Adjvnt Therapy: Destroys or delays growth of stray BC cells?
So this question popped into my head and has been bugging me. Can't get any info out of Dr. Google and I'd ask my Onc , but my next appt isn't until September.
So if chemotherapy/hormone therapy can not cure metatastic breast cancer..only hold it at bay. Is that the same for adjuvant chemotherapy and hormonal therapy after initial surgery for BC (lumpectomy/mastectomy)? How can the chemo be "destroying any undetectable risidual bc cells" if we know that it is not able to fully destroy Stage 4 bc cancer cells? Wouldn't any "undetectable residual bc cells" that could possibly be lurking in our bodies be technically the same as stage 4 cancer cells that just haven't "grown big enough" yet?
Or are undetectable residual bc cancer cells more vulnerable and able to actually be destroyed at that early state? But then some of us will still get a recurrence and/or metastasis despite doing adjuvant chemo and/or hormonal therapy. If BC has escaped into your body and not removed with the initial surgery....is it all pretty much a crap shoot as to when (not if) it will recurr?
Is our distant recurrence (stage 4) fate predetermined at the time of surgery...and adjuvant therapy is just delaying the inevitable?
Don't get me wrong... if hormonal therapy/chemotherapy gives me 5 to 10 years of being cancer free ~ I'm all for it. But I'm just wondering if we are sometimes being given a false sense of reassurance that IF we do chemo/hormone etc that we are preventing recurrence. That if recurrence is going to happen it's going to happen no matter what...and all we can hope for is a delay?
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You know I've wondered the same thing. I sort of think that's one reason some of us are told to continue the AL's for longer than 5 years. My pasters wife has had BC 2 times, though the 2nd was very local, but she was on the AL's for 10 years. Her Onc. feels she has the type of BC that wants to return, so kept her on them for a very long time. She is off as of this year at the age of 65.
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Okay I'm glad at least one person has thought along those lines... sometimes my thinking ends up in left field!
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Chemo kills cancer cells, but isn't effective 100% of the time. That is why different types of chemo, and combinations. The problem is that you have no way of knowing if you were among those cured unless you have a recurrence of the same type of cancer.
Hormonal therapy creates an unfavorable environment for anything left behind to grow, if tumor was ER+.
I thought one of the most interesting posts was by a lady who had a nasty Stage III cancer. She had neoadjuvant chemo. When they went in to do an assessment prior to surgery, they couldn't find any cancer!
She still had the surgery, but in her case, chemo meant that she went from sizeable tumors down to undetectable. Now, if there are no cancer cells left....and this could be the case....she was cured by chemo alone.
Having been through all the recommended treatment with 4 years of AIs left to go, I really believe I am cured. I am moving forward with my life at full steam based on this premise.
Yes, it is always a crap shoot, but the survival statistics tell you how the dice are loaded. I want to point out that I am limping around from wiping out on my bicycle 2.5 weeks ago. All I did was hit the pavement hard, and no worse than a nasty sprain.
But if there had been a big truck behind me, I wouldn't be worrying about the cancer survival statistics. - Claire
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I cant comment on the chemo but I believe the hormonal (as far as Arimidex is concerned) delays the recurrence. I base this on the product monograph from Astrazeneca(drug manufacturer). I have reproduced part of the monograph :
... Adjuvant therapy is given to prevent or delay these cells from multiplying and spreading. The purpose of adjuvant therapy with ARIMIDEX is to help to delay the breast cancer from recurring. Cytotoxic chemotherapy, radiation, and hormonal treatment are three common forms of adjuvant treatment.
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Claire, how are you feeling? If I remember you had a ride over the 4th. Knowing you a little sprain isn't going to get you down. You have such a great way of looking at life. By the way I got my re-bounder, and am hoping it helps with the equilibrium so I can ride a bike in the near future.
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Claire, love your last sentence. I'm getting ready to leave work for a 45-min drive home down the side of a mountain and through some pretty hairy turns. Something is going to get me sooner or later.
SusansGarden and others, questions do pop into my head from time-to-time as well so please don't think I am minimizing your concerns as we all deal with our thoughts and emotions in different ways. And, that is a great question; actually had me smiling as I could see you going out into left field, coming back to home plate, looking over to shortstop and back to the dugout!
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re: Is our distant recurrence (stage 4) fate predetermined at the time of surgery...and adjuvant therapy is just delaying the inevitable?
To this question there is no way of knowing. If a person has a recurrence, obviously those cells came from the primary, but there is no way to tell in a person that does not have recurrence. What I mean is, if a patient who has clear nodes and no LVI is given hormonal therapy (and I fit that despcription, so let's say me) and the cancer never comes back, then one of two things has occured. Either I had every last cancer cell taken out by surgery and rads OR I had undetected micro-mets that were successfully starved to death by my Tamoxifen. So, if I never get recurrence, I won't know which scenario precipitated it.
