonomous mechanisms versus contributions by the tumor microenvironment. Cell Mol Life Sci. 63:449-68. [PUBMED]
4. Tan DS, Agarwal R, Kaye SB. Mechanisms of transcoelomic metastasis in ovarian cancer. Lancet Oncol. 2006 Nov;7(11):925-34. [PUBMED]

Treatments that Target Metastasis

Metastatic Suppressors

Recent work has uncovered a group of molecules that act to induce or suppress metastasis without affecting the growth of the primary tumor. Many molecules, termed Metastatic Suppressors, have been identified. These molecules are critical for different stages of metastasis, and may function to inhibit cell death upon loss of cell adhesion, or enhance the ability of cells to migrate through the stroma. Researchers are hopeful that these molecules may prove valuable as anti-cancer/anti-metastasis targets.⁽¹⁾
It is important to realize that the majority of current anti-cancer drug studies are conducted using primary or cultured tumor cells, and the efficacy of each drug is measured by its ability to reduce the size of primary tumors or kill cells being grown in laboratories. However, because metastatic suppressors do not affect growth of the primary tumor, it is likely like many potentially useful anti-metastatic drugs have been overlooked. New methods of analyzing the ability of drugs to inhibit metastasis, rather than primary tumor growth, are being developed, and should lead to a useful new class of therapeutic compounds.⁽²⁾

Anti-angiogenesis Therapy

Because metastasis relies on the growth of new blood vessels in both the primary and secondary tumors, drugs that inhibit angiogenesis may inhibit metastasis. Currently, the combination of anti-angiogenesis drugs with chemotherapy/radiation is the most effect treatment. Unfortunately, many tumors become resistant to the anti-angiogenesis treatment, so this is generally not a longterm solution. ⁽³⁾

Current research into inhibiting metastasis is focusing on understanding which step of metastasis is the most amenable to therapy. The identification of metastatic suppressor genes has opened up many exciting new potential targets for preventing and inhibiting this deadly event.

1. Stafford, L.J., K.S. Vaidya, and D.R. Welch. 2008. Metastasis suppressors genes in cancer. Int J Biochem Cell Biol. 40:874-91. [PUBMED]
2. Steeg, P.S. 2006. Tumor metastasis: mechanistic insights and clinical challenges. Nat Med. 12:895-904. [PUBMED]
3. Gupta, G.P., and J. Massague. 2006. Cancer metastasis: building a framework. Cell. 127:679-95. [PUBMED]

A Glimpse at the 'Survivor Side' of the Cancer Journey

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Been reading your blog; won't post anything on it for all to see since there is no mention of us on it.

Prologue ~ I believe I am beginning to understand who the true cancer "survivors" are. It is not the ones with the disease. It is those who surround us.

I am so glad you are reading the blog. I do mention you guys in “.......” in July. If I am not railing against the Pink-Industry, I mostly mention Husband and kids, I think it is because managing their day to day life with my chronic disease is a FT job.

You sound offended. No slight in any which way is intended, has been intended, or ever will be intended. I truly am sorry if you are feeling slighted in any way or form.


My writing is what I am feeling about living with a chronic disease, and the blog helps me distill those feelings, whether they be outrage, disgust, euphoria, sadness, or even pedagogical and snarky.

I know that it appears I am being selfish about my cancer.

I am.

But not because I am trying to be hurtful to others.

When I am asked, I will share what I feel I am emotionally or psychologically capable of sharing at a given time. It is difficult for me, most times,  to "share" when I am speaking with people. Even with Husband it can be an uncomfortable subject...to acknowledge that my life has been reduced to a 20% chance of surviving 5 more years. ONLY if I do / did what conventional medicine offered...which I chose not to.

It is easier for me, and always has been, to write. So, now I blog. And for those who want to “know” what is up with me, my blog is a forum in which they can delve at their leisure, without ME getting in the way.

And for those few who read, commenting is voluntary and appreciated, but never necessary or required.

Thank you for sharing your feelings with me. Your one cryptic, yet pointed, sentence did speak volumes.

I may not meet your or anyone else's expectations, but do know it is not because I am trying to hurt anyone in any way. Or, that I am being consciously self-centered. I think I do understand how challenging it is for you - to be a spectator while I take this journey. You are not the only one who, at times, feels "left out."  Husband, too can only be a spectator. Cancer is not a "team" sport. And, admittedly, I am not a good Team Pink player.


But it does not mean that I don't love you, and appreciate you. I love you, as me. That's all I can do.

So you say its your birthday...IT 'S MY BIRTHDAY TOO YEAH!

