The Ericksons

Category Archives: Living with Cancer

Blog Posts about Living with Cancer


This post about visiting someone who’s ill is from chapter 3 of my book, Facing Cancer as a Friend: How to Support Someone who Has Cancer,

Here’s what Jesus had to say about it:Reading as a Writer

“Come, you blessed of My Father, inherit the kingdom prepared for you from the foundation of the world: for I was hungry and you gave Me food; I was thirsty and you gave Me drink; I was a stranger and you took Me in; I was naked and you clothed Me; I was sick and you visited Me; I was in prison and you came to Me.” Matthew 25: 34b-361 (New King James Version®. Copyright © 1982 by Thomas Nelson)

Why Visiting someone who’s ill is so important

When someone is ill, especially with cancer, it is easy for them to become isolated and withdrawn. Because they lack energy and are often immune suppressed and/or in pain, they often stay home far more than they used to. That coupled with often insensitive reactions to their illness can lead to feelings of loneliness and depression. This can be even more intensified around the holidays.

Visiting someone who’s ill or their caregiver can make a big impact on the family’s quality of life. It can also help you to see for yourself if there is something more the family needs.

*Anna: A Friend with Multiple Sclerosis

My husband had gone to a breakfast for the men at our church. A man named *George sat next to him. His wife, Anna had Multiple Sclerosis and he’d been trying to get someone from the women’s ministry to go to the nursing home and read the Bible to her on occasion. No one would.

When Dan came home and told me this, I decided that I would visit her weekly. I wasn’t prepared for the experience of visiting someone who’s ill.

My First Visit with Anna

visiting someone who's ill

I walked into her room and saw a beautiful woman, much younger than I had expected, and far more affected by her illness than I’d anticipated. I held it together as I introduced myself to her and then read to her.

After an hour I left and drove right to our church, crying the whole way. We had a pastor who specialized in visiting the homebound. I rushed up to the pastor, crying, and said that I wanted to visit Anna, but I didn’t think I was cut out for it.

He told me that it wouldn’t be as difficult to visit Anna in the future because I would never be as unprepared as I’d been that day. He encouraged me to learn about Multiple Sclerosis in order to better understand what she felt. That would raise my level of empathy while lowering any anxiety I felt about her condition.

Would I Visit Her Again?

The pastor asked me, “When are you going to be visiting Anna again?”

I wanted to say, “Never.”  But,  I’d made a commitment, and I needed to live up to it. “Every Tuesday at 10:30 in the morning.”

“I’ll write that down on my calendar, and each Tuesday while you visit with her, I’ll be praying for you and for her.” This was a good reminder to me to pray before our visits as well.

From then on, I would spend the entire drive to the care center, praying for Anna. I also asked for God to use me to bless her during our time together.

Over the course of the next 2 years, I came to know Anna well. I especially loved her sense of humor. Over those two years, a treasured friendship grew between us.

Once in a while, Anna would have a bad day, and it was difficult to see her hurting, but I took solace in the fact that when I was there, she didn’t have to hurt alone.

Takig care of yourself as a caregiver

During Visits:

  • When visiting someone who’s ill, remember the cardinal rule: Ask permission.
  • Schedule visits at times other than weekends or holidays when others may visit. Before my first visit with Anna, her husband and I decided on a day and time that would accommodate my schedule, family members’ visits, and the care center’s schedule.
  • Always call or text before your scheduled visit, to make sure that your friend is still feeling up for company. Be understanding if your friend can’t see you at that time. Again, make it clear that saying no is perfectly fine.
  • Assure him/her that if they need to reschedule, it’s okay.
  • Set a time limit for visits and phone calls before you begin. That way, you won’t wear your friend out. When in doubt, stick to 15 minutes.  Fifteen minutes can really brighten the day of a cancer patient.
  • Most cancer treatments cause fatigue. Concentrating on a conversation for an extended period of time can be difficult for patients. Be sensitive to this and when possible, keep visits one on one.

*I’ve changed these names to protect privacy.

About Heather Erickson

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with

Cover for Facing Cancer as a Friend

stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone who Has Cancer, is available on Amazon.com

The Erickson Family, August 2016. Photo By Jim Bovin

Undifferentiated, A Definition (1)

A term used to describe cells or tissues that do not have specialized (“mature”) structures or functions. Undifferentiated cancer cells often grow and spread quickly.

This is a somewhat scientific post. Keep reading because it’s very interesting.

Tumor grade is different than cancer stage.

After the doctor biopsies, suspicious tissue, he or she sends it to a pathologist. The pathologist then determines whether the tissue is malignant. Furthermore, they can tell what kind of cancer it is, as well as what the tumor’s stage is. Your doctor may also ask the pathologist to also check for specific mutations which can be treated using targeted treatments.

When a pathologist looks at the cancerous tissue under a microscope, they assign a tumor grade. This is based on how similar the tumor cells and the tissue are to normal, healthy cells. They call tumor cells that are more like healthy cells, “well differentiated.” They call more abnormal the cells, “undifferentiated.” This is important because, in undifferentiated cancer, the cells are immature. In addition, undifferentiated tumors are likely to grow and spread quickly.

Making the Grade

There are several ways to grade tumors, This is a popular method. Pathologists give tumors a grade of 1, 2, 3, or 4. The lower the number is, the more normal the cells and the organization of the tumor appears. Grade 3 and 4 tumors grow rapidly, dividing and spreading faster than tumors in grades 1 and 2. (2)

  • GX: Grade cannot be assessed (undetermined grade)
  • G1: Well differentiated (low grade)
  • G2: Moderately differentiated (intermediate grade)
  • G3: Poorly differentiated (high grade)
  • G4: Undifferentiated (high grade)

It’s important for doctors to know a patient’s health history, the stage of their cancer, and the tumor grade to determine a patient’s prognosis and put together a treatment plan.