If I manage to stay cancer-free, I don't really care which of the two it was, I can LIVE with not knowing.
Can't answer for chemo, didn't have it; my knowledge is limited.
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Great topic. I'm having such a terrible time with AIs that I got thinking...however irrational it may be. Why couldn't I (we) do chemo once a year to kill everything that might be circulating instead of AIs? We could alternate chemos as I know they all stop working at some point. I just have to believe there's something better than hardly being able to walk, type, sleep, etc......
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I don't think we will ever know. Unless there is some way to determine if a cell or cells escaped and the perfect storm is created in our body to create another tumor elsewhere. But unfortunately we can't pin point the cause as to why the cancer started growing in the first place.
What we do know is our bodies are capable of growing cancer and we need to take whatever steps available to prevent recurrence. They seem to be considered insurance policies with no guarantees.
In addition, we can boost our immune system and create an inhospitable environment in our body which may prevent a recurrence using natural medicine - aka food. Again no guarantees here either.
Bottom line is we have to do the best with the information we have today and run with it.
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Oh I'm definitely living my life to the fullest and don't sit and fret about BC.
I'm just a Curious George (sometimes hanging out in left field
...and was just trying to wrap my head around if chemo/hormone therapy can't kill metastasized BC (i.e. the cells keep mutating and eventually become immune to everything over time) then how can it "kill" rogue cancer cells during adjuvant therapy? I understand it helps. I understand it shrinks tumors to NED proportions. I'm just wondering if it's inaccurate to say it ever kills ALL cancer cells? Since it obviously doesn't in Stage 4 situations. 0 -
I have debated this too. It makes no sense to me. If cancer cells have strayed from the breast into other body parts, isn't that stage iv by definition? And we are told that chemo will not cure stage iv, so what is the point of chemo other than to delay the inevitable?
And what is the point of radiation if chemo kills all the stray cells?
Although I think the doctors (at least most of them) mean well, I often feel like they are full of it. I am sure it is more complicated than I am thinking, but I cannot really grasp the seemingly inconsistent theories surrounding the various treatments and stages.
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Elimar ~ as you said ...either every last cancer cell was taken out by surgery/rads OR Tamoxifen starved any undetected micromets.
And that's my question. Does Tamoxifen/AI/Chemo etc really starve them.... to death? ...or just to a quieted state of being for an undetermined period of time? In my/our scenario..if Tamoxifen really does "kill/starve" the little buggers...then I should be slap happy to move on after 5 years. But studies show that many ER+ people have recurrences much later than 5 years. So the Tamoxifen may, in reality, just be keeping it at bay...for those who are destined to metastisize? Bringing me back to my Curious George Question of philosophising ... maybe our recurrence fate is actually determined at the time of surgery? And anything we do afterwards in form of adjuvant therapy is really just a delay (which is great ~ don't get me wrong) but recurrence is inevitably out of our hands?
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lmk ~ very interesting that the Armidex specifically says "delay". I'll have to go check my Tamoxifen info!
Irr4993 ~ I wondered the same thing too. If you end up Stage IV...then weren't you technically Stage IV at the time they discovered your original BC? Not that they can tell at the time...but theoretically...you would have to be, wouldn't you?
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When I was diagnosed I was told I had one possibly two cancers that were close together. I decided to have mastectomy and prophylactic mastectomy of my other breast. It turned out I had three cancers, one measuring 1.3 cm, second measuring 1.1 cm and third (surprise) one measuring 0.2 cm. On my final path report it was noted two visible cancers. Third one was discovered after the whole breast was resected slice by slice.
If I had lumpectomy I would most likely end up with third one not being discovered and down the road that one could turned to recurrence.
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I'm with you on this one, it doesn't seem like there are any clear answers for this one! So I've been tossing this theory around, maybe there's some truth in it.
Chemo & rads should kill the little buggers, but if there are no guarantees, so one should do an AI, because maybe any leftover cells will be tired of sticking around. Or maybe a cell's life span isn't the 5 years that one takes an AI. But I think you would have to be right, if there are stray cells that are stubborn enough to make it through all that, then you will have a recurrence, not because you were stage IV from the get go, but because a cell that was just floating around decided to divide and multiply, to create some friends to party with.
I read somewhere it (theoretically) takes 10-13 years for a cell to turn into DCIS. I don't know if that holds true post treatment, but it would seem so, because they do have the 5, 10 and 15 year milestones post treatment. I think technology is great, and it lets us see much more than it used to, but there is quite a bit it can still miss, otherwise there would be a cure and not just treatment. I think a lot depends on the level of care, and the skill of the surgeon in getting all of it out, and not just what they can see. So maybe if we don't have clear margins, and they have to go back, does that give the cells a greater survival rate? Something along those lines. I know if I were a cell and a big knife came at me, I'd probably try to get out of the way and relocate, so would that cell miss targeted treatment?