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...and we're going to a party party...

Birthdays. We can dread them.
We can lament them.
And we can say to ourselves: "self...how did I get here?"
We can count the crows feet and smile lines.
We can frown, or do botox.
Or we can cheer.
Each one is treasured. At least well-earned.

I turned 50 today. WT...???
...and WOW!
30 years ago I could not imagine myself at 50.
That was just too old.

Now I am. And I have more money to behave more badly than I did when I was 20. Life is GOOD!

I have just had the best birthday EVER!

Why? Because it was planned and orchestrated with one thing in mind...ME! Yippee Skippee! One day a year when selfishness is not only tolerated, but expected.

The last 24 hours have been about fulfilling desires, and it was all devised by Husband. [Major...MAJOR... kudos to him.] When someone loves you enough to put together 24 hours totally meeting your happiness. Well, it is...LOVE.

Husband carted me off to Vegas. Okay, not so special, except Vegas is a land of fantasy and enchantment, and anything can indeed happen in this desert oasis.

Just put on the rose tinted glasses and let yourself IMAGINE.

T-minus 2.5 hours before my 1/2 century mark, and Husband sweeps me off to the BEATLES LOVE a la Cirque du Soleil. An amazing 2 hour LSD trip complete with soundtrack, dancers, film clips and haunting montages. And no needing to come down, or hang over. The last track came on. The silk screened props illuminated the Fab Four 1968 and I found myself tearing up.

 OY nostalgic me!

We return to the hotel room and a dozen chocolate dipped strawberries and a bottle of chilled champagne awaits!

OY sucker for a good berry, I am!

The morning of my birth arrives. Wake up! We have time for you get a bathing suit on and get you your morning coffee...HURRY! [This from the man doing his a.m. morning yoga stretches butt-naked...TMI]

Coffee is nabbed and off we are to the Dolphin Habitat. I AM TO BE A TRAINER FOR THE DAY...and it was the...entire...day. Wet suit donned, instruction begins...:

Herring kisses.
Dolphin eczema.
Fish breath.
500 lbs of pure beauty.
Goof balls.
B-a-b-i-e-s!!!
Stoop samples...ew.
Personality.
Soft bellies
Scarred bodies.
Sweet testosterone boys.

Protective matriarch.
Play time.
Exercise.
Hugs.
Friends.

...did I mention that I cried?

Back to the room.
Washing kippers out of my hair, lips and hands.

I squeeeeeeeeeeeeeeeeeze into my black skinny jeans. Put on 4 inch black patent leather stilettos (heh, heh...now I am 5'4") and slither into a black sequined tank. Next door to Caesar's Palace and the 1M Dollar Piano Extravaganza. For the uninitiated, it is Sir Elton John putting on his most memorable concert ever (and he was my first in 1973 at LA Dodger Stadium...35lbs ago. ELTON, not me! My parents gave me the tickets in 1973 for my 13th bday. I have now come full circle). EJ talked, he joked, he sang Spanish Harlem; and Husband had me strategically seated center stage piano.

Here's news...I cried!

I feel so incredible. So satisfied. The only other times I can remember feeling this euphoric: My wedding day in 1989 as I anxiously paced hoping Husband-to-be was not going to jilt me for a soccer game ~ he's a playa; the births of each of my three children (yes, I cried at each); and today, my 50th Birthday.

Thank you Husband. Thank you my children. Thank you my sister and niece...yeah yeah...and brother-in-law and niece's boy toy.

In 9 minutes I will be embarking on my 51st year, and it feels good.

...All you need is LOVE...LOVE is all you need! ...at least for today, and today is enough.

Sunday's Spillage

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....and now for something completely random....

The posting of Sunday's Random Thought only generated more thinking. As I subtly indicated, I am not one for labels, but since the marketing of cancer requires some form of appellation, I started thinking of possibilities...

[Cancer] Sojourner (n)

a person who resides temporarily in a place ....  well maybe not. Temporary is subject to too many meanings.

[Cancer] Journeyer (n)

one who goes on a journey .... add in, "especially to territories unknown," and this has potential.

[Cancer] Explorer (n)

someone who travels into little known regions (especially for some scientific purpose). ... now this definitely hits a chord with me.  Preface with UNWILLING EXPLORER and this may hit the mark. I can't see pink industry marketers doing cartwheels, however.

"JOIN US IN THE 3-DAY WALK TO BENEFIT 'UNWILLING BREAST CANCER EXPLORERS ' ....JOURNEYERS.....SOJOURNERS......."

But these just don't sell the product does it? 

They just don't capture the essence of cancer, do they?

