Cancer

Yes, everyone I've spoken with has a similar experience with chemo. I found that I could not concentrate and therefore reading was useless. Too bad, I love to read and learn - its exciting to learn by reading. Eating was not so hot either, my tasting ability was gone along with my appetite. So I ended up watching the clock tick, went for long slow walks. I improved physically as my body acclimated to the chemo. Then, I became much more active - reading, watching tv, walking, talking on the phone, checking out the internet, writing letters, and more.

Everyone is different ... my doctors told me not to expect any noticeable side effects from herceptin, however, I do have them.
My exhaustion levels are still so high. At first the doc blamed recovery from other chemo, but at this point believes it's the herceptin causing it.
Also, for about 2-3 days after infusion I have flu-like symptoms (very achey and sore and more tired). And for about a week I get taxol-recall joint pain.
That said, my doctors have said this isn't common BUT I have reacted strongly to everything we've done so far and they theorize that my body is just hyper-sensitive. Chances are you aren't and won't deal with it, but I share on the off chance you do get side effects, you're not crazy or imagining it!

Basic starting points would be listening to the patient, breast examination and appropriate imaging. It is recommended that an image-guided biopsy be done (either stereotactic or ultrasound-guided), rather than an excisional biopsy operation. Fine needle aspiration can be performed as an alternative, but the core biopsy yields more information.

Stage 0 Breast cancer is also known as Ductal Carcinoma In-Situ, or DCIS. This means that the cancer cells are filling the milk ducts, but have not broken through the lining or wall of the milk duct. This means that the cancer generally does not have the potential to spread to other areas of the body. DCIS can be quite extensive throughout the breast however and sometimes mastectomy is needed. In addition, DCIS can be harder to detect on mammogram, ultrasound, or MRI, and often the extent of disease is underestimated by imaging.

Breast cysts are completely benign, in other words, not related to breast cancer. Think of them like little "water balloons" in the breast - they develop due to enlargement of an area of the milk duct that fills with fluid. They will often enlarge and may become painful right before the menstrual period, and then often decrease without any intervention. An ultrasound can be used to ensure that a lump is indeed a fluid filled cyst and not a solid tumor. "Simple" cysts, which have a thin wall and no solid growth associated with them can safely be observed, but sometimes fine needle aspiration is recommended if a cyst is large or painful.

It depends on the patient and if reconstruction is performed, and what type of reconstruction. If a mastectomy without reconstruction is performed, usually a 24-48 hour hospital stay is required, and a patient is discharged with drainage tubes in place. The drains are usually removed after about 7-10 days, but may stay in place longer depending on the amount of fluid that is being produced. Overall recovery in terms of return to work and other normal activities can take anywhere from 2-3 weeks up to 6-8 weeks.

If reconstruction is performed using tissue expanders or implants, the recovery is similar to that of a mastectomy without reconstruction but the initial pain is usually more as the tissue expanders or implants are placed underneath the pectoralis muscle. If reconstruction using muscle or fatty tissue is performed, the hospital stay is usually 3-5 days, and may include an intensive care unit stay; overall recovery is typically 6-8 weeks and sometimes longer.

When approaching a patient with pain, the first step is to do a very thorough pain history to determine the etiology of pain, severity of pain, duration of the pain and the impact of the pain on the patient’s life and physical functioning. The etiology of the pain will guide us to understand the expected duration of the pain and the approaches that are most likely to be effective in treatment. For cancer patients in moderate to severe pain, opioid pain medications are often effective. We may use opioid pain medications in conjunction with acetaminophen or non-steroidal anti-inflammatories (NSAIDs). Our goal in treating patients is to get a stable control of pain with a standing medication regimen, with the availability of “breakthrough” or “rescue” medications for acute exacerbations of pain that may occur. When starting patients on new pain medication regimens we make sure to have close follow-up with patients to assess for efficacy as well as side effects of the regimen. We also make use of other members of the interdisciplinary palliative care team, including our massage therapists to assist in pain management. Certain cancer pain syndromes may also be amenable to interventional procedures such as nerve blocks, in which case we work with and make referrals to our colleagues in Anesthesiology who specialize in interventional pain management.