It would be interesting if they would do a study on people who have had MX and the recurrence rate, and the ones that didn't have clear margins and the recurrence rate, and if the 10-13 year theory has any credence, maybe trace back the time that it would have started (based on the size or other factors) and see what was going on at that date; such as any environmental factor or new pesticide or something had some impact on setting things in motion.
If a recurrence starts with a single cell, I don't think it makes you stage IV from the onset, because if you take 2 women who have the same treatment at the same time, but both have a stray cell left, maybe one will have a recurrence and the other won't.
Just my thoughts, I could be totally wrong.
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hi I have learned so much in the last several months and this I still find amazing. My mom who is alive and a breast cancer survivor for 16 plus years had the following. Two cancers- one invasive ductal and the other a spindel cell carninoma- highly aggressive cancer (was considered maybe fatal) plus other lcis....Treated with a unilateral mx and chemo of the 90's. Today 16 years later she still takes evista and remains NED. So I guess the theory is that a bad cell could find a home.
Interestingly, my 2nd opinion MO (super specialist) indicated that with my own stage 1.... if I could not handle the hormonals I could have my ovaries out and that would be good enough- I just started fareston leaving tami... My own MO disagreed and would like me on medication for as long as possible... So my conclusion is they don't know, and the tests cannot detect anything until its to late (reoccurance) so we are all a work in progress.
Hope this makes sense.
Chocolate
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When my medical oncologist explained to me that I needed to take Tamoxifen, he said it would, "mop up" any stray cancer cells. So I said, "Great, then if I take the Tamoxifen, I don't have to worry about a recurrence down the road." And then he replied, "With breast cancer, you never know." I've ALWAYS held the belief that from the get go, either you will get a distant recurrence at some point, or you are cured following surgery despite whatever else you do. I also think that all of the statistics that they have accumulated through the years, add up to educated guesses about who will ultimately do well and who won't. Is the Tamoxifen killing off those stray cells or creating an environment that just puts those cancer cells to sleep, I don't think anyone knows for sure. Likewise, there exists the possibility that the Tamoxifen is unnecessary because there were NO stray cells in the first place....I don't think researchers even understand why when people do get distant recurrences, why some people get it the organs while others get it in the bones. And then there is the question of how to explain why some Stage IV patients can be NED for decades....I come back to what my doctor said, "With breast cancer, you never know."
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This is an interesting topic. It was explained to me that everyone has "cancer sparks" - i.e. abnormal cells that try to divide and grow. However, the body recognizes the threat and the immune system stomps out the spark. With cancer, the immune system either doesn't recognize the threat or doesn't do anything about it, and then the cancer grows, developing a blood supply, and other things necessary to sustain it. It's been a long time since I've read it, but I think Susan Love's book also had some explanation about this process.
I view chemo and rads as giving me a clean slate, and rebooting my body's ability to recognize cancer. I am hopeful that if abnormal cells again try to divide and take over, that my body will recognize the threat and my immune system will kick into gear.
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This is very interesting. I am curious too, and take SusanGarden's point that it seems to be a contradiction. If the chemo and rads can supposedly knock out the cancer at stage I or II, then why can't chemo or series of chemos cure stage IV? Could it be compared to a bug infestation like cockroaches or bedbugs (no I haven't had those, but would prefer them to bc) - if you call in an exterminator for a small group of bugs, then chances are he will get them all with the pesticide, but if your whole house is infested, then there will always be a few escapees to keep the infestation going? What is the mechanism going on at Stage IV that keeps the all the little b@#&*@ds from being zapped by chemo and rads?0
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I think part of the explanation might be that with early stage chemo, our immune systems have a chance to reboot following tx, as tpcjkk said above. But with metastatic bc, often chemo has been used so many times, the ability of the immune system to ever regain full function is virtually impossible. Also, the majority of women dx'd with Stage IV bc from the get-go never have mastectomies, something I fail to understand. So the primary tumor isn't removed, which has to continue to put a huge toll on the immune system, in addition to what chemo does to it. Deanna
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Is bone marrow transplant ever used for stage IV breast cancer? I know it is used for other kinds of cancer, but have never herd of it being used for BC.
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Susan, your lead post's reasoning actually formed one of the bases upon which I decided NOT to do chemotherapy for my early stage BC. Hormone therapy presumably helps to starve the cells. That I opted to try.
