Cancer Recurrence Quotes

Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist.

As a twenty-one-year-old college student, Daisy Richmond’s answer to the question “If you knew you were going to die in one month, what would you do?” was full of adventure and travel to exotic lands. As a twenty-seven-year-old woman who is faced with a recurrence of breast cancer, her answer is very different. Before I Go is the poignant story of Daisy’s journey to navigate the unexpected twists and turns of life, and the painful process of letting go of everything but love.

Another example is tamoxifen, which is used for treatment of endocrine responsive breast cancer. Tamoxifen is given to patients postsurgery and dramatically reduces the rate of cancer recurrence. This drug is metabolized by cytochrome P450 2D6, the product of the CYP2D6 gene. Based on their DNA, there are patients with little CYP2D6 activity who are poor metabolizers and others with high activity who are extensive metabolizers. An FDA-approved genetic test exists for finding the variants of the CYP2D6 gene to help guide tamoxifen administration, but the lack of study data demonstrating its role in improving patient outcomes has, to date, led insurance companies to refuse to cover the test. Beyond having ramifications for drug efficacy, genetics also may play a role in the side effects of drugs.

Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire...The most obvious [response] might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day.

Yet there is dynamism in our house. Day to day, week to week, Cady blossoms: a first grasp, a first smile, a first laugh. Her pediatrician regularly records her growth on charts, tick marks indicating her progress over time. A brightening newness surrounds her. As she sits in my lap smiling, enthralled by my tuneless singing, an incandescence lights the room. Time for me is now double-edged: every day brings me further from the low of my last relapse but closer to the next recurrence—and, eventually, death. Perhaps later than I think, but certainly sooner than I desire. There are, I imagine, two responses to that realization. The most obvious might be an impulse to frantic activity: to “live life to its fullest,” to travel, to dine, to achieve a host of neglected ambitions. Part of the cruelty of cancer, though, is not only that it limits your time; it also limits your energy, vastly reducing the amount you can squeeze into a day. It is a tired hare who now races. And even if I had the energy, I prefer a more tortoiselike approach. I plod, I ponder. Some days, I simply persist. If time dilates when one moves at high speeds, does it contract when one moves barely at all? It must: the days have shortened considerably. With little to distinguish one day from the next, time has begun to feel static. In English, we use the word time in different ways: “The time is two forty-five” versus “I’m going through a tough time.” These days, time feels less like the ticking clock and more like a state of being. Languor settles in. There’s a feeling of openness. As a surgeon, focused on a patient in the OR, I might have found the position of the clock’s hands arbitrary, but I never thought them meaningless. Now the time of day means nothing, the day of the week scarcely more. Medical training is relentlessly future-oriented, all about delayed gratification; you’re always thinking about what you’ll be doing five years down the line. But now I don’t know what I’ll be doing five years down the line. I may be dead. I may not be. I may be healthy. I may be writing. I don't know. And so it's not all that useful to spend time thinking about the future - that is, beyond lunch.

To get the most out of this chapter, first find where you are on this map of the cancer journey: Critical stress points. When you have just been diagnosed with cancer or learned that your cancer has recurred or is not responding to treatment. Treatment preparation. When you are anticipating surgery, radiation, chemotherapy, or molecular target therapies. Side effect management. When you are undergoing treatment and need ways (instead of or in addition to drugs) to manage its side effects. Post-treatment. When you are adjusting to the end of active treatment, usually after the final chemotherapy cycle. This situation can, perhaps surprisingly, prove quite stressful. Remission maintenance. Although definitely good news, remission introduces its own issues, most notably fear of recurrence. Remission is also when you will be most determined to take back your life from cancer.

Adult onset diabetes will be reversed and cured. Alzheimer’s will be slowed, and in the early stages even partially reversed. Atherosclerosis will be halted, and slowly reversed. Cancer in principle will be slowed, but if a tumor has resulted, it must be treated. Future cancer risk and risk of recurrence of a treated cancer will both be reduced. Osteoporosis can be stopped and reversed. Loss of stature will, in some cases, reverse also. Osteoarthritis can be reversed in some cases. Aging will noticeably slow.

Two of the five women had a recurrence of cancer. That’s a pretty high percentage. And who was to say cancer wouldn’t return in one or more of the other three? It started to become clear to us that the medical industry had created a cancer conveyor belt.

