Cancer 101

Every day, it seems, I get an email from a well-meaning friend about a new cancer study concerning grapefruit juice, PET bottles, red meat...the list is endless. Or, a news article saying that mammograms and self-examination are a waste of effort.

Since I've recently received my umpteenth email about another presumable cancer-causer, I thought it was time to feature an interview I had with Dr. Gregg Orloff. Orloff teaches the biology of cancer at Emory University in Atlanta, and has developed an award-winning website that explains the biology of cancer: http://www.cancerquest.org/.

"Of all the environmental and behavioral factors that have been investigated for cancer, only a few have shown a clear link," Orloff says.

"It's difficult to make hard conclusions about certain activities and their impact on cancer because studies to-date haven't involved a large enough population or haven't been conducted for a long enough time period to offer anything definite. The data simply doesn't exist at this point."

Still, research has uncovered enough implications between particular behaviors and increased risk that it's worth paying attention to how lifestyle choices impact our health, he says. But in order to understand how behavior and cancer are related, we first need to know what causes cancer to form.

The Basics
"Cancer is ultimately a result of DNA damage," explains Orloff.

"We know that cancer is derived from a single defective cell that has multiplied. It occurs when a cell strikes out on its own, resulting in unregulated cell growth. These abnormal cells pile up on each other and form masses, which are commonly known as tumors."

Why does a normal cell strike out in the first place? What causes it to become cancerous?

It happens when a particular set oif genes in a cell are altered by mutagens. And, this is where lifestyle behaviors may play a role in cancer. Mutagens enter the human body by means of inhaling, ingesting and absorbing.

They derive from:
* Chemicals in the diet -- For example, charred meat from grilling (the burning process) can cause the formation of chemicals that are thought to be mutagenic.

* Infectious agents -- A problem can occur when a virus actively alters the cells. For example, cervical cancer may result after infection with the Human Papilloma Virus...a viral infection.

* Chronic infections - Cancer can result in response to an infectino. For example, hepatitis has been associated with liver cancer. When cells are killed by infection, they need to be replaced constantly, so there are high amounts of cell division occurring in these tissues. In addition, the body's immune response to fight infection is producing chemicals that can cause mutations.

* Chemicals in the envioronment -- These can be absorbed or inhaled, such as smog and industrial waste.

In other words, every time you expose your body to a cancer risk -- eating buned meat, inhaling cigarette smoke or absorbing coal tar -- mutagens enter your body. And chemicals that are mutagenic can cause DNA damage.

The Luck Factor
If we all take in mutagens, then why does one person develop cancer over someone else?

"In order for a single, normal cell to turn into a cancer cell, it must acquire five to six different changes from mutagens. So, it's a cumulative effect," says Orloff. "Two people can be exposed to the same mutagen, but in one person, the cell dies or remains the same, while the other perosn acquires a mutation in an important gene and develops cancer.

"That's why you see some people smoke their entire lives and not get cancer, and others who 'do all the right things' develop cancer. Luck plays a big role as to who gets cancer and who doesn't. "

In the Genes
There are genetic components to cancer, as well.

"A person can inherit defective genes -- such as BRCA1--which by itself doesn't necessarily cause cancer," Orloff adds. "But a defective gene can increase your chances that some important key genes will be affected by a mutation, giving you a higher risk for cancer."

Another genetic factor that can impact whether one person develops cancer versus another is possessing better DNA repair genes, which respond to DNA changes differently.

In addition, the way your body processes toxins can affect your chances of getting cancer. For example, the liver has enzymes to process and eliminate toxins -- making them soluble so they can be excreted. But this detoxification process can convert a chemical into a mutagen.

Consequently, two people may be exposed to the same risks, but their bodies may process toxins differently.

Risky Business
Whatever your body's genetic makeup, DNA can be damaged by certain behaviors.

The following factors are known to have an associated risk of cancer because of their mutagenic properties:

* Smoking -- Full of mutagens, smotking as well as second-hand smoke is connected to almost all cancers.

* Sun damage -- UV rays are mutagenic and have been proven to cause skin cancer.

* Diet & obesity -- Obesity carries an increase risk of breast and colon cancers. Certain diets can alter the level of growth factors and nutrients (protiens, lipids, sugars) in the blood, which, in turn, can stimulate normal cells to become cancerous, or cause existing cancer cells to grow.

* Alcohol -- Particularly a risk factor for breast, colon and esophageal cancers, alcohol is toxic and must be detoxified, causing stress on the body. The detoxification process can cause DNA damage.