Sinonasal undifferentiated carcinoma – high magnification By Nephron – Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=21382293

To Know or Not to Know

Patients sometimes get upset that their doctor has given them a poor prognosis based on the cancer being advanced and their tumor(s) being undifferentiated. You can tell your doctor at the outset, how much information you are comfortable hearing about your cancer. Tell your doctor if you don’t wish to be given certain details about your cancer. They will usually take care to honor that. Doctors base these predictions on statistics as well as their years of experience. Still, they are statistics. A patient is not a statistic. At the same time, a prognosis can be extremely valuable in making treatment decisions as well as end of life planning.

Our Story

Early on, we saw the word, “undifferentiated” on countless reports over the past four and a half years. What did it mean? Undifferentiated almost sounds okay. It sounds like it’s not clear, so maybe it’s not that serious. We found out how wrong we were in November of 2015 when Dan began to have a hard time breathing. He coughed whenever he tried to talk or take a deep breath, due to undifferentiated cancer filling his lungs. Radiologists call this “ground glass,” because it looks like ground glass on scans.

I have a picture of one CT scan that shows the comparison. His cancer was so aggressive that when we wanted a couple of weeks to try one treatment and then change if it wasn’t working, the doctor said, “You don’t have two weeks.” Therefore, we treated aggressively. It saved his life.  Read more HERE.

Undifferentiated cancer
The x-ray on the right shows the rapid increase in cancer in Dan’s lungs.

Everyone has their own way of coping with their cancer. Ours has been to learn as much as possible, trust Dan’s medical team, and pray, pray, pray.

Footnotes:

  1. National Cancer Institute, NCI Dictionary of Terms, Undifferentiated
  2. National Cancer Institute, Diagnosis and Staging, Prognosis, Tumor Grade

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. My husband, Dan has battled stage IV lung cancer since 2012. I help cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com.

The Erickson Family, August 2016. Photo By Jim Bovin

 


Not that long ago, cancer treatments were synonymous with losing your hair and suffering from nausea and vomiting. Now with the advancements in cancer research, it’s not uncommon for patients to go complete a treatment regimen without either of these issues.  One of these advancements is targeted therapy, also called targeted treatments. Targeted treatments “target” specific genes or proteins found in cancer cells These genes and proteins are related to cancer growth.

Many different types of cells make up the tissues in your body, from your bones to your skin. Cancer cells are created when specific genes in healthy cells mutate or change. To learn more about how cancer cells are made, check out my post, C is for Cancer Cells.

What is a Targeted Treatment?Drug Resistant

Your genes tell your cells how to make the proteins that keep your cells working. What happens if your genes change, or mutate? The proteins will change, too. This is when you get cancer cells growing and spreading out of control. Like zombies, they don’t know when to die.

Targeted treatments “target” the mutations like a zombie killer. They try to normalize the cell growth by turning off signals that tell the cancer cell to grow or divide. This keeps the cells from living longer than normal and soon, they die the death they were meant to.

Traditional Chemotherapy Vs. Targeted Treatments

Traditional chemotherapy takes the carpet bomber approach. It blasts all the rapidly dividing cells in a patient. While it’s effective at killing cancer cells (since they are rapid dividers), it also kills healthy, rapidly dividing cells like hair, nails, skin, and mucous membranes. This leads to the classic chemotherapy side effects like nausea and hair loss. Targeted treatments attempt to treat cancer while sparing healthy cells.

Chemotherapy resistance

Small-Molecule Drugs

One type of targeted treatment is small-molecule drugs. These treatments are typically taken orally in the form of a pill. One example of a small molecule drug is angiogenesis inhibitors. This type of treatment prevents the formation of blood vessels around a tumor. This cuts off the supply line of nutrients to the cancer cells, essentially starving them.

Finding a Match

Different types of tumors have their own unique genetic mutations. It’s important to have the biopsy tissue sent to a lab for molecular testing to find out if you are a match for one of the known mutations. Not all cancers have a known match, suitable for targeted treatments. This is still cutting-edge medicine. Researchers continue to isolate new mutations and develop drugs to treat them.

Cancer.Net has a comprehensive guide that you can use to see some of the latest information about a specific cancer and known targeted treatments. Look up the specific cancer, and then click on the link for “Treatment Options.”

changes in cancer treatments

Monoclonal Antibodies

Another type of targeted therapy, called monoclonal antibody therapy, is a form of immunotherapy. It binds to certain cells or proteins outside of the cancer cell. Often the idea is to get the immune system to see the cancer cells that so often elude it. These drugs are usually given intravenously as an infusion. They are also often used in conjunction with traditional chemotherapy or radiation. It has been used in a variety of diseases including rheumatoid arthritis. You can spot this kind of therapy by the “mab” at the end of its name.  For example, nivolumab, also known by the brand name, Opdivo. Researchers are still learning why these therapies work well for some diseases and not for others and why they work well in some patients while having no effect on others.

 

Side Effects

Some people assume that immunotherapy is natural or that targeted treatments don’t have side effects. These treatments are still drugs and they do still have side effects, sometimes even serious ones. If you are a good match for one of these treatments, they can be a valuable weapon in your arsenal against cancer.

Our Story

When Dan’s oncologist first diagnosed him, she sent his biopsy sample to a special lab in California where they checked it for the most likely mutation, EGFR (epidermal growth factor receptor). The results said he was positive for this mutation. He was on and EGFR inhibitor called Tarceva for 18 months before it stopped working. After a time, the mutated cells that the Tarceva was fighting would mutate again in order to avoid getting eradicated. Think of it like the zombies in the video games that keep coming back with new strengths. While it had its own side effects, it greatly improved his quality of life and extended it.

