Mary,

Thanks for your reassuring reply.

Denise

That was Allan's reply you quoted, not mine.  I presume what you want is
a clarification of his quote.  The important things to understand are:

1. Cancer grows by cell division, and that the cells divide at a fairly
constant rate say once every three months, so the mass or volume of the
tumour doubles over that same time.

2. The volume of anything is proportional to the cube of its linear
size, so for a tumour to double in diameter it needs an eightfold
increase in volume, which in the above example takes 9 months.

3. There are about one billion cells per cc in breast tissue, and one cc
is about the typical size at which tumours are first detected by mammogram.

4.  It takes about 30 cell divisions to get to a billion cells
( 2, 4, 8, 16, ... 1024 ... 32,768 ... 419,304 .. 107,374,1824), so in
the example that would take 90 months which is 7.5 years.

5. The dividing interval varies for different cancers, usually from
about a month to about four months.  Some cancers (Inflammatory Breast
Cancer) can have considerably shorter dividing rates, but these are very
rare, and have quite different symptoms such as sores and pain.

6 A normal mammogram is like a rough grainy photograph with lots of dark
and light patches on it.  A cancer may show up as a region of unusually
dark patches (in a 'positive' image) which outline the shape of the
tumour.  These are caused by small crystals containing calcium which are
left behind by dead cells, killed by the advancing tumour, which are
more more opaque to x-rays than the surrounding tissue.  A tumour needs
to be about 5mm across before it can be recognisable on the mammogram.
On a prior mammogram it may be visible with hindsight as a small
unremarkable darker patch similar to many others.

To your other question, there are really only two ways to determine the
dividing rate.  One is to compare historic mammograms, and see how
rapidly its dimensions have grown.  This is usually only possible where
a lump has been recognised but initially diagnosed as probably
non-malignant, and so just put on a watching brief.

The other is to take a sample and put a slice of it on a microscope
slide. Counting the proportion of cells that are in the process (or
"phase") of division gives a good idea of the dividing rate.  You might
see an "s-phase" count mentioned on the pathology report. The
pathologist also looks at the shape of the cells, how much they are
distorted from the normal shape of breast cells. This gives a measure of
the amount of genetic damage they have suffered, which is also an
indicator for growth rate.

Tim

Hi, Pami,

I'm not John, but am taking the liberty of replying, anyway.

It sounds like you're going through a very bad patch right now, and I very
much empathize.

I was diagnosed at stage III (yes, 3) at age 44, and had 5 tumors in one
breast (largest 3.1cm), 1 in the other breast (1.1cm), plus 1 positive lymph
node.  The enlarged lymph node was how I was diagnosed -- it didn't respond
to antibiotics, so they did more diagnostics.  The six months of chemo (3 of
Adriamycin/Cytoxan, 3 of Taxol) was a long slog.  It got pretty discouraging
at times.  At one point, I remember sitting with a friend and wondering
aloud if I'd ever feel strong or be happy again.  (Besides the BC, I had
lost my 45 y/o husband to esophageal cancer a couple of years before, which
didn't help on the happiness front).

Don't give up -- if you haven't progressed on treatment beyond stage II you
have a strong chance of long-term survival . . . and you're right -- I know
from experience with my husband -- it would be very tough for your husband
to lose you.  You *can* get through this, though it definitely isn't fun.

I'm almost 6 years out from my diagnosis now, and feeling *great*.  Maybe
better than I have in decades, in fact.  Among other things, I joined a
breast cancer survivors' rowing team, and the exercise really helped my
strength return, while the peer support helped me a lot on the psychological
side of things.  (And since then, we've seen scientific research saying that
regular exercise is one of the best things we can do to reduce our odds of
recurrence/metastasis . . . and to think I was doing it just for fun
<grin>!)

Among my rowin team-mates are a woman who had stage IV (yes, really) BC at
age 35, and has no evidence of disease (NED) now, 6 years or more later.
Another was stage III, with a 7cm lump, and even after neoadjuvant (before
surgery) chemo, had positive nodes despite dramatic shrinkage of the tumor
via chemo.  She's more than 7 years post-diagnosis, now age 53, and has just
had check-ups including some scans that showed NED.  Like you, she did
Taxotere.  She has some long-term side effects (peripheral neuropathy
reduces sensitivity of her sense of touch in her hands, for example), but it
doesn't seem to slow her down at all, and she considers it a good trade-off
for survival.

I understand that feeling of being through way too much -- after bilateral
mastectomies, the 6 months of chemo (which I started about 3 weeks after
surgery, like you), then 6 weeks of radiation, I was diagnosed with a
hypothyroid condition that prolonged the fatigue from chemo/radiation even
further.  It stinks.

You're almost through it now -- your strength will start coming back after
the last treatments.  Hang in there!

Ann T.
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Hi Pami,

It sounds like you're going through a really rough time right now. If
you're having pain, talk to your oncologist - there are things they can
do. Many cancer centres have psychologists on staff, too. Have you or
your family thought about talking to someone like that? Believe me,
they can help a lot.

Note that it's very unlikely, with a stage 2 cancer, that you're going
to die right now :) And why would you wish for something so final
without giving the alternative a chance? I had a stage 2 tumour with 3
of 7 positive lymph nodes back in '00. I was 31 at the time. I had 4
cycles of AC followed by 4 cycles of Taxotere (followed by radiation
and Tamoxifen), and there came a point for me just after the half-way
point where I was so tired of treatment and of feeling awful that I
just wanted it all to end. It was really hard to make myself go through
those last chemo treatments.

