“Illness Cleanses Us” ~ Tracey Derrick


Tracey Derrick: 1 in 9 - breast cancer photography (Advocates For Breast Cancer - South Africa)

Treatment options for breast cancer are dependent upon the type of cancer and the size of the tumour. I was diagnosed with a grade 2, invasive ductal carcinoma, tumour size 30mm. It was suspected and confirmed after surgery, that 3 out of 21 lymph nodes under my arm were infected. These were subsequently removed.

Aside from surgery, the main forms of Western medicine’s attack on cancer are chemotherapy and radiation. The two methods are based on a single principle: generally, cancer cells are extremely fast growing. They divide much more rapidly than any of the body’s normal cells. Therefore if you administer cell-poisoning drugs to the body that kill cells when they divide, then you will kill some normal, healthy cells but many cancer cells. This is what both chemotherapy and radiation do. Chemotherapy is administered intravenously and travels through the bloodstream to every part of the body. The normal cells in the body that grow more rapidly than others, such as hair, stomach lining, mouth tissue, nose, nails, will also be killed more rapidly, hence accounting for hair loss, stomach nausea etc. At the end of a successful course of chemotherapy, the tumour is dead and the patient only half dead.

I chose (how much choice did I have? – I wanted the cancer cut out, eradicated, gone), a mastectomy and six sessions of chemotherapy because the cancer had spread to my lymph nodes and possibly to somewhere else in my body – cancer cells use the lymph nodes for travelling. After chemo I now follow a drug regime to reduce the possibility of the cancer returning.”


TAKEAWAY:

How to Manage Chemotherapy Symptoms Through Food

Barely there…

Tracey Derrick - breast cancer - self portraiture: hair - Advocates For Breast Cancer in South Africa

After chemo, Tracey wrote in her seminar paper about her hair:

“Then the hair dies. Initially, it feels as if one’s scalp is burning as the roots die, then the hair falls out. The first handful is an alarming relief; it is happening as you have been dreading that it would. The boundaries between public and private begin to melt, for all to see. My hair had been a physical, public security – it identified me and I felt naked without it. Then one experiences the head sweating constantly with no layer of hair to absorb it; the body chills quickly with no hair to warm it. As the hair on the rest of the body slowly falls too, all borders between inside and outside are laid bare.

Stacey describes it well, “the loss of pubic hair reveals what has remained hidden for years. Returned to pre-adolescence and yet prefiguring an aged body, time has nothing to tell. The nose runs without any tiny nostril hairs, sweat runs into eyes without eyebrows or eyelashes to catch it. Ears are tunnels for flies and insects to enter at their ease. The hairless body is uncannily silky smooth to touch, a familiar, yet strange state. A return to childhood and yet an inevitable ageing. A big bald baby but with adult organs”. (1997:84).

Physically and emotionally this “was me” but when I looked at myself in the mirror – was it me? I photographed myself repeatedly during this vulnerable time as an attempt to regain some power over my situation.”


 

TAKEAWAY: How & Why Hair Loss Happens Because of Chemotherapy

Creamed root gratin

Another recipe for the tough times. This is pure comfort food for when you feel like nothing else.

gratin

500g potatoes, peeled and chopped
a generous cup of celeriac, peeled and chopped
1 small parsnip, peeled and diced quite small
1 small chopped onion
1 clarge carrot, peeled and very thinly sliced
1/2 teaspoon ground nutmeg, and the same of black pepper
1 teaspoon low salt stock powder
Soya milk to cover

Bring to the boil and simmer until the vegetables are very soft. Drain and mash or blend to a smooth puree.

Pile into an oiled, overnproof dish, splash with a little olive oil and soy sauce and bake in a hot oven (200 deg C) until golden.

Serve hot, sprinkled with parsley or chives.

Yummy!

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

Buddies for life!

bhf circleBuddies For Life is a bi-monthly lifestyle magazine, published by Word for Word Media in association with the Breast Health Foundation, for breast cancer patients, their families and friends. It was launched in June 2011, and 22 issues have been published to date with many more to come.