He tried various more traditional treatments with different degrees of success. Each time we learned a treatment wasn’t working, we would try another one. Then he was put on Nivolumab. That treatment wasn’t right for Dan at all.

He was ready for hospice when a drug called Tagrisso was released by the FDA early. Tagrisso was a new generation of targeted treatment that went after the Tarceva resistant mutation. It was amazing how well it worked. Dan has been taking this drug for 15 months, now. It’s been effective, with very little side effects.

Initially, Dan was given a prognosis of 6 months to live. Thankfully, with both traditional and targeted treatments, and a lot of answered prayer, he will reach 5-year survival in October 1017. That’s a miracle for a stage IV lung cancer patient.

About Heather Erickson

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

The Erickson Family, August 2016. Photo By Jim Bovin

When someone is being treated for cancer, they will work with a team of medical professionals in the oncology department. This team approach ensures you get the best medical care possible. Who are some of the people on a care team?

Receptionist/Appointment Specialist

This will be the first person you talk to at the cancer center. They take your insurance information as well as your co-pay. When your appointment is done, they will make upcoming appointments that your doctor has ordered. These may include lab work, imaging, and future oncology appointments.

Lab Technician

The lab technician will take your blood, or urine and run any necessary tests on it.  If they are taking blood, they may access your port to do this. The results let your oncologist know a lot about your health. They can see whether you have signs of being immunocompromised. They can detect anemia and other issues such as low protein or magnesium levels. From this information, your doctor can make recommendations, including whether you will receive your treatment that day.

changes in cancer treatments

Care Coordinator/Patient Navigator

This may be a nurse, a social worker, or even a volunteer. He or she will be your “go-to” person. They will likely be one of the first people you will meet in the oncology department. Your care coordinator will learn as much as they can about you, your family, and your health. He/she will Find out what your needs are and then connect you to other people who can help with specific concerns. They may help you find financial resources, counseling and support services.

Our care coordinator’s name was Anne. She was so compassionate as she listened to our story. She even cried. Her kindness touched our hearts. We knew then, that to her, we were more than names on a chart. We were people with lives in the balance. When she learned that we had three young children at home, she told us about the Angel Foundation, a resource that helps families with a parent who has cancer.

Oncologistshortness of breath

Your oncologist is the person who pulls everything together. He or she had a goal of helping you live long and well. Communicating well with your oncology doctor. He or she will do their best to help you achieve your goals.

Palliative Care Specialist

This may be a doctor, a nurse, or a physician assistant. The palliative care specialist works with other members of your oncology care team to treat and symptoms of your cancer and side effects of its treatment. They are especially skilled at pain control.

Oncology/Infusion Nurse

visiting someone who's illAsks intake questions about how you’ve been feeling since your last visit. It’s very important to tell him/her about any symptoms you’ve experienced, especially any changes. You will be asked to rate your pain on a scale from 1-10. Be honest about your pain so your care team can address it properly.

Tell the nurse about any changes in the medication you’ve been taking as well as any side effects you’ve experienced. Don’t forget about over the counter drugs. Something as simple as antacid can have interactions with your cancer medications. The medications you are taking also give your doctor clues as to your overall health. For example, if you are taking more pain medications than usual, it may indicate increased pain or the need to change to a more effective pain medication.

An infusion nurse will access your port, which is no easy feat, and they’ll administer chemotherapy. Nurses are trained to watch for side effects and other changes in a patient. I have great admiration for oncology nurses.

Physician Assistant

Physician Assistants do much of the same work that doctors do. In fact, it isn’t uncommon for people to think that a PA is an MD.  Often they will alternate appointments. This gives a patient another set of eyes to assess their health. It also allows the oncologist to see more patients without getting burned out. If you need an unexpected, last minute, appointment, it’s usually easier to get one with a physician assistant.

Every 3 months my husband gets a CT scan. A few days later, he sees his oncologist to talk about the scan results. The two monthly appointments in between scans, he sees a physician assistant. In his case, the PA is also a palliative care specialist. This is particularly helpful because he has a lot of pain.

Oncology Pharmacist

Oncology pharmacists are pharmacists who specialize in medications used to treat cancer. They understand how various drugs interact with one another as well as how to deal with the side effects of your cancer treatment. Oncology pharmacists regularly talk with patients about their treatment. They educate patients and caregivers about the cancer treatment and answer any questions they may have about their medications.

Chaplain

The chaplain in the cancer center does more than meets the eye. He or she is available to talk with patients Chaplain for Hospice and Palliative Careand their family about spiritual matters. Having cancer makes faith a priority, even for people who haven’t given it much thought before. Chaplains who work in cancer centers are very good at supporting people when they are faced with life and death matters.

They not only serve the patients directly but also give council to the doctors and nurses who work in one of the most difficult medical fields. They are available to pray with patients and staff alike. Even though they will have a particular faith background, they are a valuable spiritual resource for patients and families from all faith traditions (or no faith tradition at all).

Oncology Social Worker

An oncology social worker is an expert in helping patients cope with life as a cancer patient. They can also help caregivers and the patient’s children. They can tell you about appropriate support groups as well as financial resources. If you have a non-medical question about living with cancer, an oncology social worker is a person you will want to talk to.

Family Care ConferencePsychiatrists in the Oncology Center

Living with cancer takes a tremendous toll on a patient, not only physically, but also emotionally and psychologically. Psychiatrists in the oncology center help patients with stress management, cognitive behavior therapy, pain management techniques, and counseling to maximize the quality of life for the patient and his or her loved ones.

 

Hematologist-Oncologist

This is a physician who specializes in the diagnosis and treatment of blood diseases including leukemia, lymphoma, hemophilia, anemia, and sickle cell disease. Your oncologist may also refer you to a hematologist if the effects of your cancer treatment are adversely affecting your blood health.

