A risk we can't mitigate, cancer of the Peritoneum

One of the other types of cancer that are related to the BRCA1 gene is Cancer of the Peritoneum. It turns out this is a relatively new discovery.

The gynecologist told us that ovarian cancer is now widely recognized as hereditary. As with just about every other cancer that I've encountered on this "sabbatical," it's not one specific genetic sequence that causes cancer there are potentially many triggers.

Prophylactic oophorectomy, doctor jargon for getting a preventative removal of the ovaries is used for women judged to have a 50% risk for this disease. However, recent evidence has disclosed that a fraction of the patients who underwent an oophorectomy and whose ovaries appeared normal when surgically removed, subsequently developed abdominal cancer with the laboratory finding the lesions to be indistinguishable from ovarian carcinoma.

This abdominal cancer is where the Peritoneum goes malignant. The peritoneum is the membrane sack lining the abdominal cavity which holds all of our organs in place. The doctor stresses the risk is small but as we've seen doctors behave before, we are told of all the things that can possibly go wrong.

Turns out the ovaries and the peritoneum come from the same stem cells and the final tissue of the two is pretty much identical. Who'd of thought that?

Every cloud has a silver lining

As I was out for a walk in the snow I was thinking about all of our issues.

Then it hit me, the need for conversations about getting a vasectomy is over!

Over the years Pace and I had discussed the options; after we'd had a couple of kids she could get her tubes tied or I could have a vasectomy. There have been a spicy conversations about this subject with polarized opinions from various people.

"Why would you put your wife through such an invasive operation as getting her tubes tied?"
"Buddy, you get a vasectomy and you're not a man anymore!"
"Would you rather be a gelding or a stallion?"

So while a vasectomy is less invasive it still carries risks. Sperm takes 90 days to grow in the testes and it gets stored in the epididymis. While doctors think sperm can last up to 48 hours in the uterus and fallopian tubes they have no idea how long it lives in a man's body before ejaculation.

Vasectomies most commonly result in painful, swollen, and tender epididymis or testis in the first year after surgery. One might then think that sperm lives on for more than 48 hours...

In more extreme cases because the testis continues to produce sperm it eventually dies in the epididymis and now must be reabsorbed by the body. Some men develop anti-sperm antibodies which provoke immune system over-reactions like rheumatoid arthritis, juvenile diabetes, and multiple sclerosis.

Some studies suggest vasectomies increase the risk of prostrate cancer, others have shown no increase in risk. There is a theory but no proof.

Given everything we've been going through, it's nice to have one less worry.

So guys, would you get a vasectomy? Leave a comment!

Erin Brockovich

When I came into the living room Pace was watching the movie Erin Brockovich.

It's relevant as Erin Brockovich triumphed over the odds, she proved herself, and reinvented her life. Pace has voiced an intention of helping out young women, especially young mothers with Breast Cancer.

There is a poignant scene where Erin is talking with Donna Jensen about her cancer diagnosis. Donna has to get a double masectomy and a hysterectomy. It went something like this.

Donna: "I've had so many cysts I never figured this one would be cancerous."
Erin: "We'll make sure you get well taken care of."
Donna's eyes start welling up with tears.
Donna: "Can I ask you something?"
Erin: "Anything."
Donna: "If I don't have breasts or a uterus anymore am I still a woman?"
Donna starts crying.
Erin reaches over and gently takes her hand
Erin: "Of course, you'll always be a woman. You just won't have to buy any more underwire or maxi-pads."
Donna and Erin both smile.

This mirrors an ongoing discussion Pace and I have had. More on that in another post.

Egg Whites killing cancer?

Viragen, the company that brought us the cloned sheep Dolly has genetically manipulated chickens to produce cancer fighting antibodies inside of egg whites.

Even the antibodies are lab created, and due to the difficulty of manfuacturing they've found a way to grow the antibodies in chickens. It's so precise that the protien remains confined to the egg white.

More details in this article on Science Daily or Reuteurs.

$2.3 Billion in lost personal productivity annually

The Journal of the National Cancer Institute just published a study estimating the cost of cancer for the patient in the first year of treatment alone.

Their methodology included adding up the hours spent sitting in doctors' waiting rooms, interviewing with doctors and researchers, waiting your turn for M.R.I.s, CT scans, attending chemotherapy sessions, radiotherapy sessions and other treatments. They estimate the collective cost of Cancer to individuals is around US$2.3 billion, that's over $3,000 per person.

They did not consider a second person coming along for support and care; based on our expenses, this study is a serious underestimate of cancer's financial cost to the family.

This estimate is only time spent in the health system; getting tests, operations etc. It doesn't count the days spent home in bed recovering from surgery or regaining strength from chemotherapy and radiotherapy regimens.

Dr. Len Lichtenfeld of the American Cancer Society summed it up poignantly "Cancer is more than the just the dollars and cents for the medicines and the treatments and the doctors. It's also the lost opportunities for the patients."

There's also day care for kids, transportation, parking, outrageously expensive prescriptions, and other unexpected expenses. The there's the way cancer puts careers on hold but more on that later.

Caregiver stress and hair color over 3 years

I was looking through some of our pictures on the weekend and I came across these two.

Wow, it's amazing how the stress of Keeping Pace and our other trials of the last 3 years has stripped my hair color. That said, I have earned every one of these gray hairs.

My barber says I should strip them white this summer when I have a tan for a really striking look. Hmm. We'll have to see about that.

Decline in Horomonotherapy Prescriptions Results in Decline in Breast Cancer

In one area the incidence of Breast Cancer has declined over the last 8 years. A clinical study running since 1974 demonstrates a corresponding decline in breast cancer when compared against the decline in hormone replacement therapy.

Annual Number of Prescriptions
for Female Hormonotherapy
2001 - 12.6 Million
2002 - 11.6 Million
2003 - 8.5 Million
2004 - 6.7 Million
2005 - 5.9 Million

The upper lines of the chart on the right illustrates in yearly rates the prevalence of estrogen-only and estrogen/progestin–containing hormone therapy use, the lower lines demonstrate the incidence of invasive breast cancer in members of the Kaiser Permanente Insurance Company group for Northern California (KPNC) members, the 13-county KPNC client study area, and the overall stats for the state of California, from 1994 to 2004.

The Oncologist is happy!

Late in December we saw Dr. Rami and he told Pace that all seems well. She is healing well and the scarring is diminishing. He want's to see her every 3 months for a year and then every 6 months following.

He wanted to be sure that we were seeing the gynecological oncologist and that he strongly recommends that she gets her ovaries out. Pace told him she'd already decided on that.

He also told her to see the Plastic Surgeon as her right breast implant has changed, probably as a result of the radiation therapy or physical exertion.

From a standpoint of dealing with BRCA1, Pace has survived the Breast Cancer reaction. Now we move into the proactive stage to mitigate Pace's chances of having breast cancer again.