The glossy print and online magazine aims to educate, encourage and provide support. An array of medical professionals and experts write supportive and educational articles for the magazine on topics such as treatment, health and wellness, diet, fitness, sexuality, new advances and psychological advice that will assist those affected by cancer to understand the disease and treatment.

The content is essential reading written in a style that simplifies terminology. Super Survivor is featured on the cover of every issue and the breast cancer survivor’s story is told. On the Chemo Couch is another platform for survivors to share their unique story.

In keeping with the aims of the Breast Health Foundation, each issue contains a section dedicated to the early detection and awareness of breast cancer.

Oncology Buddies, supported by CANSA, is a new section within the magazine catering for other cancer awareness, early detection and various support groups.

Buddies For Life is available in print at hospitals, private clinics, oncology practises, Buddies for lifemammography units, radiology centres and support groups. Medipost courier the distribution of the print magazines to all the various distribution points.

A digital version is also available on www.buddiesforlife.co.za and yearly subscriptions are offered.

bu

 

The Breast Health Foundation is one of the partner organisations in the Advocates for Breast Cancer (ABC)

Hormones and the endocrine system

The role of Hormonal / Endocrine therapies in breast cancer

rain

Approximately two thirds of breast cancers are oestrogen positive which means they have oestrogen receptors on the surface of the cells and therefore depend on the hormone oestrogen for growth.

This has meant that a range of treatments could be developed with the aim of decreasing the cancer growth or stopping the cancer from coming back by preventing oestrogen action on the cells.

These treatments include: Tamoxifen, Aromatase inhibitors, and Zoladex injections.

But what are they, and how do they work?

Tamoxifen

How it works

This is a synthetic hormone that binds to the oestrogen receptors on the breast cells in place of the woman’s own oestrogen. Unlike natural oestrogen, it does not stimulate breast cell growth and therefore has the effect of “blocking” the receptors.

It can be used in both pre-menopausal and post-menopausal women.

Trials have confirmed that tamoxifen significantly reduces the incidence of local recurrence, metastases (spread of breast cancer to distant organs) and breast cancer in the opposite breast.

It is taken as a single tablet daily.

The benefits have shown to be optimal if taken for a period of 5-10 years.

Side effects

Tamoxifen is in the group of Selective oEstrogen Receptor Modulators (SERMS) which means that it has different effects on different tissues in the body. While it blocks the action of oestrogen in breast tissue, it also has partial estrogen activity in other tissues.

This is the basis for its possible side effects such as hot flushes, vaginal dryness/bleeding and endometrial thickening or polyps.

Other side effects have been associated with its use such as thromboembolism, nausea/diarrhoea, weight gain,headaches or dizziness, and low mood.

It is important to realise that not all patients experience these side effects and some may experience them to a very mild and completely tolerable extent.

Aromatase inhibitors (AIs)

How they work

Aromatase inhibitors are another way of reducing oestrogen effect in post menopausal women. In this group of women, oestrogen is no longer produced by the ovaries, but smaller amounts of oestrogen are still circulating. This oestrogen is derived from androgens which are converted into oestrogen by the aromatase enzyme in peripheral tissues such as fat. The AIs block this enzyme and, in so doing, reduce oestrogen production.

There are 3 main AIs: Letrozole (Femara), Anastrozole (Arimidex), and exemestane (Aromasin).

They are prescribed as a single tablet every day for or at least 5 years.

Sometimes they can be used in sequence with tamoxifen where the patient will switch to an AI after 2-3 years of tamoxifen, or as an extended adjuvant therapy where an AI may be started after 5 years of tamoxifen.

Side effects:

Due to the different mechanism of action, the side effect profile of AIs is slightly different to that of Tamoxifen.

The gynaecological side effects are less of a problem with the use of AIs compared with tamoxifen. However, the AIs may cause joint pain, stiffness and bone loss.

Women who are scheduled to start an AI should have a baseline and then periodic Bone Mineral Density assessments (an outpatient X-ray or DEXA scan). Calcium,Vit D supplementation and, in some cases, bisphosphonates may need to be considered.