Pathologist

You’ll probably never meet your pathologist, but they are an essential part of your oncology care team. Pathologists are doctors. They are the people who look at cells, tissue, and organs, that are biopsied to determine whether a patient has cancer. Pathologists make the final diagnosis of cancer. They also look for mutations that impact what type of treatment a patient is given.

Registered Dietitian

While a lot of people tell their family and friends how they should and shouldn’t eat, a registered dietitian makes nutritional recommendations to patients based on science and the patient’s individual needs.

One of the first appointments Dan had after being diagnosed with cancer was with the dietitian who worked with the oncology department. She dispelled the myths of cancer nutrition and told us the hard facts. (1) 20% of people who die of cancer actually die of malnutrition. (2) She told us that best predictor of survival was maintaining or gaining weight. “If you feel like eating a Cinnabon, eat a Cinnabon,” she said. This ran contrary to what we had heard from a lot of people. She explained nutrition from the perspective of oncology. She said that Dan needed to concentrate on two things. He needed to keep his calories up and eat twice as much protein. That advice has served him well.

Radiologist

Image courtesy of stockimages at FreeDigitalPhotos.net

Radiologists are doctors who specialize in reading z-rays, scan, and other imaging technology. They help in the diagnosis process. You will have regular imaging throughout your cancer treatment, as well as follow-up scans to make sure you are still cancer free. The radiologist will read all those scans. Even though the radiologist is an important part of your oncology team, you will likely never meet him or her.

There is one exception. Interventional radiologists perform non-surgical minimally-invasive image-guided procedures. When my husband had the Gamma Knife procedure done to remove a brain metastasis, there was a radiologist as part of the team and we met him.

Physical/Occupational Therapists

These amazing people help cancer patients live as normally as possible. They teach you how to regain strength, balance, and skills that cancer may have tried to steal. They help with everything from therapeutic exercise to using tools that make life easier.

Dermatologist

Chemotherapy and radiation often have adverse effects on a patient’s skin. EGFR targeted therapies cause rashes and skin eruptions. Dermatologists will assess and treat these side effects. They also make recommendations for skin care in survivorship. In a survey of cancer patients, 84% said they had never been referred to a dermatologist and over half would have felt better if they had been. (3)

Surgeon

Before modern medicine, surgery was the only cancer treatment that had a chance of success. Surgeons work with your oncologist in a variety of ways. They often take tissue sample for biopsies. They help diagnose and stage cancer. Surgeons help treat cancer when surgery is an option.

These are just some of the people who are part of your oncology team. There are so many people who affect your experience as a cancer patient. Often these team members overlap in what they do. They work together to give you the best, most complete care possible.

I am grateful to the people who have been a part of Dan’s care team over the years. They are special people who have always made us feel like he is in good hands.

Footnotes:

  1. http://www.cancercenter.com/community/nutritional-support/tab/preventing-malnutrition/
  2. http://www.nbcnews.com/id/30812433/ns/health-cancer/t/push-fight-malnutrition-cancer-patients/
  3. http://www.mdmag.com/contributor/beth-mclellan-md-/2015/07/5-ways-oncologists-and-dermatologists-can-work-together-to-improve-cancer-care-

 

About Heather Erickson

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, in spite of their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

Speaker

 

 

 

 


Today’s blog is about metastasis in cancer.

We learned in C is for Cancer Cells that one of the reasons that cancer is such a deadly disease is its ability to metastasize, or spread from one part of the body to another. Depending on what kind of cancer the patient has, this, most serious form of cancer is known as “metastatic,” or “stage IV.”

Metastasis
By Jane Hurd (Illustrator) – This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 2446 (image) (next). Public Domain, https://commons.wikimedia.org/w/index.php?curid=24060422

How Cancer Metastasizes

The place where cancer first develops is called the primary tumor site.

From there, cancer spreads locally, invading nearby healthy tissue.

If too much time passes between the emergence of the primary tumor and treatment or treatment is unsuccessful, cancer cells will break away from the primary tumor site.

They then move through the walls of nearby lymph nodes or blood vessels.

Cancer cells proceed to travel through the patient’s bloodstream or lymphatic system.

They can get lodged in small blood vessels in distant locations, lymph nodes, or other organs. Like when they initially began growing, the cells invade the blood vessel walls and surrounding tissue. New blood vessels to form, providing an abundant blood supply to nourish the tumor as it grows.

After that, they can continue to spread to more distant parts of the body. Most of these cancer cells die along the way, but some continue the invasion and form more new tumors in different parts of the body.

The Same Cancer

Common sites for metastasis
By Mikael Häggström – All imaged used are in the Public Domain, CC0, Link

Even though they’re in a new location, these metastatic tumors are the same type of cancer as the primary

tumor. Doctors can see what kind of cancer the cells are through a microscope when they do a biopsy.

This is important because the treatment options that are most likely to be successful, are dependent on the type of cancer rather than the location of the cancer.

My husband, Dan, has stage IV, metastatic lung cancer. The primary tumor in his lung was very small. Yet, in a short amount of time, it spread to his spine and his lymph nodes. Eventually, it spread to his brain. This is called a brain “met.” The cancer cells in his brain were lung cancer cells, not brain cancer cells.

Sometimes, a patient gets cancer again, months or years after they were treated cancer. Usually, this cancer is the same type of cancer the patient had before. Occasionally, the cancer is a different kind of cancer. This is known as a second primary cancer. Thankfully, second primary cancers are rare, but they do happen.

Where does a metastasis travel?