As stated in another answer (http://talkabouthealth.com/where-can-we-learn-more-about-the-current-standards-for-palliative-care-for-oncology), palliative care is specialized medical care for patients and families facing a serious illness and is appropriate throughout the continuum of a serious illness starting from the point of diagnosis. Palliative care can be provided by the oncology team, in the form of assessment and treatment of physical symptoms related to the cancer diagnosis or as a result of the anti-cancer therapies themselves. Excellent control of symptoms such as nausea and pain can help a patient to maintain adherence to anti-cancer treatment regimens. Palliative care specialty level consultation services should be utilized in situations where the symptom presentation is complex or the patient and family would particularly benefit from an interdisciplinary palliative care team.

I also had it about a week after the sentinel lymph node biopsy was positive with cancer.

Whether you have initiated the visit or another physician involved in your care, has referred you to a radiation oncologist, you are there to learn whether radiation therapy is indicated as a part of your treatment. If indicated, you will also be given information on the area where radiation would be focused on, the total dose of radiation. the number of radiation treatments necessary as well as its potential acute (aka early) and late (chronic) side effects. The radiation oncologist may also share the data supporting his/her recommendation.

How you can prepare yourself for your first visit with a radiation oncologist is very similar to visiting any other specialist but what makes it unique and in some instances challenging, is the many myths around radiation therapy. So the best you can do for yourself and the radiation oncologist you are seeing is to remove any myth from your mind. The experience your grandmother or neighbor had with radiation treatment is totally irrelevant to your situation. Maybe they had a different form of cancer. Maybe their cancer was the same but presented at an earlier or later stage. With the rapid and progressive improvement in radiation technology, comparing radiation treatment your grandmother received 10 or 20 years ago with yours, would be comparing apples and oranges. So do your best to remove the myths and fears and receive the information with an open mind.

The information one can find on the internet is as good as its source. So unless you have been given a reliable source of information, do not trust everything you find on the internet. Acquiring misinformation would not only not be helpful to you, it may increase your anxiety and apprehension about radiation treatments.

In general, I would recommend the following for preparation for your visit:

1. It is a great habit to obtain a copy of all pertinent information prior to your visit. Even though, with your permission, physicians offices communicate these vital information prior to your visit, any missing information can interfere with having a productive consultation.
2. It is extremely helpful to have your own version of your medical and surgical history to include all your past medical issues, the medications you are taking (including the supplements you might have bought at GNC or given by your chiropractor), your allergies, and very importantly your family history of cancer. Your family history of cancer may lead into genetic testing and completely change the recommended treatment for your specific cancer.
3. It is helpful to have someone accompany you. You will be given plenty of new information making it almost impossible to retain all of it. Having a second pair of ears and eyes, especially if your company would take notes, would be extremely helpful in recording and retaining the information.
4. Prepare questions ahead of time and do not hesitate to ask about anything you do not understand. As smart and intelligent as you are, you are not a radiation oncologist and are not expected to understand all the technical details of it.
5. At the end of your consultation, repeat a summary of the information you have received. It is not unusual to misunderstand something and you can only correct that by comparing your understanding with what the radiation oncology meant to tell you.
6. If you feel that you have not grasped all the information or have remaining questions, do not hesitate to ask for a second visit when you can spend more time clarifying those matters with your radiation oncologist.
7. Please understand that that final decision regarding your treatments is yours. If you do not feel comfortable with the information you have been given, do not hesitate to seek second opinion.
8. If you have received radiation in the past, please make sure to have details of your previous treatment, because that is crucial in determining whether you can receive radiation again or not.
9. Please understand that preparation for your radiation treatments may take anywhere from days to weeks. Do not expect to start your treatment on the day of your consultation.
10. Breaks during your radiation treatments would negatively impact the outcome of your treatments. So be prepared to cancel a trip you had scheduled a year ago if your radiation oncologist finds it detrimental to delay start of your radiation treatment.
11. Sometimes radiation and chemotherapy are recommended together. Even though your radiation oncologist and medical oncologist would do their best to coordinate your treatments, consider yourself a member of the treatment team and have all the information you can get to facilitate the coordination.
12. If it alleviates your anxiety ask for a tour of the department, take a look at the radiation machine and meet all the members of radiation team including radiation therapists, the dosimetrist and the physicist.
13. It is often helpful not to rely on your imagination so ask your radiation oncologist to show you some images of radiation plans and beams. It may put your mind at ease.
14. Just as you do at radiology department, please notify your radiation oncologist if you are pregnant or there is any possibility you might be pregnant
15. And last but not the least ask your radiation oncologist for reliable sources (books, websites, brochures) to educate yourself not only on your radiation treatments but also its potential side effects and your nutrition throughout the course of treatment.

