What is targeted therapy?
Unlike chemotherapy, which kills cells, which are in a similar phase of cell division, good or bad, targeted therapy “targets” specific proteins that are associated with the cancer cell. Some of those targets are Growth receptors (Epidermal Growth Factor Receptors) or EGFR, which then cannot send the growth signal to the interior of the cell. Cancer Cells are dependent on these receptors and enzymes they stimulate, to keep their fires stoked.
What is a bone marrow transplant?
Unlike a regular organ transplant (heart, liver, kidney e.g.) where the diseased organ is removed and replaced by a healthy donor organ, the bone marrow is not one organ. It is the loose tissue in the center of every bone in our body. The outer hard part is the cortex; the marrow occupies the inner hollow. It consists of a loose mesh of blood vessels and a fibrin network, which support “stem” cells, which go on to differentiate into the different cell lines, which go on to be circulating blood cells, which we talked about earlier in “what is a CBC”.
Should I get a second opinion?
In the ideal world, yes.
But it depends on what kind of cancer you have, and what kind of resources are available to you. At the very least, the pathological diagnosis should be confirmed. 2 different pathologists should review the biopsy slides, and if they have any doubt, they should be sent to a 3rd expert to review. The pathological diagnosis is the foundation on which all future decisions are made.
What is a Multidisciplinary Clinic?
Cancer treatment now requires a coordinated treatment plan, which involves surgery, radiation and chemotherapy. A multidisciplinary clinic is an opportunity to meet with all the specialists in one session. They then review all the biopsy findings with the pathologists and the radiological studies (CT scans, MRIs, mammograms, etc) with the radiologist, and recommend a course of action.
What are tumor markers?
They are proteins that are shed by cancer cells in greater numbers than normal cells. These would be desirable as screening tests because blood tests can measure their circulating levels.
None of them have proven their benefit in saving lives due to early diagnosis. Their value lies in measuring response to treatment in advanced cancers, once the cancer has been diagnosed and treated.
How to deal with advice?
When you get a cancer diagnosis, you need time to digest all the information that is being provided. Your life and your emotions have been handed a whopper, and you have to find a way of combating this disease.
Advice from well meaning friends and relatives is a double-edged sword. Obviously they mean well, but I’ve had numerous patients who have been driven to distraction by the advice that is thrown at them: drink this, don’t eat that, I have special tea that boosts your immunity, my aunt had this treatment and did horribly, etc, etc.
Chemotherapy drugs are to cancer cells what antibiotics are to bacteria. They interrupt the cell division process by preventing ongoing duplication of the cellular materials. As the immature cells die, new ones are not able to take their place and tumor growth is stopped. As chemotherapy is delivered in an ongoing fashion, more and more cancer cells are killed off, eventually, hopefully, getting them all.
Clinical trials are a process by which different treatments being evaluated against each other, or a brand new drug, to decide which is the best treatment for that particular disease, for that particular stage.
All current treatments have been selected as the standard of care, because they went through a clinical trial, and were found to be better that what they were being compared against. At any time, patients are offered “current standard of care” or enrollment in a clinical trial, to see if something better is out there.
What is Performance Status?
It is a score of a person’s Functional State. There are two commonly used scales.
The Karnofsky scale which goes from 0 to 100, where the person who is completely asymptomatic and fully functional scores a 100, and loses points for the onset of pain, mobility, weakness, or other difficulties, which lead to an impairment of function.
What is the goal of treatment?
In the ideal world we want to cure everybody. But in today’s real world we cannot. So we have to define goals that can be realistically achieved.
I would have liked to hit tennis balls like Federer or Nadal, run marathons, sing like Beyonce, or dance like Michael Jackson, but sadly, I could not. I had to deal with the reality of my limitations.
Additional tests you will see on the Pathology report:
Grade: describes the activity of the nucleus. A normal cell has normal activity of the nucleus. A cancer cell nucleus looks different. A grade 1 nucleus is less in disarray than a Grade 3 nucleus. The higher the grade, the worse the cell behaves.
Differentiation: is a measurement of how closely the cancer cell resembles the parent cell or the cell of origin.
Cancer Staging:
The next step is to stage the disease. The classical way of staging the disease depends on T (tumor size) N (number of lymph nodes involved with cancer) and M (presence of distant disease). This TNM classification provides the basis of the staging system. The bigger the T, the greater the number of involved lymph nodes, the presence of metastatic disease increases the stage from the lowest (and best) of 1 to the highest (worst) of 4.
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