It was autumn 2011. My partner was full of health and energy, and looked pretty good for someone in her late 30s.
She was diagnosed with cancer in late 2011. An operation was performed in early 2012, and chemotherapy treatment began soon after.
The most discomforting part of it for her was not the cancer itself: unless the tumor pulls adjacent tissue or is near a joint, cancer is often painless to begin with (but eventually fatal if left untreated, a combination that make it deadly). The worst part for her was the chemotherapy.
Important note: the following description (and the rest of the post) relates to women’s breast cancer. Effects of particular chemotherapy treatments vary widely (from minor hair thinning to the effects illustrated in this post). Treatment varies by patient age, cancer type and how long it has being there (and to a lesser extent, which country you are in). You may have radiotherapy only, which is far more targeted and therefore far less invasive than chemotherapy.
Symptoms of the Cure
How does chemotherapy feel? Remember the most drunk you ever got, and then recall the associated hangover. After chemo, you get that hangover for weeks.
Chemotherapy doesn’t involve pumping you full of poison, but in practical terms it’s not far off. Chemotherapy drugs are like vitamins in reverse. Instead of adding the essential elements that your body needs to grow and flourish, chemotherapy drugs prevent your body from absorbing those essential elements, thus stunting fast cell growth. Cancer cells are the fastest growing part of your body so it suffers most from this regime: chemotherapy works by starving and stunting cancer by denying it the nutrients it needs.
Non-cancerous but naturally fast growing parts of your body (such as hair, skin, taste and smell receptors, immune system, stomach and ovary linings, and short term memory cells) also starve with the tumor, so you will lose them (or they will stop growing and start to show signs of wear). You will look and feel differently, both for the worse.
How does chemotherapy feel? Remember the most drunk you ever got, and then recall the associated hangover. After chemo, you get that hangover for weeks. You may also get additional issues, such as constant itching or feeling hot/cold (both caused by chemo affected nerve endings). When your body begins to recover, you have a week or two of a semi-working but spaced-out body before the next chemo course.
Half way through this, she had no head hair nor eye-lashes and was constantly tired with persistent aches. Her memory and concentration were starting to go (‘chemo brain’). Hair loss from the head is one thing, but you’ve probably never considered what your nose becomes when you lose the hair in your nasal passage: a water spout.
The only solids she could stand were mashed potato and vanilla ice cream. Her sense of smell and taste were now so unusually good she could not stand anything else. I did not appreciate this until the week before when she had not been able to sleep, telling me she could smell milk, so I got up, went downstairs and opened the fridge to find a milk carton dripping.
So, anyway, one Sunday she was depressed. She told me she looked ugly. I said she looked beautiful. She said I would say that. There was only one thing for it. She may have only just got up and still in a bathrobe, but I had to cure this.
I got my camera.
She had bought wigs but she didn’t feel confident about them. I said go ahead and put them on: I’ll take some photos and you can see how you look.
She got to like the wigs. In the week before the next chemotherapy treatment, she would have a few days of normality, and go out. Modern wigs are very good: they make you look like you have your ‘going out hair’ on all the time but with zero effort. A good trick she learned was when she was getting unwanted attention: she would lift the front of her wig just enough to make it obvious.
This had all happened first thing in the morning, and taken about 10 minutes so far (I was shooting hand-held with only natural light so there was no setup), but she was already by now tired from all the excitement.
I put her to bed 30 minutes after she had got up.
Later that month, her eyebrows would fall out, as well as some of her nails. She would forget to take the anti-sickness tablets after one chemo, and that night throw up so hard and fast that she would end up with two black eyes from the pressure.
As of this writing she’s in remission and every now and again she will say ‘how did I get through all that?’. I show her these photos and say, look, you were beautiful.
And you were smiling.
Looking back: what I wish I knew at the start
The best technical cure we have is time. The earlier cancer is detected, the better the outcome.
We’ve met a few people through cancer, some of whom are unfortunately no longer here, but most who are. There is no cure for cancer and there may never be. Cancer is always a genetic disease and thus a disease of chance: you might have it, you might not, and family history (generic disposition) and lifestyle may put you further up or further down the lottery, but (for most people) it is still a lottery. Science is making the ‘might have it’ closer to ‘might not’, but we’re a long way from ever making it ‘will not’. And anyway, cancer is not a single disease but a class of diseases. We have no less chance of curing cancer as we have of curing all viral diseases or all bacterial diseases.