Ovarian ablation/ suppression

Surgical removal of the ovaries or ablation of the ovaries with radiotherapy has been shown to arrest breast cancer growth due to the depletion of oestrogen.

Ovarian suppression can be achieved medically by using gonadotrophin-releasing hormone (GnRH) analogs. This has been shown to have equivalent effects as surgical or radiation induced menopause with the added benefit of being reversible after the completion of therapy.

Examples of these treatments are goserelin (Zoladex) and leuprorelin (Lucrin).

They are administered as an injection under the skin either monthly or 3 monthly.

These drugs can be used in combination with tamoxifen and aromatase inhibitors in both pre-  and peri-menopausal women.

Resistance

Although tamoxifen and the AI’s have been proven to be extremely effective treatments, resistance to treatment has been described. Further research is being done in order to understand mechanisms of resistance and to combat resistance pathways.

Endocrine treatments such as fulvestrant (Faslodex) are being used in cases of advanced or metastatic disease or recurrence of breast cancer during endocrine therapy. It is an oestrogen receptor down- regulator and is given as a monthly injection.

Selection

The selection of which endocrine therapy or combination of therapies is individualised and depends on whether the patient is pre- or post-menopausal, whether she has contraindications to any of the treatments, treatment interactions with medication she may be taking for other conditions and the extent of the side effects she may develop on the medication. Of course, patient preference is an important consideration. Financial implications may influence treatment decisions too.

Dr Ronelle de Villiers
MBChB, DCH, BSc(med)

 

 

 

 

 

 

 

 

 

 

 

Keeping cool in the tough times

Two-Coolers-RecipeIt is hard to imagine feeling hot and bothered in our chilly winter weather, but cancer treatment can play havoc with our normal body temperature.

And even if you are not feeling the heat, you can always do with a fruity vitamin boost!

Two Coolers
When you feel hot and bothered or sore try these to soothe and refresh.

Strawberry and Citrus Sorbet

Fresh juice of 2 big oranges
Fresh juice of 1 pink grapefruit
Fresh juice of 2 tangerines
Zest of 2 organic oranges, finely grated
10ozs (250g,2 cups) fresh strawberries or raspberries, cleaned
5 tablespoons maple syrup

Whizz together in a goblet blender or food processor. Pour into a shallow dish and freeze for 2-3 hours. Break into chunks and process again (using a sharp blade) until smooth and creamy. Return to the freezer for 30 minutes before serving. If you want to leave it longer in the freezer put it into little ice-lolly moulds at the final freeze and get them out as you feel the need.

For a change with added food value, try adding:

4ozs (100g, ½ cup) plain silken tofu
2 tablespoons more of maple syrup
2 teaspoons vanilla essence

Include frozen bananas at the final whizz stage before the second freeze.

Frozen Bananas

The simplest soother ever! Just peel ripe, firm and perfect bananas, wrap them individually in kitchen wrap/film and freeze overnight. Nibble on them whenever you fancy something cool and creamy. Don’t keep them in the freezer for too long, just do a few at a time.

If you can find sugar-free carob drops (try health food shops) melt them like chocolate in a ‘bain-marie’ (double saucepan) and dip your bananas in for an iron fortified, luxurious treat.

THANKS TO DR ROSY DANIEL, WHO HAS GENEROUSLY SHARED THE CANCER LIFELINE RECIPES WITH US. THIS RECIPE IS FOR THE TOUGH TIMES, FOR USE WHEN YOU ARE VERY ILL, DURING TREATMENT, WHILE THE APPETITE IS POOR AND THE WEIGHT LOW.

Keeping the balance

Over the next couple of weeks, we will be posting a series of recipies that will help you as you go through treatment. The Cancer Lifeline recipies are divided into three phases:

  • Tough Times, for use when you are very ill, during treatment, while the appetite is poor and the weight low.
  • Clean Machine, for detoxification of the body, post cancer treatment, or to kickstart a holistic health creation programme.
  • Eat Right, to set the right style of eating for the rest of your life to generate optimum health.