These labels don't make a person want to run out and participate in retail philanthropy.

....
To sell a product or commodity...the Madmen[tm] have found the following to be effective. This does not make me question the Madmen [tm], but rather, their perception of the consumer. Check out NancysPoint for a different, but important take on marketing and feminism: http://nancyspoint.com/feminism-breast-cancer/

Junior High mentality (no offense to 13
year olds intended)

Does Campbell's use lead-free and aluminum
free cans? Check out the list of preservatives!

This pretty much sums up the driving force
behind the pinkindustry

Yeah...Biff is thinking about the lack of strides in finding
the CAUSE & CURE for breast cancer while
swinging on the back nine

Just don't inhale when using this product

Beer Pong Table...Really????

...there are no words for
 the feelings this ad invokes

Jumping on the Pink Bandwagon

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Maybe I have been too judgmental. "Awareness" remains a critical need during Pinktober, and throughout the year. Case in point:

I walk into our neighborhood Safeway store last evening with my 10 year old son. As I am in the check out line, the 10 year old spies a large handwritten sign that announces: REGISTER NOW TO WIN AN iPAD2!

Mom, can I go check it out?

He goes over to the table with the display. Yes, it is to benefit breast cancer, but it does not say which pinkindustry is sponsoring the drawing, the cost of tickets, or which non-profit is going to reap the proceeds. And, there are no entry forms

The manager eyes my son investigating the table, and then me. He walks over to me and informs, enthusiastically, that: yes my son may enter to win, would I like one ticket for $10 or 5 tickets for $50 (retail price break).

I ask who is sponsoring: Safeway (obvious)

I ask to whom is it benefiting: Breast Cancer (okay, obvious again...he must think I am a moron at this point)

I am still gnawing on the price break.

I rephrase. To which organization will Safeway be ~ donating (?) the funds: the funds will stay locally (what does that mean)

Deep breath...he is management after all.

I probe further. Which local organization will Safeway be giving the money raised from the ticket sales for the iPad2. Safeway  (WT....???)

Oh, Safeway has its own breast cancer organization: No, um, some money will go to Tucson (okay, I am in for a pound now)

Which organization in Tucson: Oh, there a lot of them in Tucson that do good work for breast cancer

And those would be: The large medical ones (price break goes to priceless)

I tell him that I think I am going to pass on purchasing the tickets. He still tries one last shot at inducing me to buy: Oh, and some of the money is going to Susan G. Komen, they do a lot in researching breast cancer awareness! That is a great cause.

Oh yes, yes it is!

Random Thought Sunday (10/16/2011)

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We need another label. These just don't work for me.

Yes, technically I am a patient, since I am undergoing treatment for a chronic disease. But the word "patient" conjures up antiseptic hospital rooms and off-the rack backless gowns. This just does not speak to me.

The definitions of survivor make my skin crawl. ...remaining alive after...others have died. True, to some extent, for some.    ...copes well with difficulties in life. Coping is relative. Coping well is purely subjective. Ironically, it is the public expectation that persons with cancer do nothing but cope well. No one likes a poorly or misbehaved person dealing with cancer. They don't make good poster icons for fundraisers. I can't fit myself into the paradigm of survivor.

Victim resonates: tricked, duped, offered up as a sacrifice to the pink industry. But victimization also requires a certain acquiescence. I will not go down that path.

We need another label, or better yet ... no label at all.

 pa·tient
 noun     /pey-shuh nt]

                1. A person who is under medical care or treatment.
              
              2. A person or thing that undergoes some action.

              3. Archaic ~  A sufferer or victim.

peɪʃənt/ Show Spelled

sur·vi·vor

noun /sərˈvīvər/  A person who survives, esp. a person remaining alive after an event in which others have died The remainder of a group of people or things A person who copes well with difficulties in their life A joint tenant who has the right to the whole estate on the other's death vic·tim noun /ˈviktəm/  A person harmed, injured, or killed as a result of a crime, accident, or other event or action A person who is tricked or duped A living creature killed as a religious sacrifice

"Peaking" Behind the Pink Curtain

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Today, October 13, I just recently found out, is METASTATIC BREAST CANCER AWARENESS DAY. Who knew? And, more importantly, why didn't we know?

The entire month of October is "Breast Cancer Awareness" month, and the killer form of breast cancer gets only one day out of 31. 1% of the attention. Unfortunately, that is the reality and history of breast cancer research and awareness.

No one wants to talk about the actual death rates behind the pink curtain.

It boggles my mind that as the runners race for the cure; walkers do their 3-day walk; drinkers down their Pink Hard Lemonade; fashionistas don their pink pins, bracelets, baseball caps, t-shirts; foodies eat their Kentucky Fried [pink packaged] Chicken; and Susan G. Komen markets their carcinogenic PROMISE ME perfume, that only a small percentage of concerned, well-meaning people ask the question: where does my contributing money really go, and how is it spent?

Susan G. Komen only spent approximately 20% of their raised funds on (early stage) research in 2010, despite raising over $310 million (although $22 million went to salaries).

And... Despite the platitudes to the contrary, it certainly does not go toward reducing...eliminating (?)... the deaths from metastatic breast cancer. Despite the moniker that, early detection saves lives...(the falacy of which is becoming more apparent)  the $$$ do not go toward solving the medical mystery of what causes breast cancer, and what then causes it to metastasize? And only 2% goes toward research on that form of breast cancer that causes the death of 40,000 women each year in the U.S.

Because of these life-impacting inequities, METAvivor, a non-profit organization devoted solely to raising funds for metastatic breast cancer research, as well as awareness of this deadly disease, was developed and conceived. Below is a repost of an OpEd written by the president of METAvivor, C.J. (Dian) M. Corneliussen-James, this past summer. I strongly encourage you to read this enlightening OpEd, and then go and check out METAvivor.org. 

~ TC

Opinion: 30 percent for 30 percent

Posted on 01 June 2011.

By C.J. (Dian) M. Corneliussen-James

The most devastating and feared breast cancer is metastatic (stage IV) breast cancer. This occurs when breast cancer spreads to distant, non-adjacent parts of the body. It strikes 30 percent of breast cancer patients and is fatal, taking lives on average within two to four years of diagnosis.

Clearly, ending death from metastatic breast cancer (MBC) is of critical importance not only to those living with it, but also to anyone who has had, or may at some point develop breast cancer.

Unfortunately, research for MBC is vastly underfunded. Indeed, research for all metastasized cancers is collectively funded at only 2 percent, and MBC is a subset of that group.(A recent quote of 5 percent in regard to metastatic cancer research came from averaging U.S., Canadian and European research portfolios. All statistics and information in this paper pertain solely to the U.S.)

So where does most of the money go? It goes predominantly into prevention and early detection. If one looks at the funding distribution pie charts of various organizations, these two categories are inevitably included. What is not immediately apparent is that much of the funding designated for other categories, such as biology and etiology, is also spent on issues pertaining to prevention and early detection. By comparison, MBC research is so poorly funded that it rarely even appears on a pie chart.

The preoccupation with prevention and early detection has continued since at least 1998 when the National Cancer Institute set these two issues as the national breast cancer focus. Reaffirmed in 2004, the policy has not changed — neither has the fact that each year roughly 195,000 Americans continue to be diagnosed with breast cancer, that 30 percent of these patients continue to metastasize, and that 41,000 continue to die each year.

While one cannot dispute that prevention and early detection are worthy causes, one can indeed question the inequity in the distribution of funds. Further, one can certainly ask how long we plan to direct the preponderance of research in this same direction, especially in light of what has, or better said has not been achieved.

Why are other organizations not funding stage IV research? Here are my thoughts:

1. Image and Turn-Around: Grant-givers prefer projects of short duration with a relative certainty of success. That is good for the image and encourages future donations. Mets research is enormously complex and the best chances for significant improvement tend to be out of the box ideas. Such research takes longer to accomplish and the predictability of success is shaky.

2. They are Getting Away with It. Cancer organizations have used token advances to claim they are making great strides forward with metastatic cancer. The advances they speak of are rare and normally involve extending life at best for several weeks or months, but this is not made public. Even those who know the truth keep giving, including some of those dying of the disease. They are caught up by the glamour, the big names and the enticing events. There is no need to take the difficult road.

3. Money .. Money .. Money. Metastatic cancer research is enormously expensive, especially if sufficient models (animal or otherwise), which are critical to much of the research, are to be developed.  [This block quote was copied from an earlier post by CJ and  inserted here by the blogger, TC...exploiting her creative license]

Quite a few scientists say privately that prevention in the foreseeable future is unrealistic because among other things, we do not even know what causes breast cancer and thus have nothing specific against which to target our efforts. Likewise, early detection has failed to effectively reduce death because some patients have metastatic cells prior to developing a detectable breast cancer. And thus even stage 0 patients can and do metastasize.

Research for other aspects of breast cancer is certainly being done, but on a diminishing scale. At the bottom of the scale is MBC — the only breast cancer that kills.