The best technical cure we have is time. The earlier cancer is detected, the better the outcome. Early treatment has high success rates: it means we know where the cancer is and can be sure it has not spread nor mutated so much that it no longer reacts to chemotherapy. If we detect cancer cells this early, there’s a high chance we can remove the main tumor and/or shrink it via chemotherapy, radiotherapy and hormone drugs.
One particular issue she came up against was age: doctors are trained to expect high incidence of cancer from the mid-fifties onwards but do not expect it in younger patients because its occurrence there is statistically very low, particularly for breast cancer. That means if like her, you actually do have breast cancer in your late thirties it is difficult to get an initial expert diagnosis (your general physician is not an expert when it comes to cancer – the most they can do is suspect cancer and refer you to someone else for proper tests).
We know of at least two people who were told to ‘come back in six months’ because they were too young to be at risk and there was no family history. As I said, time and early diagnosis is the only true healer of cancer, and we ended up at the funeral of one of those two people because of that six month wait. If you feel you may have cancer because of suspect changes in breast or other tissue, ask to see a specialist.
Another issue we found going through the process (and sharing with others experiences) is the effect of the Hippocratic oath. Many physicians will not tell you if a chemotherapy course has a greater chance for failure. The modern interpretation of the oath means medics must leave the patient with a sense of hope, but this can reduce remaining physical quality of life. A doctor or surgeon may or may not tell you this based purely on their judgement, but they are duty bound to tell you if you specifically ask. If you do ask, do it in medical terms so there is no room for interpretation. Ask ‘what is the prognosis of this treatment, given my condition’. You are not then just asking for the success rate of you as a patient (which may be subjective), but also the historic survival rare of previous patients with your condition who underwent your treatment. If you want to know the prognosis and expected efficacy of the treatment but are not the sufferer, my advice is don’t ask when the sufferer is there.
There are lots of websites out there that claim all sorts of things: vegan or vegetarian food stops you getting cancer (no – my partner has been vegetarian for as long as I’ve known her, and vegan before that), or there are foods that can prevent cancer (there are foods that can boost your bodys ability to detect and kill pre-cancerous cells, but that does not negate things that can cause cancer, such as cigarettes). This issue is compounded by medical staff who do not make the disease understandable. As a carer of someone with cancer, I had to sit down and read several books on cancer. I have written a summary of what cancer is and what causes it as an addendum in the notes section for this post.
Recovery, and a Cure for Cancer
Her hair began returning after treatment.
Her hair came back just like hair grows on a newborn (very fine to start off, a little curly at the back, growing unevenly to start off with), so because of that and her propensity to sleep a lot, I called her ‘the baby’ for a while.
Well… actually, the name has stuck.
The most important part of her experience with cancer has been how friends and relatives have treated her. Cancer is a mirror through which the sufferer sees how important things in life really are, and this is especially true of other people. From discussion with others, we have found this is a common theme. Cancer survivors are likely to seek change. Divorce, loss of contact, or new found affection and understanding with family members and close friends is very common, as is a sudden change of life-direction.
We’re both pretty sure that we would have separated within the last two years if it wasn’t for cancer. We had been together for over 15 years, never married and never wanted children, and time was beginning to drag. Cancer lifted the veil of familiarity and showed us what we really thought of each other. And in the end, that was our cure: a change for the better.
And for that, we have cancer to thank.
Cancer is very treatable given early detection, so time is always important. Your physician expects to see adult patients presenting possible cancer symptoms from the early 50s up. The incidence of breast cancer before your 50s is so low that some doctors will underplay its possibility unless there is family history. That’s fine unless you actually have cancer. If they tell you to come back in a few months, remind them that if you really have cancer, that delay in diagnosis may be a death sentence.
Although most people are put off by losing their hair and poor skin and nails (as well as not being able to do much for 6 months of their life), this can be managed. Good modern wigs are indistinguishable from real hair so you won’t be a recluse, but bear in mind they only last a couple of months so don’t get the top of the range one (two or three mid priced ones are better, and bear in mind that they are really hot in summer so get at least one short one. Oh, and don’t get them from that surprisingly cheap China based site that keeps changing its name (but is always the first or second paid result on Google). That one is a scam. We found out by noting that their photography was ripped from other sites or of celebrities who were clearly not wearing wigs, and further searching yielded scam-victim groups on Facebook). Do your research if you are buying online, and if you have been taken in by them, click on the Google search every couple of days (the clicks are all paid for, and using them will reduce their advertising budget).
If you are not the sufferer, how you treat a spouse or close relative diagnosed with cancer will have a big effect on how they treat you when they recover. Cancer sufferers have a lot of time to consider their past life and future direction, so actions really do speak louder than words here.
Some foods are beneficial as a cancer-prevention measure… Such foods are not the ‘super-foods’ that some websites will try to sell you, but the normal healthy eating options we all already know about: 5 fruit or vegetable portions a day, don’t eat excessive amounts of red meat nor excessive amounts of any one food.
Cancer is always a genetic disease caused by mutations in your genes. This was not known as a certainty until the 1980s, but has caused massive advances in the treatment of cancer since then. Success rates are now much higher than they were even a generation ago because we now know the underlying cause of cancer.
Generic mutations occur randomly in our cells over time, and can by chance leave a cell in a state where it becomes cancerous.
Think of this process of cumulative mutations as being like a thief trying to unlock a safe. The thief has to find the correct combination by altering the tumbler dials of your genes. This takes time because there are so many combinations, and in most cases, the thief is out of time: you have enjoyed and lived a natural lifespan before the thief gets anywhere.
If the thief does crack the combination, you have a cancer cell in your body, but there is also a window of opportunity: we can detect cancer fairly easily and eradicate it as long as there is an early diagnosis.
There are several distinct ways the thief finds the combination and gives you cancer:
- Inherited predisposition to cancer. Sometimes, part of the safe’s lock is already open when you are born meaning the thief has more chance of getting the full combination before you die. This corresponds to being born with a genetic disposition to getting a particular type of cancer, and is almost always the cause of childhood cancers, unless the patient has been very very unlucky or introduced to strong carcinogens whilst very young.
- Carcinogens. Sometimes you help the thief along by speeding up the rate he can make guesses by ingesting something that increases the rate of cell mutation. These ‘somethings’ are called carcinogens. They include cigarette tar, asbestos, soot, radioactivity (which can include too much direct sun), some substances derived from deep underground (most heavy oils will give you cancer if you leave them on your skin over a long time, which has historically affected many industrial workers). Some foods and drugs can be carcinogenic, and we will look at them under Lifestyle and Cancer.
- Retroviral action. Occasionally, the thief gets lucky by having parts of the combination given to him via certain retroviruses such as Human Papillomavirus (HPV). A retrovirus works by combining its genetic information with the host’s genetic information. Unfortunately, thousands of years ago a cancer victim was infected with HPV, and the cancerous gene is now part of the retrovirus. When the HPV virus combines with your genes, you have an increased likelihood of getting cancer because infected cells now contain an inherited predisposition to cancer (point 1 in this list). This mode of cancer infection commonly occurs for women (increased disposition to cervical cancer caused by HPV infection) and can be detected via a smear test, and this is why you should have a regular smear test. It can also happen to either sex for certain stomach viruses.
- Chance and old age. The thief can simply get lucky. This becomes more likely as we get older because the thief has more time to get lucky. It is also why, other things being equal, incidence generally increases with age. As we now live longer, the thief gets more time than he did even a few generations ago. This is one reason why cancer is now a primary cause of premature death in all developed areas of the world.
- Premature aging through viral action. Some viruses can overwork or strain an organ so it prematurely ages (or fails to replenish, thus leaving cells that are much older than they should be) a condition that leads to cancer via point 4. For example, cirrhosis of the liver can cause cancer of the liver, and Hepatitis C can cause cirrhosis of the liver, so Hepatitis C is strongly linked to liver cancer. Incidentally, overuse of alcohol can also cause cirrhosis of the liver, and therefore eventually, cancer.