The recipies have been created by celebrity chef and nutrition consultant, Jane Sen, for the nourishment and healing of people with cancer. The recipies are part of the Cancer Lifeline Kit by Dr Rosy Daniel, which she has generously shared with us.

balance

Those dreaded side effects!

sideeffects

The chemotherapy drugs cannot distinguish between cancer cells and normal cells of the body and will attack other rapidly growing cells such as hair,skin, nails, lining of the digestive system and bone marrow (blood cell lines).

Therefore there are various side effects associated with the therapy and  because each drug acts in a slightly different way, the side effects will also differ between different drugs.

Thankfully, like all drugs (including Panado and Aspirin), not every side effect is experienced by every person, and some side effects are experienced to lesser degrees in some people.

Many side effects may be unpleasant, but are not harmful. Some side effects may get worse and some may get better with each cycle of treatment. Others may develop during the course of the treatment.

Some side effects need to be treated and some can be managed by anticipating them and controlling them in advance which lessens their effect.

Some side effects are more serious and it is important to contact your doctor if you are worried.

The good news is that cancer cells divide more rapidly than normal cells and are therefore more likely to be killed by chemotherapy.

More good news is that normal cells are also more able to recover than cancer cells and therefore most side effects are not permanent and will reverse once the treatment is finished.

Blood cell counts are done each time a new cycle of chemotherapy is started. This is usually done the day before the next treatment or very early on the same morning of the treatment. Sometimes a blood test will be done mid-cycle depending on the patient or the combination of drugs used.

The most common side effects and some of the agents that cause them:

Nausea/Vomiting (FEC, AC> CMF, Xeloda)

Drugs that help prevent against nausea are given before the combinations that cause this. Medication is also given to take home for a few days after treatment too. Different drugs work for different people and it may be necessary to try more than one antiemetic before you get relief.  It is important not to give up – if the prescribed antiemetic is not effective, work with your doctor and nurse to find the one that works best for you.

Diarrhoea/ Constipation (all, but especially Xeloda, Vinorelbine)

The irritation of the lining of the bowel may lead to diarrhoea. This can often be managed with dietry changes but may require medication. Drinking lots of fluids is important to help replace losses.

Chemotherapy may cause some people to become constipated.  Others may become constipated because they are less active than before, because of diet changes, or from pain medication they may be taking.

Mouth sores and ulcers (all)

The cells lining the mouth may be affected and the mouth may be sensitive or develop small ulcers. Sometimes changes or loss of taste can occur which recovers once treatment is completed.

Lower blood cell counts (FEC,AC, CMF, Gemcitabine,Vinorelbine,)

This occurs because the chemotherapy drugs affect the bone marrow. The bone marrow makes white blood cells, red blood cells and platelets. The levels of these blood cell counts are checked regularly during treatment.

Low white cell counts (FEC, AC, CMF)– white blood cells help fight infection. If you have a severe infection and your white cell count is very low, it could be life threatening and may require hospitilisation. It is important to contact your treating doctor if your temperature goes above 38degC.

Low red cell counts (FEC,AC, CMF,Taxol, Gemcitabine)– red blood cells carry oxygen to the cells. If the count goes down you may become anaemic which will result in you feeling tired and breathless. If severe, you may need a blood transfusion.

Low platelets (Gemcitabine)– platelets help blood to clot. If the count goes down you may bruise easily.

Tiredness/Fatigue (all)

Fatigue is a common side-effect of chemotherapy and can range from mild lethargy to feeling completely wiped out.  It is not always due to a low red cell count (anaemia). It can be a deep tiredness that does not get better from sleep and tends to be worse at the beginning and end of a treatment cycle but may persist for 6 months to a year after treatment.

Hair loss (FEC,AC) Hair thinning (CMF,Taxol, Vinorelbine)

Some chemotherapy combinations (such as AC, FEC, CAF) make all hair fall out both on the head and the rest of the body.

Other combinations cause some hair to fall out so the hair thins out.