Did you know that if you’re a middle-aged woman, you have only a small window of opportunity between the beginning of perimenopause and the start of menopause to start estrogen replacement therapy to protect not only your brain but also your bones and cardiovascular system? I did not, until I dug into the science, because as a woman who was diagnosed with a stage 0 breast lump, I was scared off like so many of us from the results of the Women’s Health Initiative, which got blasted out all over the news and initially showed a link between estrogen replacement therapy and breast cancer, but guess what? That study had so many flaws, its findings are little more than useless and possibly harmful. Worse, women like me without uteri show a decrease in breast cancer with estrogen replacement therapy. But this information never made it either into the headlines or into our gynecologists’ offices. I had to find it in scientific publications such as The Lancet online. In fact, get this: Our medical system barely trains gynecologists in menopausal medicine. A recent study found that only 20 percent of ob-gyn residency programs in the U.S. provide any menopause training. Yes, any. Which means that 80 percent of all gynecological residents in school today are getting no training whatsoever in post-reproductive women’s health. These are people whose job it is to know everything going on in our ladyparts, but they have not been taught the basic tenets of how to care for either us or our plumbing after we stop menstruating. And by “us” I mean 30 percent of all women alive on earth at any given moment. Half of my middle-aged female friends deal with chronic urinary tract infections. Oh, well, we think, throwing up our hands in defeat and consuming far too many antibiotics than are rational or safe or even good for the future safety of humanity. It took Dr. Rachel Rubin, a urologist in Washington, D.C., reaching out to me over Twitter to explain that UTIs in menopausal women do not have to be recurrent. They can be mitigated with, yes, vaginal estrogen. Not once was I ever

a five-year study of more than two hundred women with breast cancer that aimed to determine whether a recurrence of cancer can be triggered by severe life events, such as divorce or the death of someone close.

need to have a prostate biopsy to confirm that the cancer recurrence is local; you will also need a bone scan and CT scan or MRI of the abdomen and pelvis to rule out the possibility that cancer has spread to distant sites. The guidelines above (see What Should I Do If My PSA Comes Back After Surgery?) may one day be adapted for men who have failed radiation treatment, but the overriding principles can be useful here in identifying the likelihood of metastases. If you have a high Gleason score (8 or greater), or if the PSA level begins to rise early after radiation therapy, or if the PSA level has a rapid doubling time, it is more likely that you have metastases than a local recurrence, and in this case, you should seek systemic therapy (see chapter 13).

overriding principles can be useful here in identifying the likelihood of metastases. If you have a high Gleason score (8 or greater), or if the PSA level begins to rise early after radiation therapy, or if the PSA level has a rapid doubling time, it is more likely that you have metastases than a local recurrence, and in this case, you should seek systemic therapy (see chapter 13).

to measure success or failure. One criticism has been that PSA increases are not always consecutive. A man’s rise in PSA with one test might be followed by a transient decrease in the next, followed by another increase. Although there may be recurrent cancer, under the ASTRO definition, this man’s treatment would still be considered a success—even though it’s just a technicality. “Fortunately, any astute radiation oncologist will not blindly follow the consensus definition in making treatment decisions,” comments Danny Song. A quirk of the ASTRO definition is that, over a short period of time after treatment, it really can’t tell us much. This is due to the gradual nature of radiation’s effects; cancer

that the radiation alone has not killed the cancer, this should be clear long before your PSA level reaches that point. However, it’s worth repeating that the consensus panel that developed the Phoenix definition (nadir + 2) advises, “Physicians should use individualized approaches to managing young patients with slowly rising PSA levels who initially achieved a very low nadir and who might be a candidate for salvage local therapies.” If your PSA level continues to rise, what should you do? To determine whether you are a candidate for surgery after radiation, you will need to have a prostate biopsy to confirm that the cancer recurrence is local; you will also need a bone scan and CT scan or MRI of the abdomen and pelvis to rule out the possibility that cancer has spread to distant sites. The guidelines above (see What Should I Do If My PSA Comes Back After Surgery?) may one day be adapted for men who have failed radiation treatment, but the

You might read somewhere that for your particular form of cancer, there is a high chance of local recurrence or metastasis,” he said. “Perhaps even fifty or sixty percent.” She nodded, tensing up. “Well, there are ways that we will tend to it when that happens.” I noted that he had said “when,” not “if.” The numbers told a statistical truth, but the sentence implied nuance. “We will tend to it,” he said, not “we will obliterate it.” Care, not cure. The conversation ran for nearly an hour. In his hands, information was something live and molten, ready to freeze into a hard shape at any moment, something crystalline yet negotiable; he nudged and shaped it like glass in the hands of a glassblower.