In response to a small but nevertheless persistent outcry that not nearly enough is being done, we have recently seen one or two promises to address the issue of MBC. Yet in reading the fine print we see that what is being discussed is research to prevent breast cancer from metastasizing — not research focused on interceding after the cancer has spread.

Is there a difference? You bet. Although any cancer research can at times yield new information relevant to another area of research, significant progress usually occurs only when research is directly focused on the problem at hand.

Metastatic cancer exists in a different realm than non-metastatic cancer. Thus MBC is far more apt to benefit from research undertaken for another metastatic cancer than it is from research involving non-metastatic breast cancer. Unfortunately, since the entire field of metastatic cancer is funded at only 2 percent, there is limited related research to draw upon.

So just what is the reluctance to sufficiently fund metastatic cancer research?

Historically, metastatic cancer has been considered too complex an issue to tackle with any reasonable expectation of success. Yet times, and the state of science have changed.

According to Danny R. Welch, Ph.D., renowned career metastasis researcher and past president of the Metastasis Research Society, “Within 10 years, suffering from and potentially death from metastatic breast cancer could be reduced significantly if the research were fully funded.” There are now many dedicated career metastasis researchers, who have the education, the experience, the skills. the ideas, the proposals and the scientific insights to make a difference. What they lack is the funding.

I could make the argument that MBC research, and not prevention and early detection, should be the premier focus for breast cancer research. Clearly those with MBC have the most urgent need for research because it is their lives, and only their lives, that are imminently at risk. Equally important is the fact that ending death from MBC is the only means to simultaneously bring peace of mind and the promise of longevity not only to all stages of breast cancer patients but also to a general public that worries about being diagnosed. By contrast, prevention and early detection are relevant only to the undiagnosed. Once a person becomes a patient, these issues are of no further value.

Yes, I could make my argument, but I am unlikely to win. Thus instead, I advocate for what I think is both fair and achievable – 30 percent for 30 percent. Thirty percent of all breast cancer patients metastasize and die. Thus 30 percent of all breast cancer research funds should be dedicated to MBC research — exclusive of research to prevent metastasis, which pertains to the non-metastatic patient and thus belongs in the domain of non-metastatic research.

If we could achieve 30 percent for 30 percent, we would save countless lives.

13 Facts You Should Be Aware Of During Breast Cancer Awareness Month

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"While there is no cure for metastatic breast cancer, some individuals are able to live longer with the disease. However, metastatic breast cancer remains a clinical challenge in the oncology community. October 13 places emphasis on the disease stressing the need for new, targeted treatments that will help prolong life." - William Gradishar, MD, Northwestern University Feinberg School of Medicine

13 Facts Everyone Should Know about Metastatic Breast Cancer ~ reprinted from the Metastatic Breast Cancer Network. mbcn.org

1. No one dies from breast cancer that remains in the breast. The lump itself is not what kills. The metastasis of cancerous cells to a vital organ is what kills.

2. Metastasis refers to the spread of cancer to different parts of the body, typically the bones, liver, lungs and brain. [ILC (invasive lobular carcinoma) is atypical in where it will metastasize first, e.g., lymphatic system, peritoneum, uterus]

3. An estimated 155,000 Americans are currently living with metastatic breast cancer. Metastatic breast cancer accounts for approximately 40,000 deaths annually in the U.S.

4. Treatment for metastatic breast cancer is lifelong and focuses on control and quality of life vs. curative intent. (“Treatable but unbeatable.”)

5. About 6% to 10% of people are Stage IV from their initial diagnosis.

6. Early detection is not a cure. Metastatic breast cancer can occur ANY time after a person’s original diagnosis, EVEN if the patient was initially Stage 0, I, II or III and DESPITE getting annual checkups and annual mammograms.

7. Between 20% to 30% of people initially diagnosed with regional stage disease WILL develop metastatic breast cancer.

8. Young people DO get metastatic breast cancer.

X-ray of a woman with metastatic breast cancer
 in her bones

9. There are many different kinds of metastatic breast cancer.

10. Treatment choices for MBC are guided by hormone (ER/PR) and HER2 receptor status, location and extent of metastasis (visceral vs. nonvisceral), previous treatment and other factors.

11. Metastatic breast cancer isn’t an automatic death sentence. Although most people will ultimately die of

their disease, some can live long and productive lives.

12. There are no hard and fast prognostic statistics for metastatic breast cancer. Everyone’s situation is unique, but according to the American Cancer Society, the 5 year survival rate for stage IV is around 20%. (Ahhh...this is where radiation onc got her figures when she played out for me her interpretation of the grim reaper. She gave me the cookie-cutter stats!)

