Friday, October 2, 2015

The "R-Words" in Cancer

Long before I was ever diagnosed with the big C, I rode along the congratulatory wave whenever in the presence of someone declared "In Remission."  

I didn't really know what it meant, except that it was good, and that commonly, after a number of years "In Remission" a cancer patient could call themselves cancer-free.  They could also resume normal living, recover from treatments, and reside in the general hope that they would remain in remission and their cancer battle was one they could proudly refer to as having been in their courageous past.  

I have yet to hear any of my oncological team say that word, in reference to myself or to anyone we have spoken about.  I don't know if it's an 80's term?  Or one for cancers other than melanoma?  Or a fictional definition?  

It can't be fictional or old-fashioned, because I have several cancer friends and family members who have been officially titled In Remission.  For years in fact, and recently!  
My vision-of-beauty breast-cancer Survivor Auntie for example, and my world-traveling Gramma who is surviving not one but two diagnoses! My Uncle too. And my local friend who battled a brutally complicated tumor and has worked incredibly hard to recover and create her new normal.  I even met a friend in a support group in the winter who is battling her FOURTH primary.  That means four different cancers throughout her life, and she is still fighting.

All very inspiring people who have every right to be proud of their accomplishments and bravely continue their fight every day.  I look up to them, and I admire them, as I do all of the cancer friends I have met along this journey, whatever stage or phase they may be at.  

I envy them as well.  I want to be In Remission.

In my experience, I am consistently informed of another R-word in cancer: Recurrence.  I have written this word in passing several times, but until now have not really explained it.  

I remember thinking a few years ago when a friend was explaining details of his wife's cancer that I couldn't possibly ever understand the kind of stuff he was talking about, the words and phrases and percentages and what it all meant!?  But now I throw these words around without taking into consideration that those listening to me may wonder what the heck I'm talking about. gave me these definitions:

 Remission (Medicine/Medical):
  • a temporary or permanent decrease or subsidence of manifestations of a disease.
  • a period during which such a decrease or subsidence occurs:  The patient's leukemia was in remission.
  • A period during which symptoms of disease are reduced (partial remission) or disappear (complete remission). With regard to cancer, remission means there is no sign of it on scans or when the doctor examines you.
Recurrence (Medicine/Medical): 
  • A return of symptoms as part of the natural progress of a disease, as in relapsing fever. 
  • Cancer recurrence is defined as the return of cancer after treatment and after a period of time during which the cancer cannot be detected. (The length of time is not clearly defined.) The same cancer may come back where it first started or somewhere else in the body. 
My future is based on my likelihood of recurrence.  I have diagrams drawn by my oncologists depicting what the percentages and statistics say about my two primaries (Papillary Thyroid Cancer and Nodular Melanoma), and I struggle every day to overcome the numbers that seem to be very clear to my medical professionals.  

I am at "Intermediate" risk for recurrence of papillary thyroid cancer, based on the results of my post-radioactive iodine treatment full body nuclear medicine scan in March.  Here is a very informative website re-capping much of what I have described or am experiencing: American Thyroid Association

As for the melanoma?  Not so easy to define, and certainly more depressing.  The reason for the 68-week clinical trial was to try to extend the time before inevitable recurrence of melanoma.  Typically someone in my situation after the node dissection surgery I had in May 2014 is given approximately nine months until the melanoma "returns" or is detected elsewhere in the body.  The pacmen are the best defense at the moment to delay that, by another nine months to a year.  

Thankfully I can report some melanoma patients have a much better story to report than that.  Save Your Skin Foundation founder Kathy was first diagnosed with stage IV malignant melanoma in 2003 and she is still here fighting - and very vocally fighting, I might add.  She had four treatments of the same stuff I had eight doses of, so here's hoping I got the same lot as she did!  I have not heard Kathy use the word Remission, but I have heard her use the word Survivor.  And for much longer than nine months.  

Every three months I await my CT scan reports... remission? or recurrence?

My heart goes out to cancer friends who experience recurrence; I have been thinking of two ladies in particular who very recently have been prescribed places back in the hot seats: CT, MRI, bone scan, Chemo, Radiation, all of those words are back in their daily vocabulary.  It is terrible, and catches one by scary surprise.  

It is this ominous mystery in a cancer patients life that gives them equally the right to celebrate survivorship as it evolves, and to dread the possibility of recurrence.  It is that which defines how the cancer journey molds a previously "normal" person into a completely new being.  


What is metastatic melanoma?

Melanoma a type of skin cancer that forms in the pigment-producing cells of skin, mucosa, eye and rarely other sites. Metastatic melanoma is melanoma that has spread to other sites of the body. The spread occurs through the lymphatic system and/or the blood vessels. Melanoma can spread to the subcutaneous tissue which lies underneath the skin, the lymph nodes, and to other organs such as the lungs, liver, to bone or to the brain.

Metastatic melanoma can be classified into local recurrence, in transit metastasis, nodal metastasis and haematogenous spread.   I am at high-risk for the first three.

Local recurrence of melanoma

Local recurrence is defined as a recurrence of melanoma within 2cm of the surgical scar of a primary melanoma. It can result either from extension of the primary melanoma, or from spread via the lymphatic vessels.

In transit melanoma metastases

In transit metastases are melanoma deposits within the lymphatic vessels more than 2cm from the site of the primary melanoma.

Nodal melanoma metastasis

Nodal metastasis is metastatic melanoma involving the lymph nodes. Every site on the body drains initially to one or two nearby lymph node basins. The lymph nodes first involved are the regional lymph nodes. Usually the involved lymph nodes become enlarged and may be able to be felt.

Haematogenous spread of melanoma

Haematogenous spread is spread of melanoma cells in the blood stream, which can happen either by a tumour invading blood vessels or secondary to lymph node involvement. Once in the blood stream, melanoma cells can travel to distant sites in the body and deposit. It can proliferate in any tissue but most often grows in the lungs, in or under the skin, the liver and brain. Many patients also develop metastases in bone, gastrointestinal tract, heart, pancreas, adrenal glands, kidneys, spleen and thyroid.  


 Article © Natalie Richardson, 2015

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