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kira, I believe bone marrow transplant proved not to be successful for bc, so is no longer used. I think it's mostly used for leukemia and lymphoma, which kind of makes sense when you think about it. OTOH, I can't help but wonder if the number of bc cases may have made insurance co's. quick to determine it "not successful" due to the high cost of the procedure? Deanna
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Hmmm.. I like that bug/exterminator analogy.
dlb823 ~ So if chemo compromises our immune system...wouldn't that mean that we would be better off "saving" it for when we definitively knew we needed it? (The key word being "needed"..as one person's "needing it" will be different from another's in the earler stages of cancer).
Athena1 ~ That's pretty much how I solidified my decision (regarding chemo) as well. My onc said something about the hormone therapy "starving" the cells too... but like voraciousreader said.... it's still not "for sure". Apparently the little buggers can live without "food" for longer than we think!
Regarding the bone marrow transplant for BC.....anybody read "The Emperor of all Maladies : The History of Cancer"? Fascinating book. I'm currently re-reading it. And I happened to be reading just last night, the chapter about when they decided to try bone marrow transplant (which involves very high doses of chemo) on solid tumors (breast cancer, etc ~ instead of just blood cancers like leukemia). They did try it on breast cancer...only Stage 4 I believe. It was not successful and way too risky/toxic for the patient.
I look forward to picking my Oncologist's brain at my next appt. I'm sure he does too.
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SusansGarden
It does require heavy duty chemo that is right. About 11 years ago my MIL went through it for leukemia. In her case the chemo itself killed her. She was never able to receive the bone marrow her system just shut down. The entire thing left a very bad taste in my DH's mouth. He was so afraid the same would happen to me with my chemo treatment. It is really sad my reaction to the chemo was as sever as it was it only added to his fears.
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kira1234 ~ I'm so sorry to hear about the loss of your MIL. It does sound like a very high risk procedure. I actually have a friend of a friend that went through it many years ago (at least 20 years ago I think)..she was young (20's) and it "cured" her (not sure if she had leukemia or lymphoma). She does have many permanent side effects but she is happy to be alive.
So your reaction to chemo was sever as well? You are fine now though?
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SusansGarden,
I only had 1 treatment. I ended up with internal radiation burns. The BS had to cut quite a bit of tissue away till he found healthy tissue. It took months till I healed, but I'm fine now.
Yes the chemo treatment my MIL had was very high risk. It only had a 20% chance of success, but that was much better than 0% without the treatment.
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I also like the theory about the bug infestation being compared to someone starting off as a Stage IV. The way I understand it, everyone has cancer cells floating around, but in only a small percent of the population, will these ever become a detectable mass. So if you start off with something out of control, it makes sense that it would be that much harder to get it under control.
I wonder if studies were done comparing changes in lifestyle, such as anticancer diet vs. continuing regular diet and adding exercise in to the mix, whether this would explain why some women reoccur and some don't. If you not only kill or starve the cells off using medication, but also change the environment in which they could grow, would this be what makes the difference?
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The effectiveness of chemo varies quite significantly by cancer, with a few success stories and more of the opposite.
Susan, yes. I always thought of Tamoxifen as something that could play a role in starving my cancer, but it was only going to be a small role, as I am weakly er-positive.
To be honest, by far my biggest trust was placed in plain old surgery. After that came: not smoking, Vitamin D3 and normalizing sleep (which for me was significant because my patterns were so abnormally awry). I don't know what will starve my cancer, but I have more confidence in the starvation approach than in the cell killing approach.
We know that chemo kills cancer cells. There is no disputing that (what is uncertain is which substance will work for whom). And for Stage IV BC, chemo's value is most felt out of all stages of BC. When it works, it can shrink tumors and lessen pain, improve mobility or allow organs to function properly (when it doesn't work it can kill the person) - at least for a while.
The problem is that killing cells does not appear to equal getting rid of the disease itself. I think of chemo like insecticide. You need to find the right brand for the right insect. So many times, the substance you use will kill insects, but it will not free your home of them - or if it does, you don't know how it happened. I have had good luck getting rid of cockroaches. Not so good luck getting rid of ants, even though I have committed massacres. Let's pretend that nothing is known about ants' and cockroaches' habits. One species disappears and the other one doesn't. To me, it is a casino game until we know more. Oh - and watch out for the dog and cat - they may get poisoned. Then you will be miserable.
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SusansGarden, as far as "saving" chemo -- I think the answer is both yes & no. Yes, if the Oncotype-DX says the risk of chemo might outweigh its benefit; then it's probably better to save it. But no if the Oncotype shows a high risk of future metastasis, because I think you'd be better off trying to prevent that from happening in the first place, rather than waiting to treat it after it happens. As my BS at UCLA pointed out, in terms of cancer, bc is a relatively easy one to treat successfully as long as it's confined to breast tissue. Once it gets into your organs, it's an entirely different ballgame. Deanna
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