DOES CANCER HURT::::AND WILL I SURVIVE ?

When you or someone close is diagnosed with cancer, you may want to know everything about the disease. But perhaps you do not know what questions to ask – or feel that you should know the answers already.
Alison Boyd, the Macmillan Cancer Information Nurse Specialist at the London Clinic Cancer Centre, who provides information and support to patients diagnosed with cancer and their families, answers some commonly asked questions.

His toughest role: Michael Douglas, pictured with wife Catherine Zeta-Jones is being given chemotherapy and radiation treatment for Stage Four throat cancer

How many different types of cancer are there?
 
About 200, but some are rarer than others. Does cancer hurt? This depends on where you have it. With the majority of cancers, people do not experience pain as a first symptom.
 
The cancer cells themselves are not painful, but when they make a tumour that presses somewhere, for example on the spine, or blocks an airway or passage, this can be painful.

If the disease is advanced and has spread to the bones, then pain may be a symptom.

How does it kill you?

Cancer at an early stage does not kill you: it is only when advanced that it can become fatal. Not all cancers kill and some have survival rates of more than 90 per cent.
The way cancer causes death varies according to what type it is. Some cancers kill you by interfering with your body’s vital functions.
Cancer can take over an organ, such as the lung, causing it to collapse and preventing you from breathing properly. Or it may cause a blockage in the digestive system that stops your body from absorbing vital nutrients.
If it reaches the liver or bones, it upsets the body’s delicate chemical balance, leading to unconsciousness and eventually death. Cancer may also make you immobile.
This causes you to develop infections such as pneumonia, which the body is too weak to fight.
However, the pain-control options available mean that those with cancer should not die in pain. 

 

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How many stages of cancer are there?

Most types have four stages. Generally speaking your prognosis is better the earlier the cancer is diagnosed.

• Stage One – localised cancer, it is contained where it started. .
• Stage Two – usually means that the tumour is larger than in Stage One, but can also mean that there is evidence of cancer in nearby lymph nodes. This would indicate that cancer cells have spread and therefore already entered the bloodstream, increasing the risk of cancer developing elsewhere in the body. .
• Stage Three – the cancer is larger than in Stages One or Two. There are cancer cells in the lymph nodes in the surrounding area. It may have started to invade surrounding tissues or organs. . 
• Stage Four – also called secondary or metastatic cancer. It has spread and there is evidence of it in other organs in the body. You can live with Stage Four cancer but it is often a case of managing rather than curing the disease.

Is it possible to tell how long someone has had cancer?

Patients often want to know the answer to this. With skin cancer, once the lesion has been removed you can measure its depth to get an idea how long it has been growing.
With other cancers it can be hard to tell. Cancer takes many years to develop before symptoms appear.

If I have had one cancer, am I at greater risk of getting another type?

Your risk increases slightly, because of the treatment for the initial cancer. If you have received radiotherapy, especially for breast, testicular and skin cancer, it damages the healthy cells as well as killing the cancer cells, and these damaged cells may then mutate to become cancerous. But this is only a slight risk.

Do age and fitness affect your chances of surviving?

It is generally seen as positive to be young and fit as you will probably have a better immune system and be strong enough to withstand the treatment.
The fitter you are, the better equipped you will be to cope. Cancer is not more aggressive in young people and there is no pattern for who gets which grade and at what age.


Do race and skin colour have any effect on your risk?
 
Generally not, though some cancers are more common in people of colour. For example, prostate cancer-has a higher incidence in Afro-Caribbean men (it is not known why) and myeloma (blood cancer) is more common in the black population.
 
Which cancers are hereditary?


Ovarian, bowel, breast and uterine cancer have identified susceptibility genes: scientists have discovered the gene responsible for each of those cancers.
It does not mean you are going to get that cancer if you have the gene, but it does put you at an increased risk.
You can, if you choose, be tested to see if the gene has been passed on.
Testicular, pancreatic and prostate may also run in families but have no identified gene, so cannot be tested for.


What is the difference between primary and secondary cancer?

Primary cancer is where the cancer started to grow. Secondary cancer is when some cancer cells have broken away from the primary tumour, travelled in the bloodstream (or lymph system) to another site in the body and started to grow.
Secondary cancer is considered to be advanced disease and becomes more difficult to treat. You cannot usually eradicate the disease once it is in the bloodstream because it will just grow somewhere else.
But doctors can manage the disease with treatment that may slow its growth or alleviate its symptoms.

Why can’t cancer be cured by organ transplants?

Transplanted organs are not used to treat cancer in organs because if the cells have already travelled to other parts of body, even if you remove the organ with the primary cancer, the cancer cells will continue to grow on the new organ, or somewhere else.
Also, you would need anti-rejection medication for the transplant to work. This would dampen the immune system that may be fighting the cancer naturally.


Can you catch cancer from someone else?

No. Cancer is caused by cell changes in a person’s body – it is an internal process; you cannot catch cells so you cannot catch cancer.

What happens if a GP suspects you have cancer?
They will refer you to a specialist for further tests according to National Institute for Health and Clinical Excellence guidelines.
Most cancers are treated by surgery first, so you would initially see a surgeon, then a medical oncologist to decide if further follow-up therapy is required after surgery, such as chemotherapy, hormone therapy and biological therapy.
If necessary, you may also be referred to a clinical oncologist for radiotherapy.


Can diet and exercise help beat cancer?
 
A good, balanced diet means that you will be healthier before you start cancer treatment. Your immune system will be in better shape to fight infection and you may heal faster.
Exercise helps you feel better, gives you energy and also boosts morale. But patients should not push themselves. Keep doing what is normal for you, within the limits advised by your doctor.

I have been diagnosed with cancer. How do I tell my children?
There is no right or wrong way. Generally, the best policy is to be honest, but not harsh. It is OK to say: ‘We don’t know what’s going to happen.’
For younger children who do not understand what cancer is, we tend to talk in terms of bad cells and good cells.
 
Can I get a second opinion?
 
Yes, and most specialists are happy to do a second referral. Speak to your current specialist or GP and ask for a referral to another specialist.
If they are not happy, you can see someone privately or speak to a clinical nurse specialist or local cancer information support centre, such as a Macmillan Centre.