Most forms of cancer can spread nearly anywhere in the body, but some cancers are more likely to spread to certain locations than others. The following is a table of the most common sites of metastasis (not including the lymph nodes) of various cancers. (1)

Common Sites of Metastasis

Cancer TypeMain Sites of Metastasis
BladderBone, liver, lung
BreastBone, brain, liver, lung
ColonLiver, lung, peritoneum
KidneyAdrenal gland, bone, brain, liver, lung
LungAdrenal gland, bone, brain, liver, other lung
MelanomaBone, brain, liver, lung, skin, muscle
OvaryLiver, lung, peritoneum
PancreasLiver, lung, peritoneum
ProstateAdrenal gland, bone, liver, lung
RectalLiver, lung, peritoneum
StomachLiver, lung, peritoneum
ThyroidBone, liver, lung
UterusBone, liver, lung, peritoneum, vagina

 

What are the symptoms of a metastasis?

Even Metastatic Cancer can be Asymptomatic. Your doctor will be keeping a close eye on you, if you have already been diagnosed with cancer. They will see you in clinic on a regular basis, and order scans at regular intervals.

There are some symptoms to be aware of. Headaches, lack of balance and seizures, are a symptom of a brain met. Shortness of breath is a symptom of metastasis to the lung. Bone metastasis is suspected when there is bone pain. Sometimes they aren’t discovered until there is a fracture. If cancer has metastasized to the liver, the patient’s skin will often become jaundice (yellow) and there may be abdominal swelling.

A Word About Brain Mets…

One of the reasons brain metastasis are common, even when treatment is working for cancer in the rest of the body, is the blood-brain barrier. A semi-permeable membrane that selectively allows nutrients in while protecting the brain from toxins. As far as your brain is concerned, cancer treatments are toxic. Because of that tumors often retreat to the safety of the brain.

Thankfully, doctors have gotten very good at zapping those nasty mets with precision radiation. By keeping a close eye on your cancer and following your treatment plan, you have the best chance of being able to get a metastasis under control.

Footnotes:

  1. National Cancer institute, Metastatic Cancer: Where Cancer Spreads; Common Sites of Metastasis. February 6, 2017.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com.

Speaker

 


The Lymphatic System

Lymphatic System
Blausen.com staff (2014). “Medical gallery of Blausen Medical 2014”. WikiJournal of Medicine 1 (2). DOI:10.15347/wjm/2014.010. ISSN 2002-4436. – Own work

Your lymphatic system is part of your circulatory system AND your immune system. It’s a network of vessels and lymph nodes that make up your body’s drainage system.

These vessels move excess fluid that’s been collected from all over the body back into your blood stream. Once the fluid enters the lymphatic vessels, it is known as “lymph.”

The word Lymph comes from the Latin word lympha, meaning, water.

As these fluids move through the tiny lymph nodes, Harmful organisms and cancer cells are trapped and destroyed by the lymphocytes. Those lymphocytes are then added to the lymph which flows from the nodes, back into the bloodstream.

Unfortunately, the lymphatic system is also notorious for transporting cancer cells around the body, also known as metastasis.

Doctors call it called lymphoma when cancer begins in the lymphatic tissue. Leukemia is related cancer in the bone marrow and blood.

What’s a lymph node?

A lymph node is a small, kidney bean-shaped organs. They contain B and T cells (lymphocytes) which are part of your adaptive immune system. (see Immune System)

Lymph Node
Diagram of a Lymph Node By Cancer Research UK – Original email from CRUK, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=34332684

Lymphadenopathy

It’s called lymphadenopathy when one, or more, of your lymph nodes, become enlarged. This usually happens when you have an infection, or in response to inflammation. When many the enlarged lymph nodes are in different areas of the body, it can be a symptom of a systemic infection like mononucleosis, or inflammation like rheumatoid arthritis. It can also be a sign of or cancer.

Lymph nodes can trap cancer cells, but if they don’t destroy all of them, the nodes can become secondary tumor sites.

Our Story

My husband felt a string of hardened enlarged lymph nodes along his left clavicle. These are supraclavicular lymph nodes. He usually avoided doctors, always thinking whatever ailed him would go away on its own. This time, though, he called and made an appointment immediately. He had stage IV lung cancer. Because doctors diagnosed and treated him as quickly as possible, Dan is still alive today.

If you discover hard, enlarged lymph nodes, get them checked out.

Lymphedema

Sometimes lymph accumulates in a patient’s face or limbs. This is called lymphedema. This is a common problem for cancer patients who have had their lymph nodes removed. Treatment is usually massage and compression sleeves. Thankfully, it’s usually temporary.

The Spleen

Your spleen is basically a giant lymph node. It filters your blood. As it does, it removes old red blood cells, recycles iron, and plays a big role in your immune system, to the point that if you don’t have a spleen, you are far more likely to get certain infections.

The Thymus

Your thymus is also part of the lymphatic system. This is where the T-cells mature.

By the way, if you’ve ever heard the term, “sweetbread,” referring to a culinary delight, they are specifically talking about a calf’s thymus. I’ve never eaten them, but have heard they are delicious.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com.

 

Speaker


What is your immune system?

The immune system is your first line of defense against infections, both viral and bacterial, as well as other diseases. The immune system, which is made up of special cells, proteins, tissues, and organs.

How does it work?

Your immune system works through a series of actions known as the immune response. This response attacks invaders including organisms and substances that attack and your body’s systems and cause illness and disease.

Three Types of Immunity

Blood Cells
One can see red blood cells, several white blood cells including lymphocytes, a monocyte, a neutrophil, and many small disc-shaped platelets. By Bruce Wetzel (photographer). Harry Schaefer (photographer) (Image and description: National Cancer Institute) , via Wikimedia Commons

Adaptive Immunity

This type of immunity is very active, developing throughout our lives as we are exposed to various germs and diseases, as well as when we are vaccinated. Adaptive immunity involved the parts of our immune system that are in our blood.

Most people know that their blood is made of white and red cells. The white blood cells are part of your immune system. They are also known as leukocytes.

