Time Heals: Today’s Cancer Patients Owe a Debt of Gratitude to Generations Past

Emperor-of-All-MaladiesOnly recently have I started to think a great deal about the history of cancer or the oncologists and patients that have come before me. I developed a fascination with these topics while watching the PBS miniseries Cancer: The Emperor of All Maladies. This three part series skillfully explores the medical and scientific aspects of cancer; even more impressive is the wonderful job that the producers have done of delving into its history and politics.

The creators of the groundbreaking television documentary based their project on a strong work of non-fiction by renowned oncologist and award winning journalist Siddhartha Mukherjee. Both the PBS documentary and Mukherjee’s Pulitzer Prize winning volume have one overriding theme. They bring to light that our current generation’s experience with cancer represents only a momentary chapter in an epic battle spanning thousands of years.

The Emergence of Modern Cancer Surgery

When I was diagnosed with fairly advanced cancer in my uterus and right ovary, the first, and most essential, part of my medical treatment involved surgery. I literally owe my life to the skill of my pelvic cancer surgeons and to the sophisticated surgical techniques available in the 21st century. Ovarian cancer is still the most serious of all women’s cancers, and the survival rates can be quite grim—the positive news is that the outlook has improved in recent decades, largely due to better surgical procedures.

For centuries surgery to remove cancerous tumours wasn’t a viable option, as the medical technology wasn’t yet available. In extremely rare cases a physician would attempt to cut out a cancerous growth. However, the circumstances would have been barbaric by today’s standards. There was no method to properly anesthetize patients and they were frequently operated on while conscious, in addition there was no use of modern antiseptics to keep the surgical wounds from becoming infected.

19th Century Surgery

The late 19th century witnessed the origins of present-day cancer surgery. Anesthetics such as either were discovered and this made lengthier, more complex operations possible. Procedures such as the radical mastectomy for breast cancer were successfully devised and implemented during this era. As a matter of fact, the medical community firmly believed that it was possible to cure cancer through surgery alone. The nature of how cancer spreads to distant sites in the body wasn’t yet well understood. Most experts mistakenly believed that its recurrence months or years after surgery was strictly due to not taking out enough tissue, reappearance of the disease was caused by the growth of fragments of the principle tumour that were left behind.

The Development of Chemotherapy

Sidney Farber

Dr. Sidney Farber

The nature of metastasis is much better understood today and a patient with gynecological cancer, such as myself, is routinely offered chemotherapy following surgery. Of course only in the past 40 or 50 years have powerful chemotherapy drugs been introduced to the arsenal in the war against cancer. Oncologist Sidney Farber (1903-1973) is considered by most historians to be the father of chemotherapy. Farber and his team in Boston began trials on children with leukemia in the late 1940s. At this time leukemia was still a death sentence for any child diagnosed with the disease.

Farber’s new therapy was almost miraculous in the sense that it led to remission in many of his young patients. Some of the children, including a patient named Robert Sandler, had their lives extended by months after the potent chemicals were administered to them. The leukemia would virtually disappear and they would momentarily resume an active childhood. Throughout the 1950s and 60s, Farber continued to make advances in cancer research, notably the 1955 discovery that the antibiotic actinomycin D and radiation therapy could produce remission in Wilms’ tumor, a pediatric cancer of the kidneys.

What the Future Holds

As I battle ovarian cancer I try to be realistic about how far treatment has come, I know there is still an extremely long way to go in the war against this insidious disease. Over the last two decades, the five-year survival rate for patients with ovarian cancer has improved significantly. Yet, according to the experts, no more than 30 per cent of long-term ovarian cancers are currently being cured. Oncologists admit that they are facing enormous challenges. While surgical advances and new treatment approvals, including Lynparza (olaparib) and Avastin (bevacizumab), have improved the outlook for ovarian cancer patients, late diagnosis and tumour resistance remain as the two most significant barriers in overcoming the disease.