13. October 13 is National Metastatic Breast Cancer Awareness Day. To learn more about it as well as resources specifically for people with metastatic breast cancer see www. mbcn.org.

Guessing at the Causes & Effects...the "What ifs" when you live with the Big C

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Pain shoots through my armpit (axillary if you are medically squeamish) down the inside of my arm.

I instinctively hold the area.

The pressure makes it worse.

Pain radiates across my abdomen.

Catching my breath.

I take deep yoga breaths trying to calm my inner self ~ both physically and emotionally.

I rise from the chair and my spine crunches and compresses.

I walk for the first few minutes gripping my elbows behind my back (thank G-d for good muscle memory & flexibility from bygone dance and martial arts).

I am so damn clumsy! Either I am emitting a negative polarity to solid objects, or going through another adolescent growth spurt. (Oops...5-0 bday looming...I mean second adolescence.)

The newest blood work came back, concerning low white blood cell and red blood cell counts,even after 6 weeks of being on supplements for both. (On a new vegan prenatal vitamin with 45 mg of iron picolinate...NO...I am not preggers I just covet their multi vitamins.)

My body is fighting an invader so my white blood cell count should be on terminator mode (think Nintendo Brawl fully loaded...yes, I have a 10 year old).

Is it apoptosis** performing seppuku with the cancer cells in my...yes say the icky word with me...armpit?

Is it apoptosis** inducing the controlled suicide of suspected infiltrating cancer cells in my peritoneum?

Is the high dose of Vitamin C I dread taking into my veins weekly ~ dread because of the pressing frontal headache, spaciness, fatigue and violent nausea that accompanies the cold drip into my sore veins ~ finally becoming my personal avenger?

Is it because all those years of pirouettes, leaps and grande battements taking its toll?

Is it because all those years of full contact sparring (sweetened with too many concussions and broken ribs) my body is rebelling?

Is it something as simple and treatable as anemia repressing my body from donning its crusader role?

The problem with cancer is the "what ifs"? Before you have, or least before you know you have cancer, you assign your symptoms to mundane causes and shake it off.

Now that the disease has infiltrated my body, my mind becomes hypervigilent with considering the "what ifs."

The mundane becomes the secondary thought, and shaking it off becomes a learned and concerted effort.

==========================
italicized words = dripping sarcasm

**Apoptosis, or programmed cell death, is a normal component of the development and health of multicellular organisms. Cells die in response to a variety of stimuli and during apoptosis they do so in a controlled, regulated fashion. This makes apoptosis distinct from another form of cell death called necrosis in which uncontrolled cell death leads to lysis of cells, inflammatory responses and, potentially, to serious health problems. Apoptosis, by contrast, is a process in which cells play an active role in their own death ~ which is why apoptosis is often referred to as cell suicide.

Random Thought Sunday (10/9/2011) ... or the Practical Side of Cancer

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Weird. I don't have a fear of dying. Dying is an inescapable outcome of having been born. The source of my stress is knowing that I may very well be on a definitive time-clock and I have so much to do. I am not talking maudlin, self-pity bucket list, to dos. I am talking about practical...getting my family life in order so as not to leave chaos in my wake, to dos.

I have to get documents in order. Life insurance policies, 401Ks, accounts...etc.
I have to get the houses in order. (No kidding, I am doing weekly trips with donations to Goodwill!)
I have to familiarize my life and business partner on how I manage the daily affairs on both fronts.
I have to get my nonprofit (Arizona Friends of Foster Children Foundation...www.affcf.org ~ yes, that was a plug) stable so I can feel comfortable to step down after nearly 16 years.
I have to continue to get my hundreds of client files scanned and archived for the "what ifs."
I have a vacillating need to seek resolution with all those relationships that formed and informed me through my life, just so as not to have any "what ifs."

Weird. This sense of urgency to do is very similar to the nesting feelings I had each and every time I was pregnant.

The reality of both life and death...two very big motivators to put your life into high gear.

Inspirational Prosthetics? Really??...Marketing hits below the bra line!

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What can I say... I got this brochure in the mail today. And, in the words of the dear-departed cultural icon, Liz Taylor, "I was knocked off my pink cloud!"

What is the Inspiration Series?

American Breast Care is so excited to introduce the Inspiration Series to you. We are so happy that you've decided to embark on this journey with us. This new line of breast forms feature a special imprint of an inspirational message on the back of one of our best-selling breast forms - the Flowable Back Triangle.

Our Flowable Back Triangle features a gel back that conforms to the curves of your chest wall. This gives you a more secure and comfortable fit.

