Cancer Sleeper Cells
One of the mysteries about cancer is why and when it may recur. We "know" our statistics and possibilities, but we also know that those are just numbers, and no one experience can be predicted with assurance. There are plenty of people with rather dire initial diagnoses who go on to live long and well, and there are others, with small tumors and negative nodes and "good" prognoses, who end up dying of their cancers.
There are also women who have very late recurrences of breast cancer. Improvements in adjuvant treatments and the long use of hormonal therapies, often as long as ten years, have resulted in more seeming cures but also more late recurrences. It is great that the disease free survival times have been extended, but that also means that the worry time is longer. I am currently working with a woman whose initial breast cancer was of the "good" variety. She had a mastectomy with reconstruction and needed no further treatment. She was fine for twenty years and then recurred with bone and lung mets. Why? How? What set off remaining cancer cells that had lain dormant for decades?
This is an excellent article from the New York Times about so-called cancer sleeper cells: those that probably remain after treatment in many of us and may at some point awaken. Here is a quote and then a link to read more:
The Cancer Sleeper Cell
By SIDDHARTHA MUKHERJEE
In the winter of 1999, a 49-year-old psychologist was struck by nausea —a queasiness so sudden and strong that it seemed as if it had been released from a catapult.
More puzzled by her symptoms than alarmed — this nausea came without any aura of pain — she saw her internist. She was given a diagnosis of gastroenteritis and sent home to bed rest and Gatorade.
But the nausea persisted, and then additional symptoms appeared out of nowhere. Ghostly fevers came and went. She felt perpetually full, as if she had just finished a large meal. Three weeks later, she returned to the hospital, demanding additional tests. This time, a CT scan revealed a
nine-centimeter solid mass pushing into her stomach. Once biopsied, the mass was revealed to be a tumor, with oblong, spindle-shaped cells dividing rapidly. It was characterized as a rare kind of cancer called a gastrointestinal stromal tumor, or GIST...
The word "relapse" comes from the Latin for "slipping backward," or "slipping again." It signals not just a fall but another fall, a recurrent sin, a catastrophe that happens again. It carries a particularly chilling resonance in cancer — for it signals the reappearance of a disease that had once disappeared. When cancer recurs, it often does so in treatment-resistant or widely spread form. For many patients, it is relapse that presages the failure of all treatment. You may fear cancer, but what cancer patients fear is relapse.
Why does cancer relapse? From one perspective, the answer has to do as much with language, or psychology, as with biology. Diabetes and heart failure, both chronic illnesses whose acuity can also wax and wane, are rarely described in terms of "relapse." Yet when a cancer disappears on a CT scan or becomes otherwise undetectable, we genuinely begin to believe that the disappearance is real, or even permanent, even though statistical reasoning might suggest the opposite. A resurrection implies a previous burial. Cancer's "relapse" thus implies a belief that the disease was once truly dead.