Cancer Cells

Meanwhile, the medical community is continuously developing new treatments for cancer, one of the most promising is called immunotherapy. For decades oncologists have known that the immune system plays an important role in certain types of cancer. They noted that there were rare spontaneous remissions of cancer without treatment and they suspected that this was because the immune system was attacking the tumour. Immunotherapy is designed to boost the body’s natural defenses to fight the cancer. Medical specialists use materials either made by the body or in a laboratory to improve, target, or restore immune system function.

At the present time it isn’t entirely clear how immunotherapy works against cancer, it may function by stopping or slowing the growth of cancer cells, stopping cancer from spreading to other parts of the body, or helping the immune system increase its effectiveness at eliminating cancer cells. There are currently several types of immunotherapy in use, including monoclonal antibodies, non-specific immunotherapies, and cancer vaccines.

Inside The Tom Baker Cancer Centre

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I’ve been a patient at Calgary’s Tom Baker Cancer Centre for over two years now, but it’s occurred to me that I haven’t presented a detailed description of southern Alberta’s primary cancer treatment and research facility in my blog. Perhaps I was waiting for the perfect time to focus on this topic in The Teal Diaries, and since my next scheduled appointment at the centre’s outpatient clinic is in approximately one week, writing down some of my thoughts and feeling about the building and its dedicated staff seems highly appropriate. Prior to my cancer diagnosis I had virtually no knowledge of the Tom Baker Centre. Like most people in Calgary I was aware of its location and had observed it numerous times at the sprawling Foothills Medical Centre, however I had never actually been inside the building. Every time I saw the five-storey cement structure, I hoped I would never be required to enter it. The very name “Baker Centre” would set off a wave of powerful thoughts and emotions—in my mind I identified it as a place where cancer patients went to receive treatment, and sometimes to die.

My first time inside was on a cold, dark November morning. Since it was my initial assessment the team of oncologists had scheduled me early, before anyone else. I still remember how terrified I was and yet how unexpectedly quiet and peaceful everything seemed to me at that hour. My mother and I were essentially the only ones present in the waiting room of the gynecology clinic. Soon I was having a detailed conversation with a nurse about my medical history, naturally there was an emphasis on any family history of cancer. Next, I was examined by one of the Baker Centre’s top pelvic cancer surgeons, Dr. Prafull Ghatage. Following my examination, my mother and I were assembled in one of the Baker Centre’s conference rooms with Dr. Ghatage and a team of other physicians.

The seriousness of my situation began to register as I looked across the table at four of five white-coated medical professionals. Dr. Ghatage explained that he wanted to perform surgery as soon as possible. This news was overwhelming, especially since I was still recovering from a total abdominal hysterectomy that I had undergone three weeks earlier. “I just had a hysterectomy and now I’m dying of cancer,” I tearfully blurted out. “You’re not dying, I’ll inform you if you are dying,” a firm voice immediately responded. These rational words jolted me back to reality, and before we left I signed a consent form for a laparotomy—a specialized procedure in which abdominal organs are removed, biopsied or repaired and a definitive diagnosis can be made.

Baker Centre building

All gynecologic cancer surgery and subsequent recovery actually takes place on Unit 42 B in the Foothills Hospital, but I was back at the adjacent Tom Baker Centre approximately two months later. This time it was to have the necessary follow-up chemotherapy. It was at this point that I began to realize how self-contained, busy and efficient the renowned Tom Baker Cancer Centre is. First my mom and I attended one of the centre’s chemotherapy orientation sessions. It included a tour of the daycare unit where specialized nurses administer powerful anticancer drugs to a steady stream of patients. About 90 patients a day receive treatment in 39 daycare treatment spaces, some of the spaces feature beds and some have reclining style chairs. Naturally, I was apprehensive when the day arrived for my first cycle of carboplatin with taxol; I was scheduled for six cycles with each treatment 21 days apart. Of course, I’d been warned about the inevitable side effects including fatigue, weakness and nausea. It was also predicted that my hair might become thinner, but that I probably wouldn’t lose my shoulder length bob completely. As a precaution, I had it cut into a much shorter pixie style.