Let me start by saying there are some components of citrus fruits that have anti-tumor activity in pre-clinical studies (those done in test tubes and mice). In particular d-limonene which is a monoterpene found in orange and lemon peels may be active against some tumors and is being investigated in phase I/II trials. Keep in mind this is a concentrated chemical extracted from citrus fruit and given in intravenous form—sound familiar? Yep, this is how chemotherapy got its start. In one trial I read, nausea and vomiting were “dose-limiting toxicities” (one goal of phase I trials is to see how much drug can be tolerated). Side effects like nausea and vomiting occur because of the effect of the drug on normal cells. Now with that said, there is no evidence that lemon juice is effective in the least for treating cancer. As for impact on “normal” cells—have you ever tried drinking much lemon juice? I think you’ll find there is an effect on normal cells.

I honestly never considered a lumpectomy. I wanted to be as aggressive as possible and leave no breast tissue behind. I was young and had a fairly large tumor and lymph node involvement so I felt like that was the best choice for me.

My thought was, "why not me?"

As far as risk factors for breast cancer I had three: 1) I'm a womman 2) I was childless 3) my periods began at a fairly early age. I also had/have an extensive family history of cancer. So in some ways, I wasn't completely surprised. Shocked? Yes. Hearing that diagnosis takes the wind out of you.

The most important thing for me was turning over the feelings of shock and bewilderment into action - into learning about the disease and the array of treatments. The best thing any of us can do when faced with a health crisis is engage and learn what we need to learn to obtain the best possible health care.

Recurrence and survival statistics are based on historical studies as well as more current clinical trial results. It is important for an individual patient to realize that they are not a statistic, and that recurrence and survival rates can never be predicted with complete accuracy in a given patient. My recommendation is to be aware of the statistics as they pertain to your individual case, but do not hang all your hopes and fears on those numbers.

In general, the earlier the stage of diagnosis, the lower the risk of recurrence. However, with breast cancer or any cancer, we can never really say that a patient is truly “cured” – sometimes “NED” – no evidence of disease – is the best we can do. We do not yet have the ability to detect individual metastatic cells which may be slowly growing, only to show up on a scan years later. We are also learning more about breast cancer and while the stage at initial diagnosis is important, the biologic behavior, or aggressiveness of the cancer, may be even more important in terms of assessing an individual patient’s risk of recurrence.

Noninvasive means that the cancer cells have not spread or penetrated through the basement membrane - the thin layer that lines the milk ducts and lobules. An invasive cancer occurs when the basement membrane is disrupted by the invading cancer cells; those cancer cells then have the potential to invade blood vessels or lymphatic vessels.

Ductal carcinoma in-situ (DCIS), is considered Stage 0 – the cancer cells have not invaded the basement membrane. Lobular carcinoma in-situ (LCIS) is not actually considered a cancer, despite the name, and many now refer to this condition as “lobular neoplasia” to avoid confusion. Patients with LCIS often do require surgical excision, but generally are not treated with additional therapy such as radiation therapy or chemotherapy. However patients with LCIS are at a significantly increased risk for the future development of breast cancer (in-situ or invasive) in either breast, so often anti-estrogen medication such as tamoxifen or an aromatase inhibitor may be recommended for risk reduction. In addition, increased surveillance may be indicated in these patients.

