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Saturday, 20 October 2012

Each cancer is individual and should be treated that way

How unique is my cancer?  Totally! 

That is one of the problems with cancer and trying to find treatments - they are all so different.  From the 'outside' it may seem that there is just one disease which should be able to be treated in a uniform manner.  Recent research has shown that it is now possible to identify 4 main sub-groups for breast cancer. 

"This has led to tests, not yet widely used in the NHS, such as ‘PAM50’. This examines 50 separate genes inside a woman’s tumour, and uses the resulting ‘fingerprint’ to group cancers into four subtypes’:
  • Luminal A cancers, which are usually ER+ and/or PR+ – and make up about half of all cases. They tend to have low amounts of Her2. Women with these tumours tend to have the best outlook.
  • Luminal B cancers, which again tend to be ER+ and/or PR+, but also Her2+. These have a good outlook (but not as good as luminal A cancers), and account for about 12 per cent of cancers.
  • Her2-amplified cancers. About one in ten cancers are ER and PR negative, but have high levels of Her2. These tumours have a poorer outlook than the two types above, but can be treated with trastuzumab (Herceptin).
  • Basal-like tumours – these are usually the ‘triple-negative’ cancers mentioned above, and make up about 20 per cent of tumours. They have the least favourable outlook.  http://scienceblog.cancerresearchuk.org/2012/04/18/increasing-the-resolution-on-breast-cancer-the-metabric-study/ "
Cancer Research UK have helped fund a genetic study which has identified 10 sub-groups of breast cancer  http://www.nature.com/nature/journal/v486/n7403/full/nature10983.html

The ten ‘clusters’

Here’s an overview of the characteristics of each of the clusters identified:
ClusterOutlookCopy number defectsComparisons and other notes
1IntermediateChromosome 17‘Luminal B’-like, generally ER+
2Poor2 x faults on chromosome 11Mixture of luminal A&B
3GoodVery few‘Luminal A’-like
4GoodVery few, mainly immune system genesHigh levels of immune cells in tumour
5Extremely poorChromosome 17 (Her2 gene)Mixture of ‘Luminal B’ and ‘Her2’
6IntermediateRegion of chromosome 8 deletedER+, generally Luminal
7GoodChromosome 16Luminal A
8GoodChromosomes 1 & 16Luminal A
9IntermediateCh 8 and/or 20Luminal/ER+
10Poor 5-year outcome; good long-term outcome if alive at 5 yearsChrs 5, 8, 10 and 12Basal-like
http://scienceblog.cancerresearchuk.org/2012/04/18/increasing-the-resolution-on-breast-cancer-the-metabric-study/

In fact what all this research shows it how individual each cancer is and how differently each should be treated.  I remember reading an article about Herceptin in a daily paper in the UK when it first came into use on the NHS.  The lady at the centre of the story was claiming that she was having her life shortened by being denied Herceptin, and this was the gist of many articles at the time.  However a short bit at the end of the emotive piece came from the hospital treating her and explaining that because she wasn't HER2+ this new treatment would not help her.  At the time Herceptin was being publicised as though it was a cure for breast cancer, full stop.

Just as there is no one form of cancer there is no 'one cure fits all' approach that can be taken; even within a sub-group.  It is all very confusing, even for those of us who have some understanding of the whole thing, but then I am not a scientist.

While the conventional medical approach should be taylored to the individual and not the type of cancer, I am personally convinced that everyone should use alternative therapies just as individually.  Let me make it clear that by alternative therapies I am not talking about standing on your head under a crystal reciting a mantra.  I am talking about nutrition, supplements and therapies such as acupuncture, reflexology (both of which I have access to and use), reiki, Chinese Herbal Medicine and so on.  There are also approaches such as Mindfulness Meditation, or any form of meditation, Tai Chi, Qi Gong, healing with or without a religious connection, which can have an enormous impact on the health and well being of any cancer patient, be they Stage 0 or Stage IV.  These are treatments which empower the patient, which may be why conventional medicine is not all that keen on them! 

The individual should also be empowered with an understanding of their cancer, if they are the kind of person who wants that knowledge and understanding; and I do appreciate that not everyone is that kind of a individual.  However, for some of us knowledge is power.  After all are you really going to understand why you have to take something like Tamoxifen for five years after your early stage breast cancer treatment if you don't understand why it is necessary.  In the UK someone was doing a survey of tracing how many people were continuing with their Tamoxifen treatment by tracking their repeat prescription requests.  Don't know the out come of that, or whether they contacted any individual who was not continuing with the treatment to find out why they had stopped.  It would be interesting to know.

I am as individual as my cancer is, and that is how I would like to be treated by health care professionals and other practitioners.  Maybe that is one reason I like acupuncture and Chinese Herbal Medicine so much.  It is taylored to the individual at that specific time and that is my choice.  It may not be yours, but then you are an individual as well...

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