The Inspiration Form not only fits and functions well, but it also serves as a gentle reminder that will keep you inspired throughout the day. Feel great knowing that you have a little something extra resting on the inside.

For this season, we share with you this special quote:

"Each day comes bearing its own gifts. Untie the ribbons."

The Semantics of Cancer

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I am here for you. What does that mean?

We learn languaguages visually. Think young child. We point to a dog or picture of a dog and say: d-o-g.

Think learning a second language. We visualize a c-u-p in our head. We translate that mental picture into, say, taza.
The meaning to words , by in large, attach through visual reference.

So, I am here for you, while you are walking out the door; hanging up from a phone call; sent via text message or email; or while channel surfing...what meaning can we attach to these visual references? My unspoken question is: where are you, really?

But you look good! An interesting comment, said either in surprise or consolation by friends and family that have not seen me in awhile, and when they are grasping for something appropriate to say.

I know this must be hard for you, but you look good! My usual response is to laugh with the follow up...and that's all that really matters. They laugh, I laugh...and they walk away feeling like its okay.



I would feel better if you....[A. consider surgery; B. consider radiation; C. rethink your opposition to chemo; D. would give serious thought to DCA; E. slow down; F. all of the above; G. none of the above; H. other]

While I appreciate the thoughts and underlying concerns...my treatment decisions are not about making you feel better. I am the one dealing with stage IV metastatic cancer

The standard of care for your form and stage of cancer is...

Who's standard? How did the standard maker arrive at this standard? Did the standard maker actually review my individual medical history?

Why do M.D.s clutch to the phrase standard of care? Wait, is it because it makes them feel better?



We have had some success with the following treatment plan...  Your cancer is 20% treatable. No, they cannot say 'cure', because they cannot offer one. But they can offer me a prescribed treatment plan...it is, after all, the current standard of care!

Awareness Revisited

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October is Breast Cancer Awareness Month and the Pink Ribbons are unfurling once again. A year ago today, I wrote and posted the following  blog. I reread it again...and found that regrettably not much has changed, save for my own personal circumstance. That is, my cancer has advanced. My awareness IQ has been broadened to understand that the proliferation rate of breast cancer is increasing. And, profoundly, despite Susan G. Komen - known as the "largest" funder of breast cancer research, spent a whopping[?] 23.5% of total revenue raised on research for the "cure" in 2007; and an impressive [?] 26.7% in 2008; and a staggering[?] 20.2% in 2009; despite Susan G. Komen's total revenues for 2010 reportedly at $311,855,544.00; and despite spending over $22M in salaries. . . 

The American Cancer Society's most recent estimates for breast cancer in the United States are for 2011:

• About 230,480 new cases of invasive breast cancer in women
• About 57,650 new cases of carcinoma in situ (CIS) will be found (CIS is non-invasive and is the earliest form of breast cancer).
• About 39,520 deaths from breast cancer (women)

Breast cancer is the most common cancer among women in the United States, other than skin cancer. It is the second leading cause of cancer death in women, after lung cancer.

The chance of a woman having invasive breast cancer some time during her life is a little less than 1 in 8. The chance of dying from breast cancer is about 1 in 35. Breast cancer death rates have been going down. [REALLY? not if you look at 2007 figures from the CDC...see below] Right now there are more than 2½ million breast cancer survivors in the United States.

As compared to 2009, when 192,370 new cases of invasive breast cancer were diagnosed among women, as well as an estimated 62,280 additional cases of in situ breast cancer...
. . .

As compared to 2007

• 202,964 women in the United States were diagnosed with breast cancer.*†
• 40,598 women in the United States died from breast cancer.*†

*Incidence counts cover approximately 99% of the U.S. population. Death counts cover 100% of the U.S. population. Use caution in comparing incidence and death counts.

†Source: U.S. Cancer Statistics Working Group. United States Cancer Statistics: 1999–2007 Incidence and Mortality Web-based Report. Atlanta (GA): Department of Health and Human Services, Centers for Disease Control and Prevention, and National Cancer Institute; 2010. Available at: http://www.cdc.gov/uscs.

Last Revised: 06/20/2011

So again, I continue to ask the question...what does AWARENESS...really mean? I have added a few updates for 2011.

Before I was diagnosed with Invasive Lobular Carcinoma, I was aware of the prevalence of breast cancer. I knew it was a disease that struck mostly post-menopausal women. I was aware that women who have family histories; who smoked; who took oral contraceptives for prolonged periods of time were more likely to be stricken with breast cancer. I was aware of mammograms and lumps and lumpectomies and mastectomies. I was aware of the existence of radiation and chemotherapy treatments.