I can laugh now, but I was rather worried that some of the veteran chemotherapy patients might be able to tell that I was a newbie. They would ascertain that I looked too healthy and had all of my hair! When I arrived for my first session, I noticed that the people around me seemed to have many types and stages of cancer—what is more, a good number of them exhibited full heads of hair. After a short wait, a nurse led my mother and I into the Baker Centre’s large daycare treatment area. My heart beat faster as we reached my assigned space and I settled into a recliner by the window. The nurse explained what she was doing as she inserted my IV line and then attached some anti-nausea medication in preparation for the potent cancer-fighting drugs.

Chemotherapy IV

Somehow the hustle and bustle of the busy daycare area had a calming effect on me, as did being in the presence of the staff and so many other patients. I left my first chemotherapy appointment extremely impressed by all that the Baker Centre does to make the procedure less stressful and more comfortable for each patient. I’ll never forget being offered coffee, tea and cookies by one of their devoted volunteers. Having been through treatment, I can appreciate how incredibly challenging it is for the team to meet the individual needs of thousands of men and women diagnosed with cancer. I was later astonished to learn that there were 20,100 chemotherapy appointments at Calgary’s Tom Baker Centre in the 2010-11 fiscal year. In my next blog post I’ll discuss some of the issues as the centre struggles to keep up with an ever-increasing demand for its services.

Survivorship 101

My health had always been tremendously good, and then one afternoon in November 2011 I received an unexpected diagnosis of both uterine and ovarian cancer. In hindsight words such as devastating, terrifying, and life-altering seem inadequate to describe the magnitude of that experience—my daily existence was shattered. Sometimes it’s still as if I’m trapped in an appalling dream, a nightmarish reality that to date has encompassed three major abdominal surgeries and five cycles of chemotherapy. As with countless other cancer survivors I have asked “Why me?” while I’ve struggled to find anything positive about living with such an affliction. I have accepted the likelihood that my life may never be exactly the same; I must adjust to a “new normal” as day by day I contend with the consequences of an insidious, spiteful, and often fatal disease.

In this blog I will be writing about various aspects of my cancer journey. I have chosen to call it The Teal Diaries, since teal is the colour used to represent awareness of gynecological cancers. While pink ribbons are strongly associated with breast cancer, significantly fewer people realize that ovarian cancer survivors, and those who wish to support them, wear teal ribbons. If there is less public awareness regarding ovarian and endometrial  cancer, I suspect that it’s because they are both less prevalent and have a significantly higher mortality rate than breast cancer.

I’ve waged my relentless battle for over a year now, I currently seem to have the upper hand and my doctors indicate that they are cautiously optimistic regarding my prognosis. Since the beginning of my cancer experience there have been moments of epiphany and numerous opportunities for personal reflection. Being that this is my initial blog post, I want to share a few of the survivorship lessons that I’ve experienced over the past fourteen months. According to professionals in the cancer field, survivorship is living with and beyond cancer. Survivorship covers the physical, psychosocial, and economic issues of cancer, from diagnosis until the end of life. This is what I’ve learned so far.

You never know how strong you are until being strong is the only option you have left.

I certainly don’t aspire to become a legend like  Terry Fox or to be anything resembling a saint or a cancer hero. But still, I’ve discovered inner qualities and personal strengths I never appreciated or properly acknowledged in myself. Subjected to the ultimate test, I’ve sometimes shocked myself with my capacity to overcome adversity and to confront physical pain and suffering. As one of the approximately 17,000 Canadian women living with ovarian cancer, I obviously know firsthand how it impacts a life. For survivors there is tremendous emotional pressure, along with social and financial turmoil.

There are moments when you have the impression that your world is spinning violently out of control. The fundamental paradox is that I’m often able to feel a sense of power, combined with courage and self-assurance. It’s as if I’m standing in life’s Category 5 hurricane and remaining resolute, steadfast and unbroken. “Okay cancer, you ruthless bastard, attack me with all the intensity you’ve got! I will still transcend you and the pure malevolence that you represent,” I sometimes tell myself. Some pundits would consider this type of resolve impressive, especially as demonstrated by a socially introverted, physically petite woman, such as myself.

Appreciate the flowers in your own backyard.

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I reached an unparalleled low physically and emotionally last year, during the spring of 2012. By May there were potentially life-threatening complications due to my rigorous cancer treatments. Vomiting and in pain, I was transported to the emergency room through early rush hour traffic. It was a bright May morning when I entered the doors of Calgary’s largest medical centre and was admitted suffering from a bowel blockage. I acknowledge that at first I literally wanted to die rather than face what was happening. Nothing had prepared me for the invasive medical procedures that I would endure in the coming weeks or for the length of my hospitalization.

Forty-eight agonizing days elapsed, during which time I received virtually all of my nutrition through a peripherally inserted central catheter (PICC or PIC line). On June 18, 2012, intestinal surgery was skillfully performed. When I awoke in the recovery room I sensed that my crisis was at last resolved. Although only half-conscious, I was filled with elation as they informed me that the procedure to correct my obstruction had been successful. The primary cause was established to be scar tissue from my previous operations and now my digestive system was expected to function normally again. Most of all, I was comforted and reassured by the fact that my cancer had not visibly metastasized to other regions of my body.

My discharge from the hospital ultimately took place on a balmy summer afternoon; the clothes I had worn nearly two months earlier felt hot and loose fitting. I was so weak from my ordeal that I struggled to walk just 10 or 20 metres, but I was in awe as I observed how the seasons had changed and nearly everything had been transformed. I can still remember the blissful journey home and my sense of anticipation during that short, but very emancipating, commute. Even the air filling my lungs was like a breath of freedom.

Upon arriving at the small bungalow where I live, something magical occurred. My eyes surveyed the backyard and the unexpected sight of poppies in full bloom completely overwhelmed me. It was as if I were seeing them for the first time. I remain inspired by their exquisiteness, vaguely encouraged by the realization that their brilliant orange petals and intricately designed purple centres will never appear ordinary to me again. I’m certain that from now on, I’ll be eagerly awaiting the phenomenal appearance of the poppies each June!

Learn how to embrace the new pretty.

There are literally thousands of magazine articles, journal studies and online resources devoted to the topic of sexuality and women’s cancers. How a woman copes and deals with the changes to her body are unique for each survivor, of course such factors as age and relationship status come into play. Studies have confirmed that the most prevalent issue for those diagnosed with uterine or ovarian cancer is a sense of profound loss. Psychologically I continue to mourn the demise of my reproductive organs and the loss of what I always perceived as an impeccably strong and healthy body.

Throughout my cancer ordeal I have felt moments of contempt, occasionally mixed with rage. I find it easy to despise a culture that is inclined to objectify women—placing intense pressure on us to possess a perfect body. I’ve become acutely sensitive to the media, the advertising industry and to what I believe are ridiculous and superficial standards of female beauty.

Belly Pic

There have been circumstances when I’ve waged war using humour or an “in your face” attitude. During my convalescence from one of my cancer surgeries I recall being engaged in a discussion with my mother while sorting through a stack of mail. I paused as I unearthed a catalogue for a major Canadian department store, cringing at the sight of the cover. Predictably it was flaunting an image of a model with an unblemished face and body. The New Pretty, the caption breathlessly announced. All of a sudden I grinned mischievously, as in one defiant move I turned and flashed my scarred and stapled abdomen. “I’ll show them the new pretty,” I boldly declared.