If you are newly diagnosed, experiencing a recurrence, or caring for someone with brain cancer, I urge you to dig in, carry on, and fortify yourself with the knowledge that personal growth may, in fact, be obtained throughout this challenge. When

In 2016, The Journal of the American Medical Association released an observational study that looked at more than 2,000 women between the ages of 27 and 70 who had undergone conventional breast cancer treatment. After analyzing this large group of women for four years, researchers determined that when women fasted 13 hours or more, they had a 64 percent less chance of recurrence of breast cancer. This is largely because fasting created a significant decrease in hemoglobin A1c, an indicator of blood glucose levels, and C-reactive protein,

In 2016, The Journal of the American Medical Association released an observational study that looked at more than 2,000 women between the ages of 27 and 70 who had undergone conventional breast cancer treatment. After analyzing this large group of women for four years, researchers determined that when women fasted 13 hours or more, they had a 64 percent less chance of recurrence of breast cancer. This is largely because fasting created a significant decrease in hemoglobin A1c, an indicator of blood glucose levels, and C-reactive protein, an indicator of inflammation.

2016, The Journal of the American Medical Association released an observational study that looked at more than 2,000 women between the ages of 27 and 70 who had undergone conventional breast cancer treatment. After analyzing this large group of women for four years, researchers determined that when women fasted 13 hours or more, they had a 64 percent less chance of recurrence of breast cancer. This is largely because fasting created a significant decrease in hemoglobin A1c, an indicator of blood glucose levels, and C-reactive protein, an indicator of inflammation.

Those who survived mustard-gas attacks later developed severe anemia, requiring monthly blood transfusions. They were also prone to recurrent, lingering, and sometimes fatal infections. In 1919, one year after World War I ended, two American pathologists, Helen and Edward Krumbhaar, performed autopsies on seventy-five soldiers who had been killed by mustard gas. They found that the gas depleted the bone marrow, where red blood cells, white blood cells, and platelets are made. They also found that lymph nodes, another source of white blood cells, had shrunk. The Krumbhaars published their findings in 1919. No one noticed. Specifically, no one recognized that if mustard gas could eliminate white blood cells and shrink lymph nodes, maybe it could also eliminate cancers of the bone marrow (leukemias) and cancers of the lymph nodes (lymphomas).

Saturate the body politic with the chemotherapy or immunotherapy of antiracist policies that shrink the tumors of racial inequities, that kill undetectable cancer cells. Remove any remaining racist policies, the way surgeons remove the tumors. Ensure there are clear margins, meaning no cancer cells of inequity left in the body politic, only the healthy cells of equity. Encourage the consumption of healthy foods for thought and the regular exercising of antiracist ideas, to reduce the likelihood of a recurrence. Monitor the body politic closely, especially where the tumors of racial inequity previously existed. Detect and treat a recurrence early, before it can grow and threaten the body politic.

Feeling disempowered can actually accelerate tumor progression and promote recurrence.

[A] political/relational framework recognizes the difficulty in determining who is included in the term “disabled,” refusing any assumption that it refers to a discrete group of particular people with certain similar essential qualities. On the contrary, the political/relational model of disability sees disability as a site of questions rather than firm definitions: Can it encompass all kinds of impairments—cognitive, psychiatric, sensory, and physical? Do people with chronic illnesses fit under the rubric of disability? Is someone who had cancer years ago but is now in remission disabled? What about people with some forms of multiple sclerosis (MS) who experience different temporary impairments—from vision loss to mobility difficulties—during each recurrence of the disease, but are without functional limitations once the MS moves back into remission? What about people with large birthmarks or other visible differences that have no bearing on their physical capabilities, but that often prompt discriminatory treatment?

In 1981, the results of the trial were finally made public. The rates of breast cancer recurrence, relapse, death, and distant cancer metastasis were statistically identical among all three groups. The group treated with the radical mastectomy had paid heavily in morbidity, but accrued no benefits in survival, recurrence, or mortality.

The evidence reviewed suggested no increase in risk of recurrence with MHT in women with early-stage endometrial cancer; squamous cell carcinoma of the cervix or adenocarcinoma of the cervix (cervical cancer); or vaginal or vulvar cancer. Evidence also showed no adverse effect on survival rates with hormone therapy in women with epithelial ovarian cancer. On women with a history of breast cancer, their conclusion was that it should be a contraindication to the use of systemic MHT.