Will cancer affect my chances of conceiving?

It depends on what type of treatment is required. Some types of chemotherapy and radiotherapy can affect fertility. It is easy for men to bank sperm, but a much more complicated and longer process for women to freeze eggs or ovarian tissue.Discuss it with your specialist.

Why are some cancers inoperable?

If tumours are in an awkward position, too close to major blood vessels or organs, or if they are growing round the spine it can be too difficult to operate, or it might not be appropriate if the cancer is at an advanced stage, when the primary site is elsewhere.
Blood cancers or bone marrow cancers cannot be operated on. But other treatments such as chemotherapy, radiotherapy, hormone or biological therapies may be used.


Which types have the best survival rate?
 
Testicular and prostate in men and breast and uterine in women, because they can be removed early.

A SPECIAL DAY FOR A VERY SPECIAL ONCOLOGIST DOCTOR VICTOR

My favourite colour is pink...maybe it is just as well.....today is world CANCER day....thinking of my Oncologist VICTOR , I would like to send a very special thank-you to him . I think many times our Doctors do not realise how much we appreciate all they do for us, Cancer is a hard fight and the battle is long but with DOCTOR VICTOR by my side I know I have the best chance to beat this and if I do not, it will not be for all the care he has shown me.

Thank-you my friend.

The Pink for October campaign is about blog and website owners showing their support for breast cancer awareness by turning our sites pink for the month of October.

CHEMOTHERAPY: TWO MORE SESSIONS TO GO

Yesterday,was cycle five, this is my second time for the return of my cancer.

I have a wonderful Oncologist and we discussed my latest Pet-Tac which was clear and went on to discuss my first Pet-Tac and both biopsy results before being diagnosed with cancer and we both reminded each other that all results were negative....rare but it does happen. Therefore for us the Pet-Tac is just a guide line it does not mean I am cancer free.

My cycle should have been six sessions but we have decided on a seventh just to be sure...after this I will have a scan to see if the liquid where my cancer lives (behind my bladder) has disappeared. If not , I guess there will be more treatment BUT thats for another day I do not want to think so far a head, one day at a time is about all I can manage.

I wore a new wig for the occasion , my brightest pink lipstick and smart clothes. I always face these sessions with the image I am not sick...and many told me how wonderful I looked yesterday. It helps, it helps a LOT.

When I enter the Oncologist ward everyone looks so sick, heads wrapped in scarves and with a yellow pallor, gaunt, tired....I of course without the 'image' look the same. BUT I am a fighter and I refuse to let cancer do this to me.

My husband, my carer, was brilliant yesterday, the needle was placed in an akward position in my hand, it was also uncomfortable. Once treatment begins the need to pass urine comes often and I was unable to undo my trousers,so along he came to assist me on no less than nine occassions. Moments like these I remind myself how lucky I am and how that man will go to the end of the earth for me without a moments thought.

Last night the pain began in my bones my entire body on fire, I cried and sobbed as the waves of shivers to hot flashes wracked my very soul. My husband,  held me all night and stroked my bald head with one or two tufts that refuse to give up the fight. He says they make me look cute.

This morning I took morphine for the pain and slept most of the day, my husband had to work and has returned exhausted, I apologized for keeping him awake all last night and said tonight I will sleep in another room. 'You will not, I want you next to me, so I may hold you'...' me too' I said.

FRIDAY IS WORLD CANCER DAY

                                 Friday is world cancer day

I'd appreciate it if you will forward this request

 93% won't forward
 A small request.. Just one line.
 Dear God, I pray for a cure for cancer. Amen 

All you are asked to do is keep this circulating, even if it's only to one more person.
 In memory of anyone you know who has been struck down by cancer or is still living with it. 
 A Candle Loses Nothing by Lighting Another Candle.

ONE SHARED BATTLE AND THREE BEST FRIENDS

When Kate Jones learned she had breast cancer at 37, she turned to long-time pals Linda and Sarah for support during her often radical treatment. Then they, too, were diagnosed before they reached 40… To mark Breast Cancer Awareness Month, they explain how their friendship and understanding helped each to take her own approach to tackling the disease

Sarah, Kate and Linda today

On her wedding day ten years ago, Kate Jones, now 40, had two close friends to wish her all the luck in the world. Sarah Wheeler was like a sister to her; the girls had grown up together in the same Hampshire village. Linda Iravani was a work colleague of Kate’s who had moved to the village and got to know Sarah. As they entered their 30s, all three were newly married and it wasn’t long before they had seven children among them. Then, one after another, they got breast cancer.

Kate was first. She has a vivid memory of a summer day in 2007, just before she was diagnosed, going riding with her two small daughters, Annabel and Tilly, now seven and eight, and thinking that her life, at 37, couldn’t get any better. Her husband Rob, now 43, was running his own graphic design agency and Kate’s image consultancy business was thriving. It was the August bank holiday weekend, a few weeks later, when she found the pea-sized lump in her armpit; she confided in Sarah, but refused to let it spoil their holiday barbecue. However, a mammogram and biopsy two weeks later revealed a 10mm lump in her breast, so small she couldn’t feel it: ‘What I’d found in my armpit was a swollen lymph gland, not the cancer. And then it all started…’
Initially, Kate underwent a lumpectomy, followed by four months of chemotherapy, through which she carried on her business more or less as normal. When her long black hair started falling out, she cut it short to make it look better. ‘My little girls said, “Mummy, you’re not pretty any more. You’re not a princess.”’ But that wasn’t what broke Kate’s heart. ‘I couldn’t have cared less about losing my hair. It’s amazing how un-vain you become. It was the thought of them maybe growing up without a mummy.’
In every group of friends there’s a glamorous one, and in this instance it’s Kate, who makes a living helping women make the most of their looks, and who will be taking to the catwalk this week with other breast cancer survivors – including one man – for Breast Cancer Care’s annual fashion show in London. From day one of her chemo treatment, Kate attacked cancer with pink lipstick, and when her hair loss got worse, she found herself a really good wig. ‘I wasn’t going to be a cancer victim. I had to keep working – I’d built my business over five years and I wasn’t going to let it go,’ she says. ‘Women come to me wanting to know how to look good. And there I was with a wig, pencilled-on eyebrows – and they never knew. I put on my brightest clothes and my brightest lipstick – and I walked the talk that I’d been giving to others.’
What she needed from her friends was for them to stop feeling sorry for her, to phone her with gossip instead of asking, ‘How are you?’ Although by now they had all moved away from the village where their friendship began (Kate and Rob now live in Whitchurch, Hampshire; Linda has moved to Surrey with her teacher husband; and Sarah, an army wife, is in Germany), the others were there whenever Kate needed to talk. ‘I wanted them to be totally, utterly and completely normal,’ Kate says. ‘Not feel sorry for me. Not dwell on it. I didn’t want them to talk about cancer.’

Brownies Sarah (front right) and Kate (rear right), 1980

Linda and Sarah (from left) with Kate (second right) at Kate's wedding, 2000

What she couldn’t have known was that she was setting a standard for her two friends to follow. Barely a year after Kate had found her lump, Linda called with the news that she too had breast cancer. ‘I just couldn’t believe it,’ says Kate. ‘It seemed unreal. I thought, statistically, I was the unlucky one.’ (In fact, the risk of breast cancer for women under 40 in the UK is one in 200: around 1,400 cases in Kate and Linda’s age group are diagnosed each year.) ‘I remember texting Linda, to say “don’t be scared”. And she said, “I’m going to follow your example – and put on my make-up!” I’m sure that knowing exactly how I’d wanted people to be with me made me a much better friend and supporter to Linda.’

Then, just as Linda was recovering from five months of chemotherapy last year, Sarah in turn became aware of an irregularity in her breast. But the likelihood that she too had cancer seemed so unthinkable that she initially delayed checking it out. Ironically, she was having a consultation for a breast augmentation to restore her confidence after feeding four children when her cosmetic surgeon drew her attention to what he thought was probably only a cyst. It wasn’t. ‘The three of us met up one day last summer,’ Kate recalls. ‘My hair was growing back. Linda’s treatment had only just finished and she was wearing a wig. And three weeks later, Sarah was diagnosed. That was the biggest shock of all – for our mothers, too, as they’re friends.’

Although they all had aggressive cancers, Sarah’s experience has been most traumatic. She contracted pneumonia when her immune system was weakened by chemotherapy and was on life support for what Kate describes as ‘the longest ten days of our lives’.

‘I wasn’t going to be a cancer victim. I put on my brightest clothes and lipstick and walked the talk I’d given to others’

Our photo shoot is the first time they have all been together since that meeting last summer. Sarah has recovered well and there is lots of exclaiming about how well everyone looks, and how glamorous, as she and Linda compare how their hair is growing back. For the moment, they are all free of cancer. But for all their
closeness and mutual support, they stress that everybody’s experience is different.
Kate’s treatment has been most radical, by choice. She resolved early on to have a mastectomy in the affected breast; then, having tested positive for a breast cancer gene that affects only five to ten per cent of women with the disease, had a second, preventive mastectomy last year as well as reconstruction surgery. She also had her ovaries removed to minimise the risk of secondary cancer. ‘I knew for my own peace of mind that I couldn’t have kept my breasts’, she explains. ‘You realise that your family and friends don’t care if you’ve got them or not. I could still wear a bikini. But I did feel sorry for my poor husband.’ Only days after our photo shoot, Kate had one last operation to reconstruct her nipples: ‘I should look normal for the first time in three years.’
Kate was also the only one of the three friends who wanted all the statistics, every scrap of information. ‘I needed to understand it. I needed to know that I was being realistic expecting to be OK.’ At times, she admits, it seemed as if there was no getting away from breast cancer: she lived through it all again with her friends, just as she was recovering and longed to put it behind her.
‘That’s why I want to do this fashion show,’ she says. ‘If I can’t get away from breast cancer, I want to help women under 40 see that you don’t have to be scared. You can still look glamorous and feminine and sexy. You can still be a mummy.  You can still look gorgeous after, and even during cancer. So though it’s awful that it has been all three of us, we’ve helped each other enormously. Three friends who have had cancer are all OK. And today we’re all laughing about the fact that we’re special friends.’

'It was great having Kate one step ahead of me. if she could do it, so could I’

Linda Iravani, 41, from Surbiton, Surrey, gave up her career in publishing after her breast cancer was diagnosed in September 2008. After a recuperative ‘gap year’ she is now a supply teacher. She is married to Tony, 42, also a teacher, and has a daughter, Emilia, six.
When I found my lump – not even pea-sized, it was petit pois-sized – I was quick to act because I knew that if it had happened to Kate it could happen to me. Her text saying, ‘Don’t worry, darling, it will be OK,’ was the most calming message I could have. I threw up for 24 hours, from shock. But the next day, the sun was shining and I thought, ‘I can go two ways – sink into depression, thinking “Why me?” or be positive.’
In hospital I cocooned myself; I didn’t want to get to know anyone at the same stage as myself. I already had people to share my fears with, and it was great having Kate one step ahead of me. If she could do it, so could I. We’d discuss our fears about our children. Unlike Kate, I soon became bald as a coot – the cold-cap treatment to prevent hair loss during chemo was excruciating, and it was obvious that my hair was falling out anyway, so I gave it up. My mum was worried, because as a child I’d even cry over a haircut, but as soon as I put on my wash-and-go wig, I loved it.
So by June last year, I was in a very happy place. There’s a photo of the three of us: my treatment was over, Kate was recovering from a mastectomy, and Sarah, although she’d found a lump, didn’t mention it so we were in blissful ignorance. I was on holiday in Antibes when Kate texted a few weeks later saying Sarah had been diagnosed, and it was a real shock –unbearable that it had happened to all three of us, especially as none of us smoked, or were overweight, and Sarah had breast-fed four children, which is supposed to reduce your risk. It was as though the three of us were in an exclusive club – only, unfortunately, it’s not that exclusive. I felt I could help Sarah because it was still fresh in my mind. This time last year, I was still so tired that I couldn’t have walked a mile. That’s why I’m amazed at how well Sarah is: she did a fundraising marathon power walk this summer.
We’ve all approached it differently. Kate was obsessed with statistics, Sarah didn’t want to know and I’m somewhere in the middle, which is unusual because I’m generally someone who does want to know. I didn’t go online for information: you only scare yourself. When you look at the three of us, we defy statistics anyway.

‘You can’t alter your diagnosis, but you can alter how you deal with it’

Sarah Wheeler, 39, is married to Paddy, 43, an officer in the Army Air Corps, and they have four children, Sebastian, eight, Benedict, six, Alexander, four, and Flora, two. She was diagnosed with breast cancer in June 2009, a year after they’d been posted to Mönchengladbach in Germany.
Looking back, it seems ridiculous, given that I knew about Kate and Linda, but I thought my lump was insignificant and I didn’t want to make a fuss. The surgeon who did my breast augmentation thought it was a cyst and told me to get it checked out; but as I’d just finished breast-feeding, to me it felt like a blocked milk duct. It didn’t cross my mind that it could happen to me too. I’d come back to England for half-term, and we all had lunch, but I didn’t say anything. I didn’t want them getting wound up over nothing.
When I got the diagnosis, back home in Germany, I wanted Kate to hear in person, so
my mother told Kate’s mother, who went to tell her. We had a cry together over the phone and then she said, ‘You’re going to be able to do this. Put a smile on your face and we’ll beat this together.’ And you do. All I could think of was that I had four small children who needed a mummy: if anything happens to me, who’ll take them for haircuts, who’ll know whose pants are whose? Life needed to carry on with a mummy who was as bubbly and bright as possible. Of course, you have days when you don’t feel very bubbly. I remember telling another friend that I was fed up being a smiley person with cancer.
In Germany everything happens very quickly: from diagnosis to starting chemotherapy within a week. I got a text from Kate before my first chemo saying: ‘Hope you’ve got your lipstick!’ You can’t alter your diagnosis but you can certainly alter how you deal with it.
I lost all my hair and the children were fine about it, except that they wouldn’t let me go
past the end of our road without wearing a hat! I remember nothing about having pneumonia: I was on life support for ten days, while Paddy was looking at the possibility of bringing up the children on his own. When I came round, I was told that 48 families had been cooking for them on a rota; at 5pm, military wives of all nationalities would turn up with food. So I had amazing support even though I was so far away.
One thing Linda, Kate and I have had to be careful of is not to get our knickers in a twist comparing treatments, what drugs we’re on, or chemotherapy sessions. Kate chose to have very radical treatment, for instance. What’s great is that at each stage we’ve been able to support each other. We couldn’t be any closer.

For more information about Breast Cancer Care’s fashion show on Wednesday at Grosvenor House Hotel, London, and for information and support for women under 45 who have been diagnosed with breast cancer, visit breastcancercare.org.uk

UNDERSTANDING TYPES OF BREAST CANCER

It may help to understand some of the key words used to describe breast cancer. I thought breast cancer was just that BUT there are many types of breast cancer, I have placed them together so we may understand more and in so doing understand our bodies and what is happening to us.

Carcinoma

This is a term used to describe a cancer that begins in the lining layer (epithelial cells) of organs such as the breast. Nearly all breast cancers are carcinomas (either ductal carcinomas or lobular carcinomas).

Adenocarcinoma:

An adenocarcinoma is a type of carcinoma that starts in glandular tissue (tissue that makes and secretes a substance). The ducts and lobules of the breast are glandular tissue (they make breast milk in women), so cancers starting in these areas are sometimes called adenocarcinomas.

Carcinoma in situ:

This term is used for the early stage of cancer, when it is confined to the layer of cells where it began. In breast cancer, in situ means that the abnormal cells remain confined to ducts (ductal carcinoma in situ, or DCIS) or lobules (lobular carcinoma in situ, or LCIS). They have not invaded into deeper tissues in the breast or spread to other organs in the body, and are sometimes referred to as non-invasive breast cancers.

Invasive (infiltrating) carcinoma:

An invasive cancer is one that has already grown beyond the layer of cells where it started (as opposed to carcinoma in situ). Most breast cancers are invasive carcinomas, either invasive ductal carcinoma or invasive lobular carcinoma.

Types of breast cancer in men

Ductal carcinoma in situ (DCIS)

In DCIS (also known as intraductal carcinoma), cancer cells form in the breast ducts but do not grow through the walls of the ducts into the fatty tissue of the breast or spread outside the breast. DCIS accounts for about 1 in 10 cases of breast cancer in men. It is almost always curable with surgery.

Infiltrating (or invasive) ductal carcinoma (IDC)

This type of breast cancer breaks through the wall of the duct and grows through the fatty tissue of the breast. At this point, it can spread (metastasize) to other parts of the body. At least 8 out of 10 male breast cancers are IDCs (alone or mixed with other types of invasive or in situ breast cancer). Because the male breast is much smaller than the female breast, all male breast cancers start relatively close to the nipple, so they are more likely to spread to the nipple. This is different from Paget disease as described below.

Infiltrating (or invasive) lobular carcinoma (ILC)

This type of breast cancer starts in the breast lobules (collections of cells that, in women, produce breast milk) and grows into the fatty tissue of the breast. ILC is very rare in men, accounting for only about 2% of male breast cancers. This is because men do not usually have much lobular tissue.

Lobular carcinoma in situ (LCIS)

In LCIS, abnormal cells form in the lobules, but they do not grow into the fatty tissue of the breast or spread outside the breast. Although LCIS is sometimes classified as a type of non-invasive breast cancer, most breast specialists think it is a risk factor for developing breast cancer rather than a true non-invasive cancer. As with invasive lobular carcinoma, LCIS is very rare in men.

Paget disease of the nipple

This type of breast cancer starts in the breast ducts and spreads to the nipple. It may also spread to the areola (the dark circle around the nipple). The skin of the nipple usually appears crusted, scaly, and red, with areas of itching, oozing, burning, or bleeding. The fingertips can be used to detect a possible lump within the breast.

Paget disease may be associated with DCIS or with infiltrating ductal carcinoma. It accounts for about 1% of female breast cancers and a higher percentage of male breast cancers.

NEW TYPE OF BREAST CANCER ; WOMEN PLEASE BE ALERT

New kind of Breast Cancer –

In November, a rare kind of breast cancer was found. A lady developed a rash on her breast, similar to that of young mothers who are nursing..

Because her mammogram had been clear, the doctor treated her with antibiotics for infections.. After 2 rounds, it continued to get worse, so her doctor sent her for another mammogram. This time it showed a mass.

A biopsy found a fast growing malignancy. Chemo was started in order to shrink the growth; then a mastectomy was performed; then a full round of Chemo; then radiation.. After about 9 months of intense treatment, she was given a clean bill of health.

She had one year of living each day to its fullest. Then the cancer returned to the liver area. She took 4 treatments and decided that she wanted quality of life, not the after effects of Chemo. She had 5 great months and she planned each detail of the final days. After a few days of needing morphine, she died. She left this message to be delivered to women everywhere:

Women, PLEASE be alert to anything that is not normal, and be persistent in getting help as soon as possible.

Paget’s Disease:

This is a rare form of breast cancer, and is on the outside of the breast, on the nipple and aureole It appeared as a rash, which later became a lesion with a crusty outer edge. I would not have ever suspected it to be breast cancer but it was. My nipple never seemed any different to me, but the rash bothered me, so I went to the doctor for that. Sometimes, it itched and was sore, but other than that it didn’t bother me. It was just ugly and a nuisance, and could not be cleared up with all the creams prescribed by my doctor and dermatologist for the dermatitis on my eyes just prior to this outbreak. They seemed a little concerned but did not warn me it could be cancerous.

Now, I suspect not many women out there know a lesion or rash on the nipple or aureole can be breast cancer. (Mine started out as a single red pimple on the aureole. One of the biggest problems with Paget’s disease of the nipple is that the symptoms appear to be harmless. It is frequently thought to be a skin inflammation or infection, leading to unfortunate delays in detection and care.)

What are the symptoms?

1. A persistent redness, oozing, and crusting of your nipple causing it to itch and burn (As I stated, mine did not itch or burn much, and had no oozing I was aware of, but it did have a crust along the outer edge on one side.)

2. A sore on your nipple that will not heal. (Mine was on the aureole area with a whitish thick looking area in center of nipple).

3. Usually only one nipple is affected. How is it diagnosed? Your doctor will do a physical exam and should suggest having a mammogram of both breasts, done immediately.. Even though the redness, oozing and crusting closely resemble dermatitis (inflammation of the skin), your doctor should suspect cancer if the sore is only on one breast. Your doctor should order a biopsy of your sore to confirm what is going on.

This message should be taken seriously and passed on to as many of your relatives and friends as possible; it could save someone’s life.

My breast cancer has spread and metastasized to my bones after receiving mega doses of chemotherapy, 28 treatments of radiation and taking Tamaxofin. If this had been diagnosed as breast cancer in the beginning, perhaps it would not have spread…

TO ALL READERS:

This is sad as women are not aware of Paget’s disease. If, by passing this around on the e-mail, we can make others aware of it and its potential danger, we are helping women everywhere.


Please, if you can, take a moment to forward this message to as many people as possible, especially to your family and friends. It only takes a moment, yet the results could save a life

MYOCET.: TREATMENT FOR BREAST CANCER METASTASIS

Liposomal doxorubicin (Caelyx®, Myocet®)

Liposomal doxorubicin is a chemotherapy| drug that is given as a treatment for some types of cancer . It is most commonly used to treat ovarian cancer| and Aids-related Kaposi’s sarcoma| , but may also be used to treat advanced breast cancer| .

•Pis a chemotherapy drug. In liposomal doxorubicin the molecules of the drug are enclosed (encapsulated) in a fatty coating known as liposome. The liposome allows the doxorubicin to remain in the body for longer so that a greater amount of chemotherapy is delivered to the cancer cells, while having fewer side effects on healthy tissue.

Liposomal doxorubicin isn’t suitable for everyone who needs doxorubicin and you may find it helpful to discuss this with your cancer specialist, who will be able to advise you on whether this type of treatment is appropriate for you.

There are two liposomal doxorubicin drugs that work in slightly different ways and are used to treat different types of cancer. These are Caelyx® and Myocet®.

Caelyx® is a form of doxorubicin| that is enclosed in liposomes. It is sometimes known as pegylated doxorubicin hydrochloride (PLDH). It is used to treat:

•Advanced ovarian cancer that has come back after being treated with a platinum-based chemotherapy drug.

•Women with advanced breast cancer who have an increased risk of heart damage from other chemotherapy drugs.

•Aids-related Kaposi’s sarcoma .

Myocet® , another form of liposomal doxorubicin, is used to treat advanced (metastatic) breast cancer| in combination with another chemotherapy drug, cyclophosphamide| .

What it looks like

Liposomal doxorubicin is a light red fluid.

How it is given

Liposomal doxorubicin may be given by a drip (infusion):

•through a fine tube (cannula) placed into the vein, usually in the back of the hand

•through a fine plastic tube that is inserted under the skin into a vein near the collarbone (central line )

•into a fine tube that is inserted into a vein in the crook of your arm (PICC line ).

The Infusion usually takes 60-90 minutes.

Chemotherapy is usually given as a course of several sessions (cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Possible side effects

Each person’s reaction to chemotherapy is different. Some people have very few side effects; while others may experience more. The side effects described in this information won’t affect everyone who is given liposomal doxorubicin, and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects and some of the less common ones, so that you can be aware of them if they occur. However, we haven’t included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which aren’t listed in this information, please discuss them with your doctor, chemotherapy nurse or pharmacist.

Lowered resistance to infection Liposomal doxorubicin can reduce the production of white blood cells by the bone marrow, making you more prone to infection| . This effect can begin seven days after treatment has been given, while your resistance to infection usually reaches its lowest point 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily, and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straight away if:

•your temperature goes above 38ºC (100.4ºF)

•you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Liposomal doxorubicin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells) While having treatment with liposomal doxorubicin you may become anaemic. This may make you feel tired| and breathless| . Let your doctor or nurse know if these symptoms are a problem.

Sore mouth and ulcers Your mouth may become sore| , or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicine to prevent or clear any mouth infection can be prescribed.

Taste changes You may notice that your food tastes different. Normal taste usually comes back after the treatment finishes.

Skin changes Your skin may darken, due to excess production of pigment. This usually returns to normal a few months after the treatment has finished.

Areas of skin that have previously been treated with radiotherapy may become sensitive again while you are being treated with liposomal doxorubicin.

Soreness and redness of the palms of the hands and soles of the feet If you are being treated with Caelyx, you may develop red palms and soles of the feet, sometimes referred to as palmar plantar, or hand and foot syndrome. This effect can begin after two or three cycles of treatment, but is temporary. It will usually begin to improve within 1-2 weeks after the treatment is finished. You may be prescribed vitamin B6 (pyridoxine), which can help to reduce this.

It can also help to keep your hands and feet cool and to avoid tight fitting clothing, such as socks, shoes and gloves. Palmar plantar is unlikely to happen if you are being treated with Myocet.

Hot flushes or backache Some people have hot flushes or backache when the drug is being given.

Sensitivity to the sun While you are having liposomal doxorubicin, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily than normal. You can still go out in the sun, but always wear a high protection factor suncream and protective clothing.

Discoloured urine Your urine may become a red/orange colour. This may last for a few hours after having liposomal doxorubicin and is due to the colour of the drug. It is quite normal.

Fever, chills and allergic reactions Back pain, breathlessness, headaches and swelling of the face may occur from the time the drug is given. If you do develop these symptoms the infusion may be stopped and re-started at a slower rate. Your doctor may prescribe a drug that can reduce these side effects and which can be given before your next treatments.

Tiredness and feeling weak It is important to allow yourself plenty of time to rest.

Less common side effects

Feeling sick (nausea) and being sick (vomiting) If you do feel sick this may begin a few hours after the treatment is given and last for up to a day. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce, nausea and vomiting| .

If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Changes in the way your heart works Liposomal doxorubicin can affect how the heart works. The effect on the heart depends on the dose given. It is very unusual for the heart to be affected by standard doses of this treatment. If affected the heart normally goes back to normal once the chemotherapy is finished. Tests to see how your heart is working may sometimes be carried out before the drug is given.

Hair loss

This is more likely to occur if you are being treated with Myocet than Caelyx, although it can happen with both. It usually starts 2-4 weeks after the first dose of liposomal doxorubicin, although it may occur earlier. Your hair may just thin but could fall out completely, although this is rare. You may also have thinning and loss of eyelashes, eyebrows and other body hair. Hair loss| is temporary and your hair will start to regrow once the treatment ends.

Injection site If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site it is very important that you tell the doctor or nurse.

If the area around the injection site becomes red or swollen you should either tell the doctor on the ward or, if you are at home you should ring the clinic or ward and ask to speak to the doctor or nurse.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain.

 Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines Some medicines may be harmful to take when you are having chemotherapy, including those you can buy in a shop or chemist. Let your doctor know about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs

Fertility

 Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility| with your doctor before starting treatment.

Contraception

It’s not advisable to become pregnant or father a child while taking liposomal doxorubicin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.



SOURCE: MACMILLAN CANCER

PAGETS DISEASE OF THE BREAST

Paget’s disease of the breast is an uncommon form of breast cancer that first shows as changes to the nipple.

It occurs in fewer than 5% of all women with breast cancer. Men can also get Paget’s disease but this is very rare.

Signs and symptoms

The most common sign is a red, scaly rash involving the nipple, which may spread to the areola.

The rash can feel itchy or you may have a burning sensation. The nipple may be inverted (pulled in) and there may also be some discharge.

The symptoms of Paget’s disease can look like other skin conditions such as eczema or psoriasis. However, there are differences. For example, Paget’s disease affects the nipple from the start while eczema affects the areola region first and only rarely affects the nipple.
Paget’s disease usually occurs in one breast, while other skin conditions usually affect both breasts.
Approximately half of patients with Paget’s disease will also have an underlying lump. Most of these will be invasive cancers, which means the cancer has the potential to spread outside the breast.
Where there is no lump, most will be non-invasive or in-situ cancers. This means that the cancer cells are inside the milk ducts and have not developed the ability to spread either within or outside the breast.

Diagnosis

Because Paget’s disease can look like other skin conditions, it can be difficult to make a diagnosis.
Once your GP has referred you to a specialist, certain tests may be done to help make the diagnosis. They include:

• Mammogram
  You will usually have a mammogram (breast x-ray) to check whether there is any underlying cancerous tissue in the breast.
• Scrape cytology
  This involves scraping some cells from the skin of the nipple. The cells are put onto a slide so that they can be looked at under a microscope.
• Imprint cytology
  In this case an area of the affected nipple is pressed onto a slide. The cells on the slide can then be examined under a microscope.
• Biopsy
  You will probably have a biopsy taken to confirm the diagnosis. This means taking a small piece of skin and breast tissue from the affected area so that they can be looked at under a microscope. This is known as an incisional biopsy and can be done under local anaesthetic.

Treatment

Surgery
As for most types of breast cancer, surgery will be the first treatment. The type of surgery will depend on whether or not you have a lump and the extent of the cancer.
If you have a lump or the cancer is widespread in the breast then you are likely to be offered a mastectomy.
If you don’t have a lump and the cancer is confined to a small area, a wide local excision including the nipple followed by radiotherapy may be suggested.
In some cases you may be given the choice, which means the surgeon thinks both types of surgery will offer the same benefits.

It is important to find out whether the cancer has spread to the lymph nodes in the axilla. This will help to find out if you need any further treatment such as chemotherapy.

This means either removing some of the lymph nodes (sampling) or removing all the nodes (clearance) or having a sentinel node biopsy.
Adjuvant treatment
Adjuvant treatments are treatments given in addition to surgery and include chemotherapy, radiotherapy and hormonal therapy.
The aim of adjuvant treatments is to reduce the risk of the cancer coming back either in the same breast (local recurrence) or elsewhere in the body.
If you have a wide local excision you will probably be offered radiotherapy to reduce the risk of the cancer coming back in the same breast. If you have a mastectomy you may not need radiotherapy.

In some cases chemotherapy is recommended, for example if the cancer has spread to the lymph nodes.

If your tumour is oestrogen receptor positive, which means it depends on the hormone oestrogen for growth, hormone therapy will usually be recommended.
Herceptin (a targeted therapy) may be offered if the invasive cancer is HER2



SOURCE:  BREAST CANCER CARE.

FEMARA / SIDE EFFECTS

Femara is used for the treatment of certain types of breast cancer in postmenopausal women. The medicine works by blocking the action of estrogen receptors in the body, which lowers the production of this hormone and helps decrease the cancer's growth.

SOUNDS GOOD IN theory but when put into practice it comes with a lot of luggage....SIDE/EFFECTS

There have been studies in the United States of America ....BUT looking at the American breast cancer forum boards they tell a very different story.

Femara has been studied thoroughly in clinical trials, in which a group of people taking the drug have side effects documented.

 This way, it is possible to see what side effects occur and how often they appear.

In these studies, the most common Femara side effects included:

• Hot flashes -- in up to 33.7 percent of women
• Fatigue or weakness -- up to 33.6 percent
• Increased sweating -- up to 24.2 percent
• Joint pain or arthritis -- up to 22 percent
• Headaches -- up to 20.1 percent
• Swelling or water weight gain -- up to 18.4 percent
• Back pain -- up to 18 percent
• Nausea -- up to 17 percent
• High cholesterol -- up to 15.6 percent (see Femara and High Cholesterol).
  

Some other common side effects (occurring in 2 to 15 percent of people) included:

• Dizziness
• Night sweats
• Cough
• Constipation
• Weight loss
• Weight gain (see Femara and Weight Gain)
• Diarrhea
• Vomiting
• Insomnia (see Femara and Insomnia)
• Breast pain
• Muscle pain
• The flu
• Urinary tract infections (UTIs or bladder infections)
• Broken bones
• Vaginal dryness or irritation
• Loss of appetite
• Indigestion or heartburn
• Drowsiness.

I have tried FEMARA...twice now on two seperate occasions, the results were the same  DEPRESSION, JOINT PAIN,  CONSTANT HEADACHES, HOT FLASHES.....joint pain like I have never known, burning ,as though my entire skeleton were on fire, my fingers became sticks I could not remove the toothpaste cap from its tube ....my feet, I felt as though I was walking on hot coals.

SOON, when I finish chemotherapy my Oncologist and I are going to have to have a long talk, because if I wish to survive I must take this drug or something very similar once more for the next five years. BUT what kind of life will this be for me ?   Of course the choice will be mine, live in the SHADOW of cancer or become a cripple to have an extra few years....This for me will be a very hard pill to swallow.......

LYMPHEDEMA

Lymphedema refers to swelling that generally occurs in one of your arms or legs. Although lymphedema tends to affect just one arm or leg, sometimes both arms or both legs may be swollen.
Lymphedema is caused by a blockage in your lymphatic system, an important part of your immune and circulatory systems. The blockage prevents lymph fluid from draining well, and as the fluid builds up, the swelling continues.

There's no cure for lymphedema, but it can be controlled. Controlling lymphedema involves diligent care of your affected limb.


Lymphedema symptoms include:

• Swelling of part of your arm or leg or your entire arm or leg, including your fingers or toes
• A feeling of heaviness or tightness in your arm or leg
• Restricted range of motion in your arm or leg
• Aching or discomfort in your arm or leg
• Recurring infections in your affected limb
• Hardening and thickening of the skin on your arm or leg

The swelling caused by lymphedema ranges from mild, hardly noticeable changes in the size of your arm or leg to extreme swelling that can make it impossible to use the affected limb.




When to see a doctor


Make an appointment with your doctor if you notice any persistent swelling in your arm or leg.




Your lymphatic system is crucial to keeping your body healthy. It circulates protein-rich lymph fluid throughout your body, collecting bacteria, viruses and waste products. Your lymphatic system carries this fluid and harmful substances through your lymph vessels, which lead to lymph nodes. The wastes are then filtered out by lymphocytes — infection-fighting cells that live in your lymph nodes — and ultimately flushed from your body.

Lymphedema occurs when your lymph vessels are unable to adequately drain lymph fluid, usually from an arm or leg. Lymphedema can be either primary or secondary. This means it can occur on its own (primary lymphedema) or it can be caused by another disease or condition (secondary lymphedema).

Causes of PRIMARY lymphedema


Primary lymphedema is a rare, inherited condition caused by problems with the development of lymph vessels in your body. Primary lymphedema occurs most frequently in women. Specific causes of primary lymphedema include:

• Milroy's disease (congenital lymphedema). This is an inherited disorder that begins in infancy and causes a malformation of your lymph nodes, leading to lymphedema.
• Meige's disease (lymphedema praecox). This hereditary disorder often causes lymphedema in childhood or around puberty, though it can occur in your 20s or early 30s. It causes your lymph vessels to form without the valves that keep lymph fluid from flowing backward, making it difficult for your body to properly drain the lymph fluid from your limbs.
• Late-onset lymphedema (lymphedema tarda). This occurs rarely and usually begins after age 35.

Causes of SECONDARY lymphedema


Any condition or procedure that damages your lymph nodes or lymph vessels can cause lymphedema. Causes include:

• Surgery can cause lymphedema to develop if your lymph nodes and lymph vessels are removed or cut. For instance, surgery for breast cancer may include the removal of one or more lymph nodes in your armpit to look for evidence that cancer has spread. If your remaining lymph nodes and lymph vessels can't compensate for those that have been removed, lymphedema may result in your arm.
• Radiation treatment for cancer can cause scarring and inflammation of your lymph nodes or lymph vessels, restricting flow of lymph fluid.
• Cancer cells can cause lymphedema if they block lymphatic vessels. For instance, a tumor growing near a lymph node or lymph vessel could become large enough to obstruct the flow of the lymph fluid.
• Infection can invade your lymph vessels and lymph nodes, restricting the flow of lymph fluid and causing lymphedema. Parasites also can block lymph vessels. Infection-related lymphedema is most common in tropical and subtropical regions of the globe and is more likely to occur in developing countries.

Infections. Lymphedema makes your affected arm or leg particularly vulnerable to infections. Possible infections include cellulitis — a serious bacterial infection of the skin — and lymphangitis — an infection of the lymph vessels. Any injury to your arm or leg can be an entry point for an infection.

              Image of Lymphedema and Cellulitis

 

Lymphangiosarcoma. This rare form of soft tissue cancer can result from the most severe cases of untreated lymphedema. Possible signs of lymphangiosarcoma include blue-red or purple marks on the skin.

SOURCE:  MAYOCLINIC

PET-TAC: NUCLEAR

I ALWAYS LIKE to start by saying a funny thing happened to me on the way to the doctors...but have to change to a funny thing happened to me as ALWAYS..... while  with the doctor.

Yesterday I had an appointment for a Pet-Tac...I am used to this by now and no, it does not hurt at all...although the thought of  being full of chemo from ten days ago and now my poor body bombarded with tiny atoms does not a happy bunny make. 

I first spoke with the doctor who likes to keep a record of all his patients and as he peered at me over his spectacles said  'AH yes I remember you well'....Not so well it would seem when question number one arose...'Which breast'' he asked...Niether,' I replied..........puzzlement filled his face and there was silence in the room. 'BUT you have a diagnosis of breast cancer'.....'yes' I replied....'BUT not in the breast.'..bafflement ....as I once again had to explain. 'Yes I have breast cancer but NOT in the breast...stomach and colon and now spread to an area behind the bladder called the PERINEAL'.... once more a very strange place for advanced breast cancer to spread...or as in my case, perhaps not.

'Mmmmm do you by any chance know your treatment?' asked the bemused doctor......'MYOCET' I replied ....'AND are you on any treatment or medication?'......'Yes 'I replied, 'chemotherapy' ????....Myocet is a chemotherapy for treating women with advanced breast cancer!!!!!!!!!!!!

These moments of leaving the medical profession lost for words and with a muddled brain reminds me of how it must have felt when blonde bombshell   MARILYN  MONROE.....left the room .

BREAST CANCER: METASTASIS

When breast cancer spreads beyond the breast, it is said to be ?metastatic?, meaning that it has traveled from the breast to another part of the body.

Cancer cells can travel through either the lymphatic system or the blood vessels.

There are two types of metastatic breast cancer. When the cancer cells travel from the breast to the under arm (axillary) lymph nodes, it is still considered an ?early? or potentially curable breast cancer. With proper surgery and systemic treatments, there is still a good chance that all cancer can be removed from the body.

If the cancer has traveled past the lymph nodes to another part of the body, a woman is said to have ?distant metastasis?. The most common places that breast cancer spreads to are the bones, the liver, and the lungs. Many treatments are available for breast cancer that has spread to other parts of the body, but unfortunately once cancer has escaped from the breast and under arm lymph nodes, it is no longer curable.

The goal of treatment in this case is to prevent the cancer from spreading further while at the same time minimizing side effects from the treatment.

A woman may be found to have a distant metastasis of her breast cancer at the time when her initial breast cancer is found, or months to years later.

This occurs because breast cancer cells can escape from the breast before surgery and may take a long time to form a tumor in another part of the body.

When breast cancer comes back months to years after it was originally found, it is called a breast cancer recurrence
.
Treatment for Breast Cancer Metastasis

Once breast cancer has spread beyond the breast and under arm lymph nodes, it is considered a ?systemic? disease, meaning that it is necessary to treat the whole body rather than just one particular spot.
This is because, once the cancer has traveled through the blood stream or lymphatic system, there are likely to be breast cancer cells in many different parts of the body, even if scans only show a few spots.
For this reason, treatments that reach all parts of the body, such as chemotherapy and hormonal therapy, are used to treat metastatic breast cancer instead of treatments that just treat one part of the body, such as surgery.

In general, surgery is not a part of the treatment of metastatic disease because treating only one area allows cancer to grow in other places.

It is unfortunately not possible to remove all of the parts of the body where the cancer has spread because it is impossible to measure the individual cancer cells that will grow into a tumor without chemotherapy or hormonal treatment.

Breast cancer often responds to many different kinds of treatments, and most patients can live for months to several years with metastatic breast cancer.

Recent research has shown that there are many different types of breast cancer, and the best treatment plan for a particular patient needs to be decided by a woman and her medical oncologist.

In general, a woman might be treated with a hormonal therapy if she has a hormone responsive (estrogen or progesterone receptor positive) tumor and does not have a large amount of cancer in her liver or lungs.

Women with tumors that are not responsive to hormonal therapies or who have a large amount of disease in their bodies are usually treated with chemotherapy.

There are many different types of chemotherapy that are used for breast cancer. In general, it is important to remember that the goal of treatment is to stop the cancer from growing while still allowing the patient to live a normal life.

Many times the chemotherapy that is chosen in this setting is less toxic than the chemotherapy given after breast cancer surgery.

In recent years, there has been much interest in developing new types of medicines that kill breast cancer cells in new and different ways.

Some of these medicines, such as trastuzumab (Herceptin), are designed to work against a specific type of breast cancer. Others, such as becizamab (Avastin), may work well in combination with chemotherapy to increase the likelihood that a treatment will stop the tumor from growing for a longer period of time.
In general, most women with metastatic breast cancer will be treated with several different types of therapy over the course of their disease.

Over time, cancer cells become resistant to a treatment, and will begin to grow. When this happens, a change in treatment is needed.

Unlike many other types of cancer, breast cancer cells can be controlled by many different types of chemotherapy, and women with metastatic breast cancer are living longer and longer.

Hopefully with further research, women will no longer die of this disease in the future.