This can be upsetting but it is temporary- the hair will begin to grow back a few weeks after treatment has stopped. It may grow back different in colour or texture though.

Skin and nail changes (Taxol, Xeloda, Vinorelbine)

Skin may become dry and sensitive to sunlight and some drugs even cause rashes. Nails may also become brittle or discoloured.

Hand-foot  Syndrome (Xeloda)

The earliest symptoms of Hand-foot Syndrome is a painful sensitivity of the hands and feet. It may progress from sensitivity to redness and swelling on the palms of the hands and soles of the feet.  The redness looks like sunburn and it may blister and in severe cases form sores.  The affected skin can also become dry and peel.  It is important to advise your doctor or nurse about any Hand-foot Syndrome symptoms, even if they are mild, as treating early can help prevent severe cases.

Eye problems (all)

Sore eyes, “gritty” eyes, watery eyes, infection in eyes(conjunctivitis), and blurred vision may occur in some people to varying degrees during their treatment.

Phlebitis (FEC, AC, CMF, Vinorelbine,)

Damage to the lining of the veins used in some chemotherapies can result in discomfort or burning sensation in the veins. This may last for some weeks. If venous access is difficult a port (a cannula inserted under a general anaesthetic)into a large vein in the chest) may be advised. If the vein is burning or painful during chemotherapy, please alert the chemotherapy sister.

Peripheral neuropathy (Taxol, Vinorelbine)

This is experienced as a numbness or tingling sensation in fingers or toes. In more severe cases it may be painful. It is most commonly seen in diabetics and in those who have had multiple courses as it tends to be cumulative. It may persist for a few months after completing treatment.

Allergic reactions (Taxol)

If this occurs, it usually happens with the first dose. If it occurs it will happen in the chemo room and not later at home. It is usually prevented by and easily treated with antihistamines and steroids.

Liver changes (Gemcitabine, Vinorelbine,Xeloda)

In many cases this is only noticed on the blood tests and goes unnoticed by the patient. It will go back to normal after treatment. In the cases of breast cancer that has already spread to the liver, the liver function may be affected by the cancer itself and may actually improve on chemotherapy.

Menstrual irregularity and infertility (all)

When women receive chemotherapy it can damage the ovaries and reduce the amount of hormones they produce, resulting in short-or long-term infertility (inability to fall pregnant).  The effects of ‘chemo’ on your hormones may result in:

♦          Menstrual periods becoming irregular or stopping completely

♦          Menopause-like symptoms, e.g. hot flushes and itching burning, or dryness

of vaginal tissues

♦          Vaginal infections are more likely

Menstrual function can start again up to 2 years after chemotherapy. The onset of menopause may also be brought earlier and fertility may be impaired. If a woman may want a baby after chemotherapy, it is a good idea to discuss this with the doctor before starting chemotherapy.

Remember that, chemotherapy is not a safe method of contraception and a safe contraceptive is very important during chemotherapy as the drugs would be extremely harmful to the foetus.

Cardiac failure (FEC, AC, CAF, Xeloda)

In very rare instances some chemotherapy can lead to heart failure. If your doctor thinks you are at risk a cardiac function test will be done before starting chemotherapy.

There are many other possible side effects of chemotherapy, many of which are extremely rare or mild and therefore not covered here but can be discussed individually with your doctor if you have concerns.

Frequently asked Questions:

“So just how bad am I going to feel?”

This is impossible to predict.  Everybody is different.  Many people can continue working during chemo, but may find they need to take a day or 2 off after chemo before going back to work.  Remember your experience will be different from the lady sitting next to you in the chemo room, so don’t panic if you find you are having a harder time than she (or an easier time!).  Tell your doctor.  Often something can be done to make the next time better.  Some things  you may have to grin and bear.

“What about other medicines, drugs and supplements during chemotherapy?”

It is important to discuss this with your specialist any other drugs your are taking or additional drugs you would like to take.  This includes vitamins or dietary supplements, vaccines or immunizations, immune boosters and herbal medicines.  They may interfere with the effectivity of your chemotherapy treatment.  Whatever boosts you may boost your cancer cells too!!

Blog written by Ronelle Lovric http://www.capebreastcare.org

 

 

Tailor made treatment

Miko Kapidzic works at University of California San Francisco

Did you know that when you get chaemotherapy, you will get a treatment plan that is tailor-made just for you?

The type of treatment you’ll get will depend on the type of cancer, where exactly it is and the stage of development of the cancer. The oncologist will also take into account whether the cancer has spread, your general health and the purpose of the treatment –  to cure or to relieve symptoms.

Research into cancer treatments goes on all the time, and new treatment regimes are always being developed. What that means is that your experience of chaemo may be different to any one else’s.

So, what happens when you get chaemo? It may be administered directly into a vein, it may be given to you in the form of a pill, you may get an injection or it may be applied directly to your skin.

The most common form of administration is through a vein. A thin needle is inserted into a vein on the hand or lower arm. This needle is removed once the chemotherapy has been completed. Chemotherapy can also be given intravenously by means of catheters, ports and pumps. A port is a round plastic or metal chamber that is placed under the skin. It is connected via a thin tube to one of the major vessels in the chest cavity. This method is more permanent and can be used for as long as necessary.

Most patients receive chemotherapy as out-patients in the oncology unit and do not need to be admitted to hospital.

Chemo Q & A

http://www.thewhyfoundation.org/cancer-answers/cancer-treatments/what-does-chemotherapy-look-like/
Original colour photograph by Mary Elizabeth Gentle from the article by writer, Allison W. Gryphon, Stage 3a Breast Cancer Survivor: “What Does Chemo Look Like?”

 

How often is the chemotherapy given and how long does it take?

This is decided by:

  • the type of cancer.
  • the goal of the treatment — i.e. either curative or to relieve symptoms.
  • the different chemotherapy drugs.
  • how your body copes with the chemotherapy.

It can be given daily, weekly or monthly and given in cycles where treatment is alternated with rest periods. Just make sure that you stick to the schedule so that you can get the best results.

Can I take other medication?

It depends what you are taking. Make sure that you give your oncologist a list of any prescription drugs or over-the-counter medication you are taking so you can get the best advice for your specific situation. e.g. vitamins, allergy pills, indigestion aids, pills for colds and flu, aspirin, pain killers and any minerals or herbal supplements.

ADVOCATES FOR BREAST CANCER_what is chemo_what does chemo look like_south africaBlack and white photograph of a chemotherapy drip/cancer treatment - via The Why Foundation: "What Does Chemo Look Like?"

 

 

 

 

 

 

 

 

 

~ original colour photographs by Mary Elizabeth Gentle from “What Does Chemo Look Like?” by Allison W. Gryphon ~

How will I know if the chemotherapy is working?

When necessary, you will be sent for examinations and tests which will help your oncologist determine how effective the treatment has been. Please ask your oncologist to explain these tests to you.

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Important questions to ask before you start:

When you are having treatment, it is sometimes difficult to know what to ask about — so here are some ideas to get you started:

  • Why should I receive chemotherapy?
  • What are the benefits of chemotherapy?
  • What are the associated risks of chemotherapy?
  • Are there any other methods of treatment available for my specific cancer?
  • What is the standard of treatment for my type of cancer?
  • Are there any ongoing clinical trials for my type of cancer?


Ask these questions about your TREATMENT SCHEDULE:

  • How many chemotherapy treatments must I get?
  • Which chemotherapy drugs/agents will I receive?
  • How will the chemotherapy be administered?
  • Where will the chemotherapy be given?
  • How long will each chemotherapy treatment take?

Ask these questions about the SIDE EFFECTS of chemotherapy:

  • What are the possible side effects of my chemotherapy?
  • When will the side effects start?
  • What side effects usually occur with my type of cancer?
  • Are there any side effects that need to be reported immediately?
  • What can I do to minimise the side effects?

To ask any more questions – or answer other users’ questions – join us on Twitter here or Facebook here!

TAKEAWAY:

A must-read by THE WHY FOUNDATION:

What Does Chemo Look Like?