- A weakened immune system. As discussed previously, your immune system catches many cancerous cells before they get a foothold. If your immune system is not there to perform this function, your chances of getting a tumor increase
- Lifestyle. See the secion below for more on this.
Lifestyle and Cancer
What you are putting into your body (or adverse conditions that your body is going through such as extreme stress) can increase the cancer risk.
If cancer is always caused by genes, how does eating something give you cancer, given that food does not generally change genes?
- Some foods and drugs are simply carcinogenic: not so poisonous that they kill cells, but instead damage the cell DNA whilst leaving the cell alive. This causes increased rates of cell mutation (effectively speeding up the rate the thief works against us in getting the combination). Smoking is a good example of this.
- Other foods contain chemicals that affect the local hormone balance, which can change the way our cells work for the worse. Cheap meat full of animal growth hormone may have some causal effect.
- Some foods and drugs can overload an organ and lead to premature aging (and because age is related to cancer incidence, premature localised aging increases the risk of cancer in that location). Drinking so much alcohol that your liver begins to die will give you cirrhosis, which in turn can kill you through liver cancer.
- Some foods are beneficial as a cancer prevention measure. They boost your overall resilience by feeding your immune system and prevent you getting cancers in the digestive system (such as bowel cancer), although you can’t count on these foods curing you if you already have cancer. Such foods are not the ‘super-foods’ that some websites will try to sell you, but the normal healthy eating options we all already know about: 5 fruit or vegetable portions a day, don’t eat excessive amounts of red meat nor excessive amounts of any one food.
- Stress in itself probably doesn’t have anything to do with it, but it may be an indirect secondary cause (stress tends to prevent you making healthy choices, reduces your immune system and may stress some organs), all of which can be significant if they occur together.
- Finally, obesity can increase the risk of cancer through associated hormonal changes. Obesity is also a significant complication that may make treatment more difficult.
Except for smoking or drinking heavily, it is not clear whether or not any single lifestyle choice on its own will cause cancer, but it is clear that if you are living under several poor livestyle choices, your probablility of getting cancer will go up.
Adding it all up: probability of getting cancer
So far we have seen that cancer is a game of chance, but there are things that increase it’s likelihood. You can have an inherited predisposition to cancer, a weak immune system or you can simply be long lived so cancer becomes more probable for you. There are also behaviors that make cancer more likely (smoking, long term heavy drinking, never having smear tests, living in a house that sits over a radon gas deposit, sunbathing until your skin burns, working in an oily or sooty environment and not washing it off, or lacking a varied diet so you end up eating too much of certain foods causing a carcinogen build-up in your body).
Finally, as with any game of chance, you can simply be unlucky.
Eating fruit and vegetables will make you healthier (plus give some protection against certain cancers) and bump up your immune system so some pre-cancerous cells are detected and killed naturally by your body, but the reverse effect is far more marked. Eating carcinogens is a much bigger issue and is not negated by eating well: being vegetarian but smoking probably puts you in negative territory overall. You always need to consider the overall risk your lifestyle is introducing.
Further, a healthy immune system only targets a subset of pre-cancer. If you have a family history of breast cancer, filling your body with healthy ‘super-foods’ and vitamins is a start but you really need to be having regular cancer checkups or going on a pre-emptive course of Tamoxifen. Carrot juice on its own will just not reduce an existing tumor.
How cancer can kill you
Cancer is always present in your body: you are actually born with some cancerous cells. The human immune system detects most cancerous cells and will kill them itself, and will do this often throughout your life. We don’t usually talk about such cancerous cells when we talk about cancer because they never come up on our radar. There are some cancers that the immune system does not respond to.
These cancer types are fatal if left untreated because cancer cells prevent the infected organs from carrying out their normal function (cancer cells generally provide no biological function, so are fast growing deadweight that crowds out or starves normal function).
Where cancer infects cells that you can live without, it is still dangerous because it can (and will if left untreated) spread to other, more vital organs. Thus, breast cancer is dangerous not because you cannot live without breast function, but because breast cancer can spread to other organs that you do need to live. Most cancers actually have a number of stages to go through before they become dangerous, and these are
- Carcinoma in situ: a small number of cancerous cells that have not yet started to invade nor form into a tumor or lesion. Sometimes this is called a pre-cancer stage because it is not yet dangerous (but will become so if untreated).