The thing is, the treatment does end. When it does, you'll start to
physically feel better. No, really. You will. You'll laugh again, too.

Unfortunately, my cancer returned this year, and we're awaiting biopsy
results - it looks like I have bone mets. Had I not had the treatment I
did 5 years ago (or had I given up when I wanted to), I'm sure that I
would be dead now. That would be a shame, because these last 5 years
have been the best of my life. I've done things I never thought I'd do,
and have enjoyed these years more than I did the 31 before the cancer.

Chantelle

Hang in there Pami.  By your diagnosis - stage 2; 3 nodes, you have a
pretty good chance of seeing this through. Chemo is very disheartening,
but think of it as "what doesn't kill me makes me stronger".  If you are
feeling bad, think how bad the cancer is feeling.  If there is any left
at all by now.

It is a kind of double whammy that at the same time as coping with the
treatment, you and your husband also have to come to terms with with the
"what if you don't make it" scenario, preparing for the worst.

Chemo is horrid, but it does pass.

Tim Jackson

That would be way premature. Even if the chemo is not 100% effective,
you probably have at least 3 to 5 good years left. Many BC patients
with a diagnosis similar to yours have gone on to live cancer-free lives.

Chemo is the only treatment I know of that has a chance of killing
the cancer cells that have traveled through the bloodstream to
other parts of your body. Yes, chemo can make you extremely tired.
But after the treatment is over, you will start feeling better.
My wife had three good years after her chemo was completed.

A loving husband does what needs to be done. I sat with my wife and
held her hand through every chemo session, and waited on her hand
and foot. It helped that I was already retired. She was only 57 when
she passed. I didn't start falling apart emotionally until after the
memorial service.

It could have passed down one of the minor lymph ducts that run around
the front of the torso, or it could have gone straight to the
bloodstream by invading a vein.

It doesn't *have* to invade the lymph nodes before spreading elsewhere,
it just usually does because lymph ducts are easier to invade than
veins, and the bulk of the lymph goes through the axillary nodes, which
capture most of the cancer cells to keep them out of the bloodstream.

Tim Jackson

Chemo works for many patients, so I wouldn't discount it
just because it (apparently) didn't do the job for my wife.
At the time of the initial BC treatment she was given an 85%
chance of no recurrence over the following five years.
Someone has to make up that 'unlucky' 15%, although
you never think it will be you.

Grading is not a matter of fact, it is an evaluation of the available
evidence, and it is updated as more evidence becomes available, so it is
not uncommon for the stage to change in the light of the path report,
after that have examined the excised tissue under a microscope.

The mastectomy is I expect not because of the staging, it is because of
the failure to obtain "clean margins".

Her situation most commonly arises when the cancer is found to extend to
the edge of or beyond the excised lump, They normally would try a second
lumpectomy first, unless there is not enough tissue left to warrant
another larger cut, or the cancer is found to be very aggressive.

I'm sure they didn't take them at random.  It is likely that there were
only five nodes in the lymph path that drains the breast.  The number
varies a lot from person to person, maybe anything from 5 to 20 are
common.  The number present does not seem to matter very much for
diagnosis, it is the number of positive nodes that is most significant.

Insignificantly.  Most cancers, at the time of detection, have been
growing for about 10 years, most of that time they were too small to
see.  So another couple of weeks isn't likely to make much difference.
Early chemotherapy would also interfere with the wound healing.

Once it gets past the nodes it passes into the blood. and goes
everywhere, but particularly places where the blood slows down a lot and
there is a suitable environment for the cancer to attach and grow.  This
is mainly the long bones and skull, also lungs, liver and brain.  The
fact that there is cancer in the nodes means that certainly some has got
into the bloodstream.  The big question is whether any have got well
enough established to be beyond the reach of chemotherapy.  With four
nodes affected, the chances are about 50/50.

The cancer was there then, no doubt at all.  It just wasn't showing a
recognisable trace on the mammogram.  It happens.  Other tools might or
might not have detected it - sonogram or PET scan.  PET is good but is
very much a judgement call, it is expensive, it exposes the patient to a
lot of radiation, and it is not available everywhere.  So it is not
prescribed lightly, the doctor has to feel there is a good reason to be
looking, otherwise he is likely to create more cancers than he cures.

For all the media hype, diet is not that important. We are not what we
eat, and cancer hits pretty much at random, although some lifestyle
choices increase the risk.  Obesity is probably the biggest manageable
risk factor.

Understandable, but not logical.

Tim Jackson

Many many people get cancer who have always led healthy lives.  It isn't
about anything she did or didn't do.

Don't beat yourself up, depression is a real illness and makes people
think irrational thoughts.  You *didn't* kill yourself and now you're
able to be there to be a loving support for your Mum.

My son was in exactly the same position as you, but he has been my rock
during the past year after I had my mastectomy, and suffered what seemed
like an endless seroma followed by a long-running abscess and finally
chemotherapy.

Since his illness prevents him working, he did all the shopping, all the
cooking and all the housework, and when I was still in bed for most of
the day, he kept popping in to see me to make sure I was OK, usually
bringing a cup of tea or some other little treat.

And strange as it may seem, I'm almost sure that my illness has been
partly instrumental in making him feel very much better.  I couldn't say
why, though.  Maybe it was because he felt of use.

I'm thinking about you both.  Your Mum will probably have many years of
happy life ahead of her, so don't despair just yet.  I know it's hard
when you're depressed, but lots of people live for years and years after
diagnosis.