There are two basic types of leukocytes:

Phagocytes

Phagocytes are cells that destroy invading organisms. The most common type of phagocyte is the neutrophil. Neutrophils fight bacterial invaders.

Lymphocytes

Lymphocytes are created in the bone marrow. If they stay in the bone marrow to mature, they become B lymphocytes (think B for bone marrow). B lymphocytes produce antibodies.  Antibodies are special proteins that lock onto specific antigens. Antigens are foreign invaders in the body. These antibodies stay in your body, preventing you from getting sick with the same disease in the future. An example of this is the chickenpox. Once you get chickenpox, you usually won’t get it again.

Immunizations utilize this function to prevent certain diseases. Most immunizations are an inactive virus or disease which doesn’t make you sick but still causes your body to produce antibodies, protecting you from getting sick with that disease/illness in the future.

B lymphocytes are great at finding invaders, but they can’t destroy them on their own. They need the help of another type of lymphocyte.

While the B lymphocytes are maturing in the bone marrow, there is another type of lymphocyte that leaves the bone marrow early and head for the thymus gland, where they mature into T lymphocytes (think T for thymus). T lymphocytes destroy the invaders the B lymphocytes have identified. Sometimes, people call T lymphocytes, “killer cells.” Another thing that T lymphocytes do is signal other cells in the immune system, such as phagocytes, to do their job.

Antibodies can neutralize toxins. They can also activate a group of proteins called a complement, which assists in killing viruses, bacteria, and infected cells.

Innate Immunity

Everyone is born with natural immunity. This is known as innate immunity. This type of immunity protects one species from getting illnesses of another. For example, humans don’t get heartworm and Dogs don’t get HIV.

Some of our innate immunity comes from parts of our immune system that form a barrier between us and potential invaders.

One of these barriers is our skin. If you get a cut, the defensive barrier is broken. As the cut heals, you are vulnerable to infection. Thankfully, immune cells on the skin attack invading germs, protecting us.

Mucous membranes are also part of our innate immune system. These gooey barriers to germs and other invaders line our nose, throat and gastrointestinal tract. As you breathe, the mucus membranes that line your nose trap air pollutants. It’s your first line of defense.

Passive Immunity

In the early years of life, we are most vulnerable to infections and viruses because we haven’t yet developed a strong immune system that recognizes and destroys invaders. Thankfully, babies can get antibodies in their mother’s breast milk. These antibodies protect them against many early childhood illnesses and infection.

What if it doesn’t your immune system doesn’t work right?

There are 4 main things that can go wrong with the immune system:

  • Immunodeficiency is when part of the immune system isn’t working properly.

Primary Immunodeficiency is when you are born with the problem.

Acquired (or secondary) immunodeficiency develops later. They can be the result of malnutrition, disease, or medication such as chemotherapy or steroids.

  • Auto immune disorders are when the body’s own immune system attacks its own tissue as if it were a foreign invader. Examples of autoimmune disorders are rheumatoid arthritis and lupus.
  • Allergies happen when the immune system over-reacts to antigens (allergens), producing excess histamine, causing a variety of symptoms ranging from mild itching to life-threatening anaphylaxis. Associated disorders include eczema, allergies to food, environmental allergies, and asthma.
  • Cancers of the immune system include lymphoma and leukemia. Both are common childhood cancers. Thankfully, most cases of these cancers in kids are curable with current treatments. Leukemia involves out of control growth of leukocytes. Lymphoma involves lymphoid tissues. Both cancers weaken the immune system making it harder for the patient’s body to fight off infection.

How does cancer treatment affect your immune system?

Medications like chemotherapy and radiation destroy cancer cells. Unfortunately, they also destroy healthy cells like those found in bone marrow and other parts of the immune system. Patients lose neutrophils, which fight infection-causing bacteria. Doctors call this “neutropenia.”

Immune System
By Volker Brinkmann – (November 2005). “Neutrophil engulfing Bacillus anthracis”. PLoS Pathogens 1 (3): Cover page. DOI:10.1371. Retrieved on 2009-01-04., CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=2107792

Boosting your Immune system

Doctors sometimes give patients non-specific immunotherapies alongside traditional cancer treatments such as chemotherapy and radiation. This improves their overall immune system function.

An example of this is the Neulasta shot which prevents/treats neutropenia. This is a colony-stimulation factor, a man-made form of a protein which stimulates the growth of white blood cells. There are no common side effects of Neulasta. My husband, Dan, experienced one side effect that occurs in less than 30% of patients. The side effect was bone pain. This is caused by the rapid production of white cells in the bone marrow.  It feels like growing pains, only much worse. Dan was in the worst pain of his life.

When someone is in active cancer treatment, they must be more careful about coming into contact with bacteria and viruses. One person’s minor cold can put a cancer patient in the hospital since they are immunocompromised and can’t fight the illness. Cancer patients often decline to shake hands or attend social functions when their immune system is compromised.

Can your immune system fight cancer?

Immunotherapy is one of the most recent developments in cancer treatment. The goal is to stimulate a patient’s immune system, causing it to be more effective in fighting cancer.

Cancer cells grow and spread because the immune system doesn’t recognize them as foreign, Immunotherapies are inactivated forms of cancer cells or proteins that are unique to cancer cells. These are introduced to the patient’s immune system to try to “teach” it to recognize cancer cells and attack them. These therapies aren’t without side effects, and they only work for certain patients with certain cancers. For those patients, immunotherapy can be a powerful; weapon in their cancer battle.

Immunotherapy is opening doors to new ways of fighting cancer. With every new discovery, researchers gain a greater understanding of the enemy we are up against, and the possibilities for eliminating that enemy.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

The Erickson Family, August 2016. Photo By Jim Bovin

One of the questions I get most frequently is how to encourage a cancer patient or caregiver. After all, when we see someone going through something so difficult, it’s natural to want to encourage them–but how? The monster they’re up against seems so immense!

