Tumor Evolution

It turns out that tumors do evolve. And the result of the evolution is that sometimes the cancer treatment stops working.

"A new study by researchers at Huntsman Cancer Institute (HCI) at the University of Utah observed how breast cancer tumors evolve over time and demonstrated how changes within tumors may contribute to the process by which cancers no longer respond to treatment. Further, the research identifies that some of these changes may be shared across certain treatment-resistant breast cancers."

The problem in examining tumors is getting samples because that is that can be invasive. You can't really say to a woman with breast cancer 'be sure to stop by for your yearly tumor biopsy'. They really do not want to keep the tumor around if they don't have to. So they had to be unique, which also meant a very small study size:

"For this study, Werner and her collaborators were able to trace the timeline of treatment of four breast cancer patients, over the course of between two to fifteen years for the patients analyzed. In a unique collaboration between several researchers and medical oncologists, samples of cancerous tissues were collected from breast cancer patients during their regular course of treatment. The tissue samples were then sequenced to study how the samples changed over time and how the tumors responded to each treatment. Using these data, the researchers were able to assess how changes in the tumor coincided with when the patient's cancer stopped responding to treatment."

Four patients is a very small study. However what can be learned from this study can lead to new research. Due to the invasiveness of tumor access, I can't see how tumor access is going to ever be much easier. With most patients, tumors are removed as soon as possible. I guess if there is a recurrence, presto you get a new tumor to biopsy - but if its not the same tumor does it count? Or sometimes tumors are not removed right away because chemo is used to shrink them..... But what do I know? I am a mere patient who is rambling on here.

"The ultimate goal for the researchers is to understand what is happening in a patient's tumor in as close to real time as possible, to predict what will happen next, and to adjust treatment accordingly.

Two new clinical trials set to start early next year at HCI and City of Hope will build on this research. Werner says "ultimately we want to actually predict what is really going to work best for your tumor during the course of your disease. While we're not ready to apply this to standard patient treatment now, with this work we are one step closer to doing that."

So if this tiny study is going to result in more research, I am all for it. You have to start some where and I find it fascinating that this area is one to be explored. I never really considered tumor evolution but if you think about it, tumors must acquire new characteristics as they grow in size. I'm ready to learn more and wait for more results.

Tumor Size Doesn't Matter

All cancer tumors start small and end up bigger. This is logic that is clear as day.  Tumors don't show up 3 cm across out of nowhere.

A new study states that even small breast cancer tumors can be aggressive. Well duh. If all tumors start small, of course aggressive ones and indolent (slow growing) ones are included. I don't call this news. I just call this an exposure of logic.

When I was diagnosed with breast cancer I was happy to learn more about my tumor. Its hormone status (ER/PR) was important, Her2 status was important, and tumor grade was import. The grade is a scale of one to three on how aggressive a tumor is. (This is my non medical training kicks in.) If there are lots of dead tumor cells, that shows growth because tumor cells which are aggressive are growing fast and dying off fast. The presence of lots dead cells is an indication of this. An aggressive tumor warrants more aggressive treatment.

I was lucky. My breast cancer was average in many ways. It was ER+/PR+ - meaning I was a good candidate for hormonal therapy, Her2- - meaning I didn't require additional treatment of Herceptin, and grade 2 - meaning it was average on the scale of indolent to aggressive.

I had a friend who was diagnosed about the same time as me. She was gone in three years. Her cancer was about the same as mine except hers was very aggressive. That's the difference with an aggressive cancer.

However this study does provide some good information:

""This study shows that it's not only tumor size that is important for breast cancer patients but also tumor biology. All tumors in the study were small - less than 1 cm - and the lymph nodes were free of cancer (node negative), which in principle should be a signal of good prognosis. But nearly one in four patients - those identified as genomic high risk - derived benefit from chemotherapy.""

""Small node negative tumors can be very aggressive, even if they are classified as clinical low risk," said de Azambuja. "Tumor biology needs to be taken into account when deciding adjuvant treatments in this patient population. One cannot forget the patient's age, performance status, comorbidities and preferences during the discussion.""

Its not a tumor....

So life in cancerland is basically summed up by the one thought: "will it come back?"

As this child helpfully tells us in Kindergarten Cop, that is the one thing we can't get out of our heads.

Every ache and pain could be a something, meaning a bad something. We have to learn is how to balance that thought. Sometimes helpful people say wonderful, well meaning things like this to us which help raise our cancer-cootie-concern-level. Or sometimes a peak inside our insides in an MRI, PET or CT scan gives us bad news. At which point the cancerland roller coaster starts going up the really steep hill and becomes a whirling twisting ride until we hopefully can get back to the smaller hills.

No I am fine but this video popped up on my radar the other day and it makes a valid point.

Living in the "Its not a headache its a brain tumor" years

Once you are diagnosed with cancer, the doctors usually do a few other tests to make sure there are signs of cancer anywhere else. Then, if you are like most cancer patient, you research the crap out of your diagnosis and start finding out about metastases and recurrences.

Then you get paranoid and decide you are going to die. Cancer is going to get you. You are doomed! Eventually you start to calm down and decide it was all in your head. But its very easy to start going down that road again - especially if your oncologist says you need a few more tests or something.

With most cancers recurrences head for major organs such as liver and lungs and even your brain. If you get brain metastases, the outlook is usually not very good. It is the one that is feared the most I think. But also every little ache and pain makes you think is that a cancer symptom? Over reactions to every little ache or pain are very common. Its not a head ache its a brain tumor. Its not a stomach ache, its stomach cancer. Every pain becomes a cancer symptom. That paranoia again.

But sometimes a head ache can be a brain tumor. This article talks about finding a brain tumor and their symptoms. I personally know someone who is a brain tumor survivor for over 20 years so I can rationally say it can be beaten. But that little paranoid side of me always cringes at the first sign of a headache.