* Medications -- Certain drugs can potentially cause a problem. For example, female children of women who took DES (now outlawed) while pregnant have higher incidences of cervical and uterine cancer.

Healthy Choices
On the other hand, there appear to be certain behaviors that may help reduce your risk of cancer:

* Exercise - In some studies, exercise has been shown to have positive beneficial effects on breast and colon cancer. The benefits of exercise may be due to a wide variety of effects, ranging from enhanced immune system function to increased GI motility.

* Diet -- Overall, a well-balanced diet with fruits, vegetables and nuts is beneficial. Specifically, foods that contain antioxidants (such as leafy green and cruciferous vegetables) have cancer fighting possibilities.

This is because our bodies produce oxygen radicals, which are highly reactive molecules in cells that act as mutagens and can cause DNA damage. Antioxidants act as interceptor missiles, neutralizing oxygen radicals before they affect DNA.

In addition, studies have indicated that Vitamin D, selenium and calcium might potentially prevent or limit cancer growth.

"None of these things, alone, offers a huge reduction in cancer risk," warns Orloff. "But we know enough from studies to advise people to take care of their body."

The Bottom Line
"There's no holy grail in that if you do this set of behaviors, you won't get cancer," says Orloff. "All you can do is limit your risks.

"It's like avoiding a car accident," he says. "You can limit your risks by wearing a seat belt, not driving late at night, and not driving while talking on the cell phone. But all these things still can't guarantee that you won't get killed in a car accident."

"The same goes for cancer. Individuals have to decide what risks they want to live with."

Off Balance

After breast reconstruction, I found myself falling over easily...and often. In fact, I lost my balance so much that I feared I had developed a brain tumor. Not that I obsess...

It wasn't until I heard about other women with breast reconstruction who also experienced the loss of balance after surgery. I finally surmised that because we had our core muscles cut, we no longer have the abdominal strength to balance us.

Therefore, if you're slipping and falling frequently, fret not. Instead, sign up for a strength training class to build back your core. Since I've been working out with my personal trainer -- who, incidentally had me hauling concrete blocks and stepping up and down on a bus stop post last week -- I realize I've been stumbling less.

It's painful, but it will keep you from injury in the long run. So, go find some concrete blocks and start moving.

Resiliency

I was slogging through rush-hour traffic in Atlanta the other night while listening to Terry Gross with"All Things Considered" interviewing Elizabeth Edwards about her just-released book, "Resilience."

At the interview's end, Gross asked Edwards how she defined resiliency. Edwards' answer was so profound that I practically drove off the road trying to write it down. Since I haven't purchased her book yet, I will paraphrase what Edwards said:

"Resiliency is accepting the new reality of your life after loss-- and live it fully -- rather than long for the past and what it held."

If ever there was a quote for cancer survivors, this is it. I don't know about you, but sometimes I am wistful of life before cancer -- without all the surgery scars and missing pieces...when I was stronger and more flexible...when I had eyebrows (sigh)...when I could remember every detail (before chemo deleted my brain)...when I was innocent and naive, thinking I was invincible and immortal.

I don't obsess about these things, but every now and then, I get frustrated trying to be the "old me." And that person doesn't exist.

The new reality is an older, scarred, wiser woman who knows first-hand the body's limitations and the eventual result of death.

On the other hand, she also knows she has more courage in the face of fear than she ever imagined. That she doesn't take a single day of life -- or a single relationship -- for granted. That every day counts. Every interaction. Every choice. Every action. It all matters.

She also knows that she is loved far more than she ever realized. She knows that pain and suffering produce depth and insight. She understands what's truly important and what needs to be discarded or not taken so seriously.

Life after cancer is my new reality. I can never run away from or ignore what has happened to me. I can't go back and recapture my youthful self.

But, as Edwards points out, resiliency is the ability to "live fully" in your new life. That takes on a different meaning for each cancer survivor. For me, it's accepting my physical limitations, while at the same time, appreciating that I have a better grasp of what is true and valuable.

Advice from A Fitness Expert

This is an email my fitness instructor sent me recently:

"I met someone today in my bodywork class. She wanted ideas to rebuild her abs, since she was cut for breast cancer surgery and reconstruction.

This is the third person I've come across in a similar predicament, so I am planning to do some intensive research on exercise for women who have had breast cancer.

I hate to see breast cancer survivors frustrated with their bodies, when everyone seems amazed by how far you have come , medical teams happy with the results...you seem to be the only ones left with a feeling of unfinished business...and indeed it's not over for you.

You have a different body, you are and you are not the same person. You need to assess these changes and how slowly they will be part of you from now on. You need to work with these changes that you may not quite understand or even know about.

Your battle is not over, and everybody has left.

I believe strongly into the amazing ability of the body to heal repair and adapt, but also in the power and relation the mind has on this process.

Your will and courage is your victory. We, as instructors, need to wake up to this specific growing demand and try to work together with the health professionals to assure not only recovery, but long term health , happiness...and fitness!

Women who have had breast cancer need to work specifically on core, abs and upper body strength--which seems to be the 2 areas of most changes and trauma...psychologically, physically and physiologically.

See you in class!"

Helene Villinger

AFAA Certified Personal Fitness Instructor

http://fitnessislife.tripod.com/

When Rubbish Happens-Part 2

Recent layoffs among several people I know have prompted responses from well-wishers, telling the newly unemployed they'll "be in a better place" one day and "when one door shuts, another opens"...blah, blah, blah.

While I believe these statements can be true, there's a catch. It's up to you to open the next door to get to a better place. It doesn't automatically open. This pertains to jobs, or cancer, or any other disappointment in life.

Some people I know responded to their layoff by aggressively applying for jobs, networking, heading to the gym and keeping a positive attitude--which ultimately lead them to their dream job. Others headed to the bar, sat on their backsides and decided to be bitter.

A friend shared his fear of wasting his life due to working long hours and not having a Hemingway-like adventure every weekend. While I don't endorse workaholics or couch potatoes, it's not a job or lack of fun that wastes a life.

Rather, it's wallowing in anger, depression, fear and bitterness in response to life's challenges. Instead of moving forward with courage, you become paralyzed in your grief.

Life CAN be better when bad things happen to good people if you rise to the occasion. It's becomes better because it changes you -- you grow up, get a new perspective, learn to handle problems. Tough times can deepen you, pulling you out of your self-centered, self-absorbed, childish, all-about-me context.

And becoming a deeper, less selfish person is what allows you to live a richer, more fulfilling life.

Changing for the better is earned the hard way--the way we all try to avoid--through pain and suffering. But in the long run--by plowing ahead with courage--you can look back and say, "I'm in a better place because this happened."

When Rubbish Happens-Part 1

A friend, who is younger than I, is now in hospice, dying of cancer. It has not escaped my notice that I've survived cancer for the time being, while she did not. This begs the question--why her and not me? Why did she get the death sentence while I was spared?

This has always been a tricky question that arises when life throws you a curve ball (or in the case of cancer, when life throws you a grenade). I don't claim to have the answer. But I do know, that as modern day Americans, we've come to expect a Disney ending to tragic things of life. And it's just not so.

Why did I get life over others in my condition? It's not because I'm exceptional, or that God loves me more, or that prayers for me outweighed prayers for others. I've known far better and nicer people--with much greater faith--to experience an early death while I lived. You have to wonder why.

After pondering this over time, here's what I hold to be true: "To whom much is given, much is required."

My writer-counselor friend, Sue, wrote a poem, "The Scarecrow” in which she points out that our life experiences "make our stuffing deep, rich and available for God’s use, whenever and however He decides to scatter it."

So, until the day comes when I'm in hospice, I'm in a strategic position to be a blessing to others. After all, it's what's required.

1 Year Later

It's been a year since my double mastectomy, oophorectomy & reconstruction (phase 1), so time for a progress report.

My reconstruction surgeon said my right breast needed some "tweaking" since it's smaller than my left. The reason for the size discrepency is I had radiation in my right breast during cancer treatment years ago. Tissue in a "radiated breast" responds differently to surgery than a non-nuked breast. Translation: I need a larger implant.

Tip: If you must undergo radiation, ask your doctor how it will affect your breasts long-term. It's good to know for a variety of reasons.

Surgery to exchange an implant is an outpatient procedure (yaay!), but nevertheless involves anesthesia, tests, needles, blood, drains (%&#*!), nausea, and no exercise except walking for 6 weeks.

Right now, I'm not up for all the pain (from needle jabs) and suffering (from lack of food) this surgery calls for. So, like Scarlett, I'm going to think about it another day.

A small breast is no big deal. What is a big deal is that my stomach is still expanded like Demi Moore on the cover of Vanity Fair. (And that's the only similarity between my body and her pregnant one.)

I ask--what happened to "your stomach will be flat as this wall," as my surgeon swore?

Instead, after a year of surgery, when I was sliced in half, my abdomen has a small "pooch" like I'm in my first trimester.

What they don't tell you is that all the cutting and stitching of your abdominal muscles causes them to expand whenