Our Immune System and Cancer

Strengthen your immune system to stop cancer by eating specific foods is a message I see in certain social media circles. This message about food usually comes from people promoting natural, alternative approaches to disease prevention and treatment verses man-made conventional treatment options like chemotherapy. It gives the impression that cancer is a simple disease that can be prevented or even cured by healthy living. Of course eating healthy allows our bodies to function at its best and respond to invaders that make us ill, but this message about food, our immune system, and cancer is not exactly accurate. Cancer is our own cells, so our body doesn't always detect those cells as harmful. Plus cancer cells do some tricky things to their microenvironment and to certain types of immune system cells in order to survive. After looking at a video on u-tube--link included at bottom of post--I found our immune system's natural response to cancer is way more complicated than anything I imagined.

Even if you don't finish reading this post, please watch the video below. If nothing else comes of your watching it, you will at least have a glimpse of why breast cancer survival rates are not changing rapidly. 

At this point, you might be thinking, "But what about the immunotherapy approaches to cancer that are making the news these days?"

There are a few drugs (Herceptin is one) used today that target a specific part of a cancer cell. These drugs are suspected of enhancing a body's immune system and its response to cancer. Unfortunately--at least in my understanding--how these drugs actually cause an immune response is not completely understood. 

Targeting an individual's particular cancer using their immune system is no easy task. In the case of cancer vaccines, each person's cancer must be analyzed for targets such as proteins and then the person's immune system is "taught" (for lack of a better way to describe it) or altered in some way to find the cancer cells and stop them. (Immune system cells are first taken from an individual and taught to recognize a cellular malfunction. Then they are infused back into the body to seek and destroy those cancer cells.) From what I can tell, immunotherapy can only be used presently in a small subset of patients because there are so few drugs currently developed that can target specific proteins on cancer cells or enhance other immune cells so they can recognize the abnormal cells. In my opinion, the term immunotherapy may not be the best word to use for this kind of treatment, but I do not have the medical background and understanding to offer another term in this new realm of precision medicine.

(Cancer.org has good information about immunotherapy. Please go to their website for more information since I may have created a indecipherable mess in my explanation of it.)

As I stated in the beginning of this post, I watched a video--found on twitter--about cancer and the immune system of mice. Below is the tweet I saw about this video describing how cancer cells are able to enter the bloodstream and metastasize.

This is what I saw:

Dan Buzovi ‏@danbx96 Dec 18

Spying On Breast Cancer Metastasis http://bit.ly/1OdzgYN .

The video shows how macrophages created from white blood cells actually help cancer cells move around the body. Did you read that word in bold? "Help" is a dark contrast to the meaning of "stop" in a discussion about cancer metastasizing. The macrophages are helping cancer cells find their way into the bloodstream therefore the immune system has taken an unexpected role in response to a damaged cell. This once again tells me there is so much still to learn.

You may remember learning about macrophages from high school biology class or possibly from Biology 101 in college. If you didn't or don't remember, macrophages develop from a special group of white blood cells. When cells are damaged because of infection, macrophages engulf and digest the cells. Then an antigen forms on the outside of the macrophages signaling other macrophages to seek and destroy other cells infected in the same way. Any future invaders of this type will quickly be eliminated by the immune system because the body has macrophages already created to kill this particular invader. If the immune system is working correctly, they will detect and destroy them before an animal shows any signs of illness. Remember cancer is not an invader therefore the difficulty to get our immune system to recognize there is a problem is not easily solved by simply eating an asparagus smoothie.

The research and video describing how macrophages help instead of hinder cancer cells was done at Albert Einstein College of Medicine in New York City. Edison Leung and Allison Harney are the creators. Since this immune response has only been captured in mice, saying this is how cancer metastasizes in humans is a jump, but the possibility is real. 

The video is short. For science lovers, I hope you find it informative and fascinating--also terrifying of course.  

Letter to My Email Subscribers/HTML messing up my feed!

Update December 29, 2015 - I received news today that a few of my subscribers received an email about my December 28th post. I guess I fixed my email problem! Hopefully the fix will last a long while.

Updated Post December 22, 2015
Email Subscribers: Despite my best efforts, I do not think I can repair the troubles I am experiencing with my blog and its relationship with Feedburner. I hope one day to be able to send email updates, but for now HTML coding and Feedburner's file limit baffles me. Why? Oh why, did a simple blog turn out to be so complicated? Ugh.

Written December 16th, 2015
Dear Email Subscribers,

I have discovered that all of you have not been receiving my updated posts. This wasn't something I realized right away, and I apologize for that. Because I am not technically savvy when it comes to my blog, I was unsure how to correct the problem. Over the last few days, I found the time I needed to look at this problem and try to correct it.

My email subscriptions are managed by an add-on service called Feedburner. Feedburner has a limit of how large a blog's feed size can be. That limit is 512K. In January or February, I went over that limit. In order to reduce the size so you could receive emails again, I had to do a lot of reading. Once I devised my plan to fix it, I discovered that my plan could possibly create more problems. Over the last few days, I have tried several remedies. Hopefully, the solutions I have attempted will work and this post will arrive in your inbox.

Each of you are important to me, and I greatly appreciate your thinking enough of me to sign-up to read my posts. I hope that in this absence you have continued to read my blog by searching for it on your favorite search engine or placing it in your favorite's list. Of course if you would rather not receive any new posts in your inbox, you can unsubscribe, and I promise I will not tag you as my least favorite person. Then again, my fixes may not solve the problem, and this post will be irrelevant. I hope that is not the case.

The beginning of a new year has always been my favorite time of year. I hope this post finds all of you happy and warm during these last few weeks of 2015.

Thanks for reading and . . .

HAPPY NEW YEAR!!

Lisa

P.S.

I learned that copying and pasting from Microsoft Word or other processor into a blog post can cause HTML problems. I use Microsoft Word and apparently it can add unnecessary characters that Feedburner does not like.  For my size problem, I added a parameter of (1) to my Original Feed Address. That should limit the amount of posts in the feed to only one.  For the Microsoft Word text pasting problem, I typed this post directly into my blog. The rest I will (try) copy and paste into Notepad to clean-up the HTML problems and then place back into my blog. I have also "pinged" it in order to update the feed.

If anyone has experience with this situation, please leave a comment below. I don't think my problems are resolved and may never be with my limited knowledge.

This has turned into quite a pain.

It would help me a lot for any subscribers to leave a comment below to let me know you did receive this in your inbox or send me an email located in the "contact me" page above.

Thank you!

Inevitable Change/Treatment #42, TDM-1 #25

Living is a continuous chain of events involving change. Luckily, change is not always one enormous chaotic event. Everyday changes can be subtle--a preferable condition don’t you think?  Unless you win a million dollars; that is another issue altogether.

Changes can be good or bad. My platelet changes continue to be not so good. Three weeks ago my platelet count was 106,000 per cubic millimeter. Before my recent blood-work, I figured my count would not be too low because I cut myself with scissors and after applying direct pressure, the bleeding stopped. They were down, though--86,000. Not the number I wanted to see, but a number that was acceptable to continue my treatment with ado-trastuzumab emtansine (Kadcyla/TDM-1).

I continue to do well physically after Cyber-Knife radiation to the one remaining tumor in my right lung. Occasionally I feel pain at the bottom of my artificial breast where the radiation was concentrated. The pain may be bone related rather than soft tissue; it is difficult for me to discern.

I saw my wonderful physician’s assistant during my regular infusion appointment. She was involved in the decision for my recent radiation. In my opinion, feeling cared for is probably the most significant part of the patient and medical professional relationship. She definitely meets this criteria by addressing even the smallest of my concerns, cancer related or not.

Back in September, I didn’t receive my scan report so I asked for a copy. Words like “worrisome” and “worsening” are difficult to read. Those words and similar ones from my past have left me trying to regain my balance on this tight-rope of life that I am walking. When I first was made aware of my cancer’s recent progression, I teetered. With radiation given the go-ahead instead of the head shake of “no” that I typically see and hear after my suggested treatment ideas, I recovered. Now, with radiation behind me, I continue to cling to the words my radiation oncologist spoke at our first meeting. His words gave me hope that the opacities seen on the scan are not suspicious for new metastases. I take comfort in believing the radiation continues to change the 13 mm nodule in my right middle lobe into a harmless group of dead cells allowing me to walk balanced and steady on that rope.

February will bring news of what is happening inside my body. My future will again be told. This is the life I lead. Every three months or more, I get a glimpse into my immediate future. The changes may not be noticeable, might be subtle, or might be chaotic. We all experience change, but a cancer patient is constantly reminded that change is happening.

This happened in  August--thank you, Toyota! 
I feel like I have lived in my van for the last 10 years. 
We bought this van just before my first diagnosis with breast cancer.

I am grateful for modern medicine and the people behind the scenes that continue to give me an excellent quality of life. Because of it, I have been able to drive hundreds of miles on North Carolina roadways bringing my children home from college for the holidays. I feel lucky that I can think ahead 6 months and allow myself to imagine witnessing my two oldest daughters graduating in May. Once they graduate, change will once again greet me as my twin daughters make decisions about where in this world they will live and work. 

Yikes! That is a long way away.

Last week we learned my second-born-twin daughter, before she settles into a new job, will experience new sights and sounds with her first airplane ride—that she remembers—and her first travel outside of the USA. After months of preparing, she submitted an essay, an itinerary of cities to visit and cultural events to see all done to win a $9,000 travel-abroad scholarship through the university she attends. A selection committee of 7 interviewed her and made the decision to offer her the opportunity to spend three months in Japan this summer.  We went to the post office a few days ago where she applied for a passport—something I have never done. My academically driven daughter gave up many social pursuits to have a chance for this experience. Her hard work has not always opened doors for her, but because she continues to work hard despite disappointments, she found a door that opened, and she was welcomed through it. (Sort of reminds me of my continuous pursuit of treatment options not considered by my doctor. My recent suggestion, radiation, was one of those options she had not considered.) My daughter’s award brings new excitement and fear within me—Japan is 14 hours away by plane, approximately 7,000 miles from home. If she needs me, I can’t jump in my van and be there in hours. My precious baby’s face that I continue to see from 21 years ago, is no longer a baby. I will put her on an airplane and while she is gone, I will have trouble falling asleep, but I know it is a trip she must take. She will return changed; I will be changed as well. When I gave birth to all of my children, I didn’t consider how profoundly the letting go part of parenting would affect me. It is hard and necessary.

Some change is difficult; some change is not. Some is quick; some is slow. I continue to hope for slow gradual changes in my life. That kind is best. Like a child growing-up, it may feel like it happened over-night, but it didn’t—it was slow and steady.

Flipping for Fifty-One

In 1984, I was a cheerleader for the University of NC at Charlotte. That is me in the picture on the right. I loved to flip and perform. I can't flip like I did all those years ago, but I can still remember how it felt; it was awesome. Today I am flipping in my head because I turned 51 years old! Two and 1/2 years ago I didn't think I would make it to 51, but here I am.

Rain fell from the sky, but I didn't care. It was a good day anyway. My daughter and I stayed indoors. We home-schooled, played with her parakeets, and enjoyed our time together.

On the 18th--Wednesday--I finished radiation. I have had occasional pain where the radiation was concentrated at the bottom of my right artificial breast. Overall, radiation was very easy with little to no side-effects--at least so far. On Monday, I will start TDM-1 again. That will be my 41st treatment for stage IV disease and the 24th with TDM-1.

A scan will be done in February. Of course I worry about the length of time I was not treated systemically while having radiation. Despite the worry, I will continue to feel happiness that I get to continue treatment with TDM-1.

 

Respecting Life Gone Missing

Because of what has happened in Paris, France, I am sharing a link to the map below. It offers much to think about. With all the good that can come from religiosity, the bad is great as well. People are cruel to one another in so many ways. The incomprehensible evil that has happened in human history is often related to the want of land and power disguised and promoted by a religion. The solutions offered by others to stop these self-righteous acts of violence in our world are--at best--temporary and involves the killing of more people including the innocent. All of it is sad and disgusting.

Click here to view animated map.

 By the way--I am annoyed at the media's calling this event a "cancer metastasizing". There is a huge difference between the spread of cancer and the spread ideas. Cancer cannot think. People can.
Maybe my feelings about this are tied to my feelings about the battle language in cancer. It feels wrong to me.

Me and the Machine

Collimater--the EYE of the machine
All images from: Bing Images
There are only Seven Cyber-Knife Machines in North Carolina.
 

On a recent Thursday in my life, I took a ride in a wheelchair through the basement level of the hospital where I receive treatments for my disease. I can walk, but because of hospital safety rules I rode. Through hall after hall, a young woman pushed me. The rhythmic tapping of her shoes allowed me to feel the passing of each of the 360 seconds that it took to reach the room for my turn with the life extending Cyber-Knife machine.

Light beige walls, polished floors, a black phone and a red one decorating a few otherwise empty walls were added to my memories of what it is like to be a cancer patient. With every change in direction, I saw another hallway. I passed rooms with closed doors, rooms with open doors. Quick glimpses allowed me to see other people sitting, waiting. I was struck by how odd the eeriness of each quiet hallway felt. It made me question whether I was riding toward the extension of my life or toward my departure from it.

I wished I would have been allowed to walk. It would have helped distract my thoughts away from the unknown before me; it would have lessened my fear about what was happening inside my body. With no systemic treatment since September 8th, I was feeling completely vulnerable to my tiny monsters. Thankfully, TDM-1 has a long half-life meaning it continues to stay active in the body for weeks after treatment.

My chair ride came to a stop momentarily inside a narrow room. To my left were several computer monitors. In a split-screen format, one of the monitors provided a view into another room. That room held my future with this disease. After giving my name and date of birth, the woman pushed me farther out of this room and into the other. Before me, in a room with no windows, was the Cyber-Knife machine.

I arose from the chair and was dressed in a special vest that would soon have probes attached to it to monitor my breathing. After placing myself in a vertical position on the table in the middle of this room, nestling into the mold made especially for me, I was told not to move at all--don’t scratch, don’t wiggle, stay-put. The two technicians soon departed leaving me alone. Now, it was just me and the machine.

In the quietness of the room, I had only my brain to entertain me. I added more memories to my on-going story as I took surveillance of the room. My sight was limited since I wasn’t supposed to turn my head. Despite this, I managed to see the machines important in this treatment.  Near the ceiling, two cameras were attached, one in front of me, the other to my right. Those allowed the technicians to view me and the objects in the room. A red beam of light painted the ceiling perpendicular to my body. It extended between two ceiling-mounted machines. Those were the x-ray machines. Every 60 seconds a picture would be taken to keep track of the four gold fiducial markers inside and surrounding my tumor ensuring the Cyber-Knife machine sends radiation to the desired location.

My study of the room was soon interrupted by a clicking noise. The machine was coming to life.  I followed the robotic arm as it moved the emission head up, down, sideways, closer to and farther away from my body. The machine located every physicist directed and computer calculated angle as it prepared to shoot the light beams into my tumor. Luckily, my healthy tissue radiation exposure would be limited; the greatest concentration of radiation would occur where each beam crisscrossed all others.

The emission head housed a metal attachment called a collimater. The tiny orifice in its middle measured 15 millimeters. I know that because of the carved out number with the mm beside it. Later a different collimater with an orifice of 10 mm would replace the existing one. Those holes determined the size of the photon beam penetrating my body. I learned from one of the technicians that--in my case--two were used so every area of the tumor was radiated. Let me take a moment to explain by using this example: Pretend my tumor is a golf ball. The larger sized beam stamps a 15 mm diameter sized beam all over the outside. As you know, when four circles are pushed beside one another there is a place in the center that remains untouched. That is why a second beam is needed. The machine shoots those beams at all the places around the golf ball untouched by the first beam.

I watched as the tiny black hole moved around my chest. The movements would end abruptly and then ever so slightly continue to move correcting its position as I breathed. A high-pitched humming noise let me know the machine was fully prepared to begin shooting invisible x-rays through my tumor’s cells causing their demise. It was a weird and wonderful at the same time.

What is actually happening in my body during this treatment is interesting. I have done a lot of reading and had a conversation with one of the technicians handling my treatment in an effort to grasp the simplified version of how this process works. The more detailed version involves quantum physics. I will not venture there. If I get something wrong, please let me know in the comments.

Bing Image below

Photons are light particles that make-up different electromagnetic waves. In my case, x-rays are used. These waves are long enough to penetrate my tissue and reach my tumor. The photon particles are energized inside the linear accelerator at the end of the Cyber-Knife’s robotic arm. These highly-charged particles penetrate each cell in the path of the beam—the good and bad ones. Once inside, they change the atoms within the cell by taking away one of their electrons. This creates an ion. That is why it is called ionizing radiation. The chemistry change of the atoms disrupts cellular function. It destroys proteins and damages the DNA of the cells. As the cell continues through the phases of rest, growth, and division, it is halted at the division phase and the cell dies--apoptosis. That is why this treatment continues to work weeks and months after completion. I don’t have to tell you how good that is for the patient.

Initially, after treatment, I felt no pain. But after the second session when I breathed deeply or when I attempted to sleep on my right side, it hurt. In the morning I felt no more pain only tightness around the radiation site.The evenings after the rest of the treatments, I experienced pain only when I laughed. It, too, was gone by the morning.

There were a total of five treatments (fractionated-a lower dose at each treatment) altogether. My last one was yesterday. I feel like I am radioactive and a danger to my family. I asked about that and was told not to worry.

The last few weeks I have spent considerable time driving east and west on I-40. It will be good to get back to the routine I have grown accustomed to of infusions every three weeks. For now, my encounter with the machine has reached the end.

On Monday, I will begin treatment again with TDM-1. On that day I will be told when my next scan will occur. Until then I will continue to remain hopeful that this treatment will get my condition back to “no evidence of active disease”.

Note: I asked how it is determined if future cancers were caused by the radiation a person received. The answer was not as easy as I anticipated thinking there would be a cellular identifier in the cancer indicating its type. Apparently, it is not always completely clear if the cancers are caused by the radiation. But, cancers that occur years (10-15) after radiation in the position where the radiation occurred are considered a result of radiation. Typically radiation is avoided in young children because their life expectancy is far longer than someone of my age. At my age and diagnosis, it is definitely a risk worth taking.