The type of breast cancer is generally determined by the microscopic appearance of the tumor. When the pathologist examines the tissue, either from a needle core biopsy or surgical excision, they make a determination if the cells are ductal or lobular in origin, and whether or not invasion is present. There are times when it is difficult to tell exactly what type of cancer is present – breast cancers can have a variable appearance and the diagnosis is not always obvious by the initial microscopic appearance. A variety of special stains may be used, and these additional tests can confirm if a tumor is ductal or lobular (some cancers are “mixed” , having features of both cell types), of if invasion is present or not.

I attended a conference this weekend and was appalled at how many patients had not be educated regarding side effects such as Lymphedema,neuropathy, etc. as well as measures one might take to avoid recurrence. These are important topics. There is so much that can be done to avoid these issues that I find it shocking that more docs do not have these discussions.

The way I made it through chemo was just by dragging myself in, and doing it. No special strategies or skills. But I will say that what I learned to be helpful along the way was the other patients. We shared snacks, boob jokes, a little about ourselves. I called them my chemo clic.

Of course part of getting through chemo is dealing with side effects. I had very few. But let me tell you about the couple I had and what I did:

I had a few mouth sores and my oncologist prescribed a mouth wash that worked beautifully. I’m sorry I don’t remember the brand name, but know that your onc can prescribe something more effective than the over-the-counters if you have this problem.

I became severely neutropenic (very low white blood cells). I had to stop chemo for a few rounds and then push and push my doctor to give me booster shots to raise my white cells. (I was in a clinical trial that would not allow the boosters). So the point I want to make here is that in my case, I wanted to get around the road block that was preventing me from resuming treatment, and the way I dealt with it was to be my own advocate.

I was dawg tired! Who isn’t when they go through treatments? The neutropenia definitely heightened the fatigue. I was not good at taking naps, but I would suggest that you do this. Sleep or at least rest in bed or out in the sun on a nice day. Let your house work go some. If you have anyone around to help with the jobs you’re used to taking on, have them help you. I graciously accepted the few meals friends made and I made enough food to have leftovers to save me cooking the next night.

What else helped was having someone to talk to who would just listen, not tell me what to do, not make judgment calls. I found very few friends who were this supportive. But I’d suggest gravitating toward the ones who are, and maybe getting in a support group of other survivors or patients on similar paths.

Melanoma is the 5th most common cancer (other than sqaumous and basal skin cancer) but is only the 12th most common fatal cancer. This is probably due to the massive public education campaign that has been ongoing since the rapid rise in melanoma in the 90's (doubling in incidence since then). Almost all melanomas are caused by UV A/B radiation from the sun (there are rare melanomas such as ocular and mucosal [anal, oral] that account for <2% of all melanomas) and more recently from tanning beds.

Melanoma typically spreads in an orderly fashion from the skin to the regional lymph nodes that drain that skin and then elsewhere in the body. Fortunately, spread to the lymph nodes is unusual with < 20% of patients having lymph node metastasis. Spread elsewhere in the body is even rarer < 12-14% of patients developing systemic spread. Death from melanoma is rare (<10%) if no lymph nodes are involved but survival does decrease if if lymph nodes are involved to ~70% at 5 years and beyond. If the melanoma has spread beyond the skin/lymph nodes, survival decreases further and depends on where it has spread - subcutaneous fat (70%), lung/liver (40%) and brain (10%).

The chance of recurrence/spread is based on the microscopic characteristics of the melanoma. Factors that make it more likely to return are ulceration, increasing thickness, mitoses (number of cells seen dividing under the microscope) >1/millimeter, and vertical growth phase. There are 4 main types of melanoma - nodular, sperficial spreading, acral and lentigo, with nodular and acral (palms of hands/soles of feet) tend to be a little worse but prognosis is really more related to the thickness than the type.