What is cancer?
I’m a nerd. I love to learn about new and interesting things. I get it from my dad I suppose. On family vacations, he and I always stop at each of the marker signs at a point-of-interest and read the whole thing.
Mark and I have learned so much about what cancer is and how it grows and spreads. One of the most significant things we’ve learned is how many different types/subtypes there are and how they all react differently to treatment. I’m hesitant to post here about the science behind cancer because it’s difficult to explain, and I know I will not be 100% accurate, but I’ll explain my understanding with the caveat that this is only my understanding and not to be taken as gospel truth.
Cancer is amazingly fascinating and horrifying at the same time. The body’s gene sequence basically forgets how to manage cell growth, division, and death. Healthy cells will normally grow, divide, perhaps rest, perhaps stop growing, and eventually will die. With cancerous cells, the body (one or more genes) fails or forgets how to instruct cells on proper life-cycle activity. These cells can grow at accelerated rates and then refuse to die when they should. That’s it. That’s cancer. Eventually, those malignant cells find a hospitable source to make a home, say fatty tissue in the breast, and they congregate there. That’s a tumor. The cancer cells might then spread through the blood stream to other hospitable environments in the body such as lymph nodes (near metastasis) or other vital organs (distant metastasis). Once distant metastases has been reached, breast cancer is incurable.
There are so many types of cancer. Each has unique characteristics and to be honest, I haven’t spent much time looking up information about the different types. I’ve focused on breast cancer types naturally.
Breast cancers are defined as one of the following subtypes: ER positive, PR Positive, HER2 Positive, or Triple Negative/Triple Positive
ER ( endocrine receptor) is hormone estrogen driven. It is common in older women, and it is the most common type of breast cancer overall.
ER/PR (progesterone receptor) is another category where cancer is driven by progesterone. Both ER and PR (ER/PR) have a good chance of responding to endocrine therapies.
HER2 is a protein-driven cancer which makes up about ¼ of all breast cancers. It can be more aggressive but there are focused treatments which can target those cells very well. There seem to be many promising advances in the treatment of HER2 cancers.
Unfortunately, sometimes breast cancer is neither ER, PR, nor HER2 and this type is called Triple Negative since it fails to be identified as any from that trio. Occasionally, breast cancer can be identified as expressing all three, and that is called triple positive. I have triple negative breast cancer (TNBC). All of these different types react differently to the various forms of chemotherapy/drugs which exist. Also, two people with the exact same type of cancer might have different responses to identical treatments. That’s why it’s so difficult to find a cure. There are so many different types of cancer and so many different reactions to the therapy.
Triple Negative breast cancer sucks because it’s difficult to target those cancer cells, and it is often fast-growing. Women typically have a poor prognosis when diagnosed with TNBC.
Treatable vs Curable
Many cancers are curable. If they are found soon enough, they can be treated and surgery can be performed to remove the tumor(s). Radiation regimens and then chemo follow-up helps ensure all of the cancer cells are destroyed. If that goes well, many people can go on to live full, normal lives free from cancer.
Unfortunately, some cancers can’t be cured. I don’t know the science behind it all, but I know that metastatic breast cancer can’t be cured through modern medicine, surgery, chemo, or radiation. It can be treated and “held off”, but it can’t be cured.
Stages of Cancer
From the day I was diagnosed, it was already stage IV. Stage 0 cancer means there is cancer in one localized area with no spreading. Stage I means that the tumor has spread to nearby tissue surrounding the tumor. Stages II & III mean the cancer has spread to deeper tissue and to lymph nodes. Stage IV cancer means the cancer has spread to other organs or body parts. Stage IV breast cancer is incurable. The initial diagnosis by stages never changes. So if a person was first diagnosed with a stage I cancer but the cancer returned years later and other organs had cancer cells in them, it would still be Stage I cancer but “with metastases” would be added to the stage 1 cancer diagnosis. The new information regarding the cancer is simply added on to the diagnosis. The staging of cancer is significant, and the type of breast cancer I have (the fact that it is an unknown kind) makes my diagnosis quite harsh.
This is where I have to say I have experienced a small amount of frustration as a woman with an incurable cancer. Inevitably, people try to encourage me by telling me about a friend or relative of theirs who had cancer (not triple negative breast cancer and not metastatic and incurable) but they were cured and are now doing well. It’s strange to say it like this, but that actually only serves to discourage me. It shows a lack of understanding of my situation by the person telling me the story. My story won’t end that way unless God reaches in and performs a miracle. I hope that doesn’t sound too harsh, but it’s true. Survival stories are wonderful, but it makes me feel like I have a different disease altogether. I love when friends encourage me, and like I said, this is just a small form of frustration. I’ve learned from these experiences that I can often be more encouraging to my friends by simply telling them that I don’t have words to encourage them, but that I am sorry they are experiencing it, that I am with them, and that I am praying for them. Empathy is just the best way to relate to someone with cancer.
This is also the reason Mark stopped participating in message boards in the cancer community. It was as if everyone on there had a lesser severity of cancer, and they couldn’t relate to Mark who was looking to basically communicate (commiserate?) with others in the same situation. He loves to speak with our oncologist because it often seems like that Dr is the only one who truly gets us, and that somehow makes it feel like he is with us. That’s another reason it’s so important to find an oncologist who not only presents a good treatment plan but to find one who also relates well personally. Meetings with our oncologist have at times made us feel calmer; it’s therapeutic to be able to talk to someone who fully understands (more than we do I suppose).