17 March 2009

The persistent nature of cancer

Fifteen years after having a melanoma removed from her back, Lynn started getting unexplained headaches. We take a look at the horror of cancer recurrence and metastasis.


Fifteen years after having a malignant melanoma removed from her back, Lynn started getting a series of unexplained headaches. After numerous blood tests and fistfulls of painkillers, she was booked in for a CT scan.

The scan picked up two brain tumours and, after a biopsy and some more scans, they were diagnosed as metastatic melanoma. This suggests that some melanoma cells stayed behind when the initial melanoma was removed. These spread (metastasised) and started forming new tumours in her brain.

Though a number of cancers can be "cured", what exactly constitutes a cure is unclear. Cancer patients, or survivors, face the ever-present threat of their cancer spreading in the body or coming back if it was in remission.

The American Cancer Society (ACS) defines remission as "a period of time when the cancer is responding to treatment or is under control". In a complete remission all the signs and symptoms of the disease disappear. After a few years of such a complete remission, a patient might be considered cured.

As happened with Lynn though, cancers can come back after as many as 15 years.

Dormant for years
Professor Raymond Abratt, head of radiation Oncology at the University of Cape Town and Groote Schuur hospital, explains that cancer cells can lie dormant in the body for many years, until the right environmental conditions in the body trigger them to start multiplying again.

You might say that these dormant cancer cells are like plant seeds waiting for the right kind of soil before they start growing. The cells break off the original tumour (in Lynn's case the melanoma on her back), spread through the blood or lymph fluid, and then years later start growing in another part of the body where conditions are favourable for those kinds of cancer cells. So, even though Lynn also later discovered tumours in her liver, these tumours were in all likelihood made up of melanoma cells.

Similarly, breast and prostate cancers often metastasise to bone where their specific kind of cancer cells find favourable conditions. Even though the cancer is in the bone, it is still called breast or prostate cancer. Bone cancers on the other hand, would be cancer that originates in the bone and are very different diseases altogether.

Quality of treatment
Abratt explains that in many cases treatment is shaped by the needs of the patient. Someone like the cyclist Lance Armstrong, for example, had to have treatment that had a minimum impact on his lungs so that he could continue cycling. Similarly, treatment choices for young women with certain lymphomas might be influenced by whether they plan to have children or not.

The quality of treatment a patient receives, he says, is key in determining whether a patient goes into remission. He also claims that survival rates have been increasing by 1-2% annually for the last 15 years, because treatment is improving.

Given the limited resources available to our public health system and the astronomical costs of certain cancer treatments, the possibility exists that many South Africans may not be in a position to share in these advances.

Abratt declined to make any generalisations about the differences in treatment likely between the public and private sectors, pointing out that the quality of treatment in the public sector is often very good. He does however concede that there are far more resources available in the private sector, and that issues such as access to drugs may be a problem in the public sector.

A tough fight
Even with the best possible treatment, cancer can be a very tough disease to fight.

Since Lynn's cancer came back, she has had about as high a quality of treatment as you can hope for. From chemo and radiation and a variety of scans, hospital stays and help from her medical aid, just about everything current medical science can offer was thrown at the cancer.

Even so, after a scan picked up a number of tumours in Lynn's liver - on top of those in her brain and chest and one on her spleen – her body had taken about as much strain as it could.

Lynn's husband recently let us know that she has passed away. To read his message, and Lynn's often very funny account of the progression of the disease you can visit Lynn's blog.

We at Health24 would like to extend our condolences to Andre and the rest of the family.

Avoid sunburn
At least two thirds of all cases of melanoma are caused by excessive exposure to ultraviolet radiation from the sun, and we are at particularly high risk in South Africa.

A mole changing in size, shape, or colour can be a sign of melanoma. Contact your doctor if you notice any such changes. If someone else in your family has had melanoma you should be particularly vigilant. A fair skin, burning rather than tanning, red hair, and blue eyes also indicate an increased risk.

Remember, melanoma can be cured if detected early, before it spreads to other areas of the body.

(Marcus Low, Health24, article updated March 2009)


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