I was aware of our local news station and its "Buddy Check 12" campaign. I was aware of the Pink Ribbon campaigns. I was aware that every October there was a hub-bub about the Susan B. Komen Race for the Cure. I was so aware that for the 15 years prior to my initial diagnosis in 2009 I ran the Race for the Cure; ironically shaving off up to 8 minutes in my pace time each year. (As it turns out, I guess I wasn't running fast enough!!!!)

But it wasn't until I was blind-sided with a diagnosis of breast cancer in the summer of 2009 that I became aware of the breadth of my ignorance. There was, and still is, so much that I did not know about the disease and its treatment. And, none of the information I received prior to my own personal diagnosis...acquired through my "pink" involvement ever even hinted at the depths of my naiveté.

For example . . .

I did not know there were myriad of causes of breast cancer - the majority being environmental

I did not know that women without genetic predispositions could get breast cancer

I did not know that the risk for women under 50 years of age in developing cancer was and is increasing each year

I did not know that breast cancer specialists have not figured out how to "write a new textbook" for the under 50 crowd

I did not know that women who did not live a high-risk lifestyle could develop breast cancer

I did not know that there were subsets to breast cancer (ductal, lobular, inflammatory and Paget's Disease)

I did not know that as a pre-menopausal woman in good health could develop breast cancer

Metastases in lymph

I did not know about sentinel node biopsies

I did not know about drainage tubes ("d-bombs")

I did not know about tram flaps

I did not know about the severity of long term effects of chemotherapy and radiation

I did not know about Adriamycin (aka "Red Devil")

I did not know about Tamoxifen (or that outside of the U.S. it is listed as a cancer-causing carcinogen)

Metastases in brain

I did not know about Herceptin and Aromatase

I did not know that the medical community treated pre-menopausal women differently than post-menopausal women

I did not know about Oncotype DX and Mamma Print tests for chemo efficacy

I did not know about how a cancer is "staged"

I did not know that mammograms are not a reliable or effective way to early-detect Invasive Lobular Carcinoma

I did not know that a Vitamin D deficiency can be a contributing cause in the development of breast cancer

I did not know how key Vitamin C is in preventing the occurrence and recurrence of breast cancer

I did not know that a buildup estrogen in the body is toxic

I did not know that there is tangible link between iodine deficiency and breast cancer

I did not know about E-cadherin and protein tests and saliva tests and hormonal balancing

Metastases in liver

I did not know that breast cancer research is focused on early stage breast cancer and not advanced stage & metastatic breast cancer

I did not know that women don't die of breast cancer, per se, if only the cancer stayed in the breast

I did not know that women die of breast cancer because because of the multitude of sites where it can metastasize

I did not know that a full radical mastectomy is not a guarantee against breast cancer metastasizing

I did not know about mouth thrushes, or lymphedema, or neuropathy

Metastases in bones

I did not know that an acidic imbalance in our body chemistry gives a fertile ground for cancer cells to proliferate

I did not know that when the CDC and other entities cite statistics on death by breast cancer it does not include those women who died from the complications and side effects of treatment (heart disease, heart failure, pulmonary disease, stroke, uterine cancer, stomach cancer, cervical cancer, etc.

and so it continues to go on, . . . and

I do know now what an insidious and pervasive industry breast cancer has generated in the U.S.

I do know now the difference between a "CURE" and a "PROTOCOL".

I do know now that the med pros are vociferous in the application of their established protocol; that the protocol has not changed much in 50 years; and that despite the protocol women are still dying - at times as a result of the protocol.

I do know now that even though 100s of millions are raised for research, awareness, marketing and merchandising that we are still no closer to a cure.

I do know now that some of the pharmaceutical companies that produce & distribute cancer treatment drugs consciously include cancer-causing carcinogens in the household products and foods they heavily market and consume as a society...check out all the variants of benzene products....they are in every commercial sunscreen and most store-brand and high-end cosmetics.

I do know now that even Susan G. Komen is heavily invested in contributing to the proliferation of breast cancer...check out their requisitioned perfume, PROMISE ME, that contains a well-known hormone disrupter and neurotoxicant.

I do know now that I have to continue to be my own "lay expert" in order to direct the discussion regarding my own health and treatment.

October is Breast Cancer Awareness Month. And, I am a little more aware now than I was in October of 2009 -- and worlds beyond my breast cancer IQ when I too was a Pink Ribbon accomplice. I am also excruciatingly aware that my continued search to be enlightened, educated ... aware ... has nothing to do with the flying of little Pink Ribbons and all its accouterments.