- Tumor: When a group of cancer cells have invaded the local healthy cell population, stole their blood supply and grown, you end up with a tumor. A tumor’s danger is specified by several things, but generally, these are to do with time (how long it has been there, how big it has got, and how much like normal cells they are), the importance of the organ they are in, and how easy it is for us (and chemotherapy drugs) to get to the tumor.
- Node: A tumor does not usually hit the jackpot and start in an organ that can kill you: it normally has to spread before it can kill you. Most of our organs are self contained, separated by membranes, There is only one way out of an organ: through the Lymphatic system. This is effectively a drainage system with an immune system tacked on: it drains your organs of fluid and is a gatekeeper and defense system for when things go wrong. Cancer cells have to exit through the lymphatic system, and we can see when this has happened because some lymph nodes contain cancer cells. If you have very few or no infected lymph nodes then its probable that the cancer has not yet spread from the original organ.
- Metastasis: When a large number of your lymph nodes are cancerous it is seen as a sign that the cancer has become mobile and has spread to other parts of your body. This is called the metastatic stage.
Generally the further along these four stages, the more advanced the cancer. Your specialist will certainly discuss how far your cancer has got with you, and often in terms of the stages noted above. Most of the stages have sub-stages. For example, the Tumor stage has different levels depending on the tumor size.
An important feature of a cancer is how far it has mutated vs. how well it remembers its original cell function. If it does remember its original cell function, it becomes easier to treat because the cancer cells will respond well to normal body chemistry, and can therefore be killed by blocking normal cell growth paths (i.e. blocking hormones that the original cells need to grow and thrive via chemotherapy). Another issue is where the original tumor is. A tumor in your brain does not have to get very big before it affects normal function, and a tumor in certain organs (such as your bone marrow) is harder to treat because chemotherapy nor radiotherapy can get to it.
Historically, there have been different types of individual treatments, all with some success (but none with 100% success on their own), including tumor removal, disconnection of the affected area from the lymphatic system, chemotherapy, radiotherapy, and long term hormonal drug treatment. Modern treatments combine more than one of these individual treatments so that the success rate is very high. For example for breast cancer, you may get tumor removal and chemotherapy (the exact order dependent on personal preference or the specific cancer), followed by a short radiotherapy course, then a long term (5 years) on Tamoxifen hormonal treatment, and finally regular checkups for life. Having such interleaved treatment vastly increases success rate to the high 90s, and close to 100% for early detection.
Once you have gone through treatment, you will have tests to find any traces of the cancer. Full remission means no traces of cancer were found. It may mean you are totally clear of cancer, but that is not the same as being totally cured because of the way cancer works. There may still be one or two undetected cancer cells there, which is why you may go on long term hormone therapy such as Tamoxifen: that is targeting the one or two cancer cells that may still be there even though you are in remission. If you have a genetic disposition for cancer, it may mean that there are other pre-cancerous cells in your body, and again, that is what the hormonal treatment is targeting. Finally, a genetic disposition to cancer means that you may get the cancer again. Often the chances are lower than getting it the first time if you get to full remission: you will have died through old age before the thief gets lucky again.
What that all means is that cancer is a lottery, so doctors don’t say ‘cured’, they say ‘in remission’. In practical terms, this means you will have to take regular precautionary tests for the rest of your life. That is not a bad thing: all things being equal, the chances are that you will have lived a long and normal life well before the thief gets to you again.
- All photographs taken with a Sony A500 DSLR, hand held, natural light, unless otherwise stated. Converted from RAW with DxO Optics, then post-edited in Lightroom.
- Some of the shots have extreme depth of field that is greater than that possible on a crop frame camera, and really hard on a full frame camera unless you have very fast and expensive glass. I cheated: it was done in post via Photoshop’s Field blur filter. See here for a youtube tutorial on the process. In addition to this technique, the slight ‘halo’ around the face seen in chemotherapy #2 and chemotherapy #3 is created by increasing the background selection to include about 2-3 pixels of skin. This causes the skin to be part of the field blur and this creates the halo.