It's a Numbers Game

It's a numbers game.

I am happy to say that I can start this installment off with good news. I know, good news, an anomaly.

Well are three ways by which my doctors can discern how well I am doing. First, by a PET scan which are extremely expensive at about $10K a pop. The second is by the highly subjective method, my doctors ask me how I am feeling and I tell them. The third and most objective is by measuring a cancer marker in my blood called CA 27-29.

Let’s learn about cancer markers. I will need some help from the American Cancer Society. (www.cancer.org)

What Are Tumor Markers?
Tumor markers are substances that can be found in the body (usually in the blood or urine) when cancer is present. They can be products of the cancer cells themselves or of the body in response to cancer or other conditions. Most tumor markers are proteins.
There are many different tumor markers. Some are seen only in a single type of cancer, while others can be detected in several types of cancer.
To test for the presence of a tumor marker, the doctor sends a sample of the patient's blood or urine to a lab. The marker is usually detected by combining the blood or urine with manmade antibodies designed to react with that specific protein.
For these reasons, only a handful of tumor markers are commonly used by most doctors. When a doctor does look at the level of a certain tumor marker, he or she will consider it along with the results of the patient’s history and physical exam and other lab tests or imaging tests.
Determining the Effectiveness of Cancer Treatment
Most doctors find that the most important use for tumor markers is to monitor patients being treated for cancer, especially advanced cancer. If a tumor marker is available for a specific type of cancer, it is much easier to measure it to see if the treatment is working rather than to repeat chest x-rays, computed tomography (CT) scans, bone scans, or other complicated tests (PET.) It is also less expensive.
If the marker level in the blood goes down, it is almost always a sign that the treatment is having an effect. On the other hand, if the marker level goes up, then the treatment probably should be changed. (One exception is if the cancer is very sensitive to a particular chemotherapy treatment. In this case, the chemotherapy can cause many cancer cells to rapidly die and release large amounts of the marker, which will cause the level of the marker in the blood to temporarily rise.)
Specific Tumor Markers
CA 27.29: CA 27.29 is a marker used to follow patients with breast cancer during or after treatment. This test measures the same marker as the CA 15-3 test, but in a different way. Although it is a newer test than CA 15-3, it does not appear to be any better in detecting either early or advanced disease. It may be less likely to be positive in people without cancer. The normal level is usually less than 38 to 40 U/mL, depending on the testing lab. This marker can also be elevated in other cancers and in some non-cancerous conditions and may not be elevated in some women with breast cancer.

Now that you have had your tutorial about the fascinating subject of tumor markers I will give you the good news. On July 17th my count was 210. By August 8th the count was up to 278. During this time I was in unremitting pain. I was up at all hours of the night either with pain, nausea, or trouble moving. I could only sleep off and on and was miserable. I believe that there was this part of me that a lot of this time period I was just overwhelmed with what was happening. My diagnosis, how strange my cancer was behaving, how aggressive it was and how long I had suffered with the symptoms.

For many of you that are not around me on a day-to-day basis you missed what had been going on since January 2007. Every week or two I would have another area of my body that would just flare up in pain. First it was my ribcage on the left. I could barely drive or breathe. I went immediately to the Physical Therapist and got three treatments in 3 days. It seems to resolve. The other said would flare up. I figures that since I had been guarding the left it made since the right was bugging me. Then it was my hips. First, one side and then it would resolve about 3 days later. Then my sternum or shoulder or collar bone. These are all examples of the metastatic bone cancer spreading throughout my body from January to July. What was I saying to myself? “I am 40 years old; I am a working mother of 2 and my body is falling apart.” Ask Matt how many times I complained about our mattress and how we needed a new one because I couldn’t sleep without pain. Again, I am just getting old and falling apart.

On July 26th I had my first treatment. By July 30th my pain was being managed very well but my GI symptoms were just unbearable. We were warned about this. All this distress and agony meant that the treatment was working. I must say it is super hard to get yourself wrapped around this miserable existence when your arms are wrapped around the toilet.

On August 3rd I was in to see the oncologist again because my nausea/diarrhea was out of control. At this time they drew another CA 27-29 and as you previously read it was up to 278 from 210. This is one of the aspects of cancer treatment that is counterintuitive. Just like when you are first pregnant. Sometimes if your morning sickness is really bad and you are puking every day you go into see the obstetrician and the nurse full of smiles asks you if you have been experiencing any morning sickness. “Yes,” you reply, “Every day and it is so bad and I can’t be away from the bathroom and I feel sick all the time.” Then the obstetrical nurse responds, “Good, that means the baby is sticking.” Grin, smiles, and a little wink.

So it is with cancer. The shittier you feel the better the better the treatment is working. From August 3rd to August 14th I really had a marked turn around. Since the 14th I have felt even better. So with this news I am happy to let you all know that the blood draw from August 14th was down to 157. That is more than 100 points. My oncologist is optimistic, Matt is cautiously optimistic and I am over the moon. The gross, disgusting days of feeling like crap may return. But I say to you with a grin, smile and a wink at least we know it is working.