“I Just Don’t Know What to Say.”

It’s difficult to know what to say when a friend or family member’s life is turned upside down cancer. After all, there is nothing you can you say that will change their diagnosis. But you can encourage your friend. What’s important isn’t what you say, but that you care enough to be there and listen.
In fact, “I don’t know what to say,” is the perfect way to let them know that you realize there are no easy answers. It lets them know that you care enough to be there for them through the hard place they are in. And, it’s certainly better than not calling or visiting out of fear or discomfort.

Examples of Helpful Things to Say:

“I’m sorry this has happened to you.” This means more that you may think. In fact, it’s the simplicity of it that helps. There are no expectations or pressures put on the patient. Instead, it simply acknowledges that the situation is terrible and that you care.

“What are you thinking of doing?” Then, don’t question the wisdom of their plan of action. Rather, support it. This shows respect for the patient and their decision-making process. Adding your own opinions would only cause the patient to second guess themselves and the decision they have put so much thought and research into making. Don’t give advice unless asked, and then, be reserved and careful.

“Is there any way that I can I help?” If there is something specific you would like to do, offer. Let them know that you would like to encourage them by doing this.

“I’m thinking about you.” This is especially appropriate in a card or email. Often people assume that the patient has a lot of support, so they don’t want to “bother” them. Unfortunately, many times other friends make the same assumption and the patient has no solid support system. Even if they do have plenty of support, your card will remind them that you, in particular, are thinking about them.

“If you ever feel like talking, I’ll be here to listen.” Even if the patient isn’t ready to talk in the beginning, saying this assures them that if they need a friend to talk to, they can count on you.
(If you are a praying person) “I am going to be praying for you.” Then, remember to actually pray. Better yet, pray for them right then and there, and continue to pray later.

Examples of Unhelpful Things to Say:

“I know just how you feel.” Everyone is different. Even if you have been in a similar situation, saying this demeans what the patient is going through.

“How long do you have?” First of all, Prognosis are wrong all the time. Asking this is validating the hopelessness of the situation, rather than allowing the patient to experience their own level of hope or lack of hope.

“I’m sure you’ll be fine,” “Think positive,” or “You just need to have faith.” While these phrases are often said to encourage the patient, they instead belittle the patient’s fears and feelings.

“Don’t worry.” Like the phrases above, this is often said to try to put a positive face on what is happening. This will likely make the patient feel very alone, since a person who say this has no understanding of what he/she is facing.

“I know just what you should do.” Again this undervalues the situation by implying it has an easy fix.

Be Real

You can still be humorous and fun when appropriate and when needed. A light conversation or a funny story can make a friend’s day. Talk about common interests, hobbies, life events and other topics not related to cancer. People going through treatment sometimes need a break from the disease.
This doesn’t mean ignoring the elephant in the room. Be cheerful when you naturally would be, and allow for sadness when it’s appropriate. Your friend may need to talk to someone he/she trusts.

Some More Suggestions to Encourage a Friend Facing Cancer:

Most patients have a medical team as well as close family members participating in their decision-making process. Adding your two cents can be like the proverbial “too many cooks in the kitchen.”
Avoid bringing up behaviors (past or present) that might have contributed to his or her disease, such as smoking or drinking. They are fully aware of these things and often feel guilty about them already.

Even if they express a desire to give up, avoid the natural reaction, “You’ve got to just keep fighting.” This can make the patient feel guilty, and like you didn’t really hear them as they expressed their feelings.

Instead, at times like this, be supportive of your friend’s feelings. Allow them to be negative, withdrawn, or silent. Resist the urge to change the subject. Silence and holding their hand can be a greater comfort than words.

Telling them they are strong can cause them to act strong even when they are exhausted, so avoid this.

Instead of giving advice, ask advice. This helps him/her maintain an active role in your friendship. Just because your friend has cancer, doesn’t mean their need to help and be heard has gone away.
Before asking questions, ask if it’s welcome. They will likely be happy to answer, but they may wish to keep some things private.

Ask your friend if they are in any pain or discomfort. See if there is anything you can do to ease the discomfort by using pillows or moving furniture. Try to ensure that you are directly in front of your friend so that he/she doesn’t need to turn their head.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com


One of the things we learned early on in Dan’s cancer journey was that even if a treatment worked, eventually, it wouldn’t. Cancer cells become drug resistant.

Our Story

When doctors first diagnosed Dan with stage IV lung cancer in 2012, they perscribed a targeted treatment called, Tarceva. The treatment worked well for 18 months before the cancer in his body became drug resistant and again progressed.

After that, he volleyed back and forth between targeted treatments, immunotherapy, and traditional chemotherapies. He would take each treatment until the cancer again became drug resistant.Then, the doctors would put him on a new drug. This is something that’s often difficult for people to understand.

Once a treatment works, why can’t you use it indefinitely?

There are several reasons for this.

Remember in yesterday’s blog on cancer cells, we learned about the ways that cancer cells are different from healthy cells? As these cells mutate, they act more and more abnormal. One of the ways they differ is that the cells can become drug resistant to the chemotherapy treatments that we rely on the kill the cancer cells.

One form of drug resistance in chemotherapy is similar to the way we become drug resistant to antibiotics after taking antibiotics repeatedly, inappropriately, or for long periods of time, The bacteria which aren’t killed become stronger.

In chemotherapy, some cells survive and mutate. They then continue to multiply and soon there are more cells that don’t respond to the treatment than those that do.  This is one theory as to why Dan became resistant to Tarceva. Thankfully, over the years, researchers have been working on this problem. Just in the nick of time, the FDA approved a drug called Tagrisso. This is another targeted treatment that is used when the original EGFR mutation that some lung cancer patients have, becomes drug resistant to the currently targeted treatments that are available such as Tarceva, Iressa, and Afatinib.

Chemotherapy resistance

A Drug Resistant Protein Molecule

Cancer cells use a molecule called “p-glycoprotein” to protect themselves against cancer drugs. Resistant cells often have high levels of this protein, in the cell walls. The protein acts like a pump which removes toxins from cells. This includes pumping chemotherapy out of the cell faster than it can take the treatment in. Because there isn’t enough of the chemotherapy in the cell, it can’t kill the cell.

An Inactive Gene

In a study done on colon cancer cells, researchers discovered that cells which were initially sensitive to the drug oxaliplatin and later became drug resistant, had inactivated a gene in their DNA. This caused the cells to repair these breaks and they are back in business, growing and spreading. This is known as acquired resistance. Researchers are also studying how the loss of this gene function causes tumors to be drug resistant from the outset, otherwise known as primary resistance.

Lack of Transportation

Cancer cells can become drug resistant because the protein that transports the drug across the cell wall stops working.

Gene Amplification

Sometimes, a cancer cell can produce hundreds of copies of a particular gene, which triggers an overproduction of protein rendering the treatment ineffective. This is known as gene amplification.

Multidrug Resistance

If cancer becomes drug resistant to one drug, it’s more likely that it will be resistant to others. For example, once Dan’s cancer became resistant to Tagrisso, and EGFR targeted treatment, his cancer was resistant to all of the other EGFR targeted treatments.  This is known as multidrug resistance. This is why it’s so important to choose the best possible treatment first. Sometimes, doctors give patients multiple drugs in combination, to reduce the chances of becoming drug resistant to any one drug.

Drug Resistant

We need to adjust our expectations.

Often, our expectations of cancer treatment are too high. The human body is complex on every level and when it breaks down, there is no easy fix. Sometimes the systems which protect us under normal circumstances can be the very problem we encounter when things are no longer working as they were designed to. Thankfully, researchers are continuing to look at ways of preventing drug resistance.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

The Erickson Family, August 2016. Photo By Jim Bovin

 


I recently went to the dermatologist for a full exam. As a bonus, she removed a small lump that I’ve had for years. She numbed the area and in 2 seconds (maybe even less) removed the pea-sized lump, putting in a couple of stitches and a Band-Aid. Then, she labeled the sample and sent it off to the lab.  She assured me that it looked normal, so I shouldn’t worry, but that it was very important to make sure that I get the results. Then she gave me written post-biopsy care instructions.

Other biopsies

I thought about other times in my life when a biopsy has been important.  In the early 1980s, my dad discovered a tumor behind his ear. I still recall hearing my parents talking about it, worrying until the results came back benign.

It was that experience that I remembered when I felt my husband’s hard, enlarged, supraclavicular lymph nodes. Only, I knew more as an adult. It was even scarier.

I was also in the room when they did a biopsy on Dan…and when we got the results.

What is a biopsy?

A biopsy is an examination of tissue removed from a living body to discover the presence, cause, or extent of a disease.  Usually, when we think of biopsies, we think of cancer, but they help doctors diagnose other types of disease, as well. Biopsies tell whether or not a patient is rejecting transplanted organ.

There are many types of biopsies.

I’ve already told you about my skin biopsy. The doctor removed a lump just under the skin, like any other skin biopsy. A circular “punch” blade removed the cylindrical shape sample.

If the lump had been larger or in a difficult to reach place in the body, the doctor would perform a surgical biopsy.

The most common type of biopsy, the needle biopsy, uses a needle to remove the tissue the pathologist will test.

When Dan had his biopsy done, they did a fine needle aspiration biopsy. The doctor used an ultrasound to guide her as she inserted a fine needle into his lymph node and sucked up cells to test. They pulled cells from several lymph nodes. By using this technique, they could avoid going into his lung. They also knew from the positive results that cancer had spread through the lymphatic system.

Sometimes rather than using ultrasound, the doctor will use a CT scan to guide the needle.

Biopsies vary depending on the type of tissue the doctor is collecting.

A bone marrow biopsy- When a doctor suspects a blood cancer such as leukemia or lymphoma, they insert a needle into the pelvis bone to collect the sample,

A liver biopsy- The doctor inserts a needle through the belly to gather the liver tissue.

A kidney biopsy- The doctor inserts the needle through the patient’s back into the kidney.

In a prostate biopsy- Doctors take multiple needle biopsies at a time from the prostate gland via a probe inserted into the rectum.

Some biopsies are more invasive than others.

The doctor can perform a skin biopsy right in the doctor’s office with minimal discomfort during and after the procedure. Dan’s doctor did a fine needle aspiration biopsy a clinic, as well. Sometimes patients go to a hospital for this type of biopsy and take pain medication after the procedure.

After the doctor collects the tissue, he sends it to a pathologist. The pathologist will examine the tissue under a microscope. Most of the time, the pathologist will be able to diagnose the patient’s condition. Sometimes a pathologist will attend the procedure and make a diagnosis immediately. Usually, they will take a week or longer.

It’s never fun, getting a biopsy done, but, it’s the only way to make a definitive cancer diagnosis for most types of cancer.

ABOUT HEATHER ERICKSON

I am an author, writer, and speaker and homeschooling mom of 3. Since my husband, Dan was diagnosed with stage IV lung cancer in 2012, I’ve focused my writing and speaking on helping cancer patients and their families advocate for themselves and live life to the fullest, despite their illness.

My goal is to help people face cancer with grace.

My book Facing Cancer as a Friend: How to Support Someone Who Has Cancer, is available on Amazon.com

The Erickson Family, August 2016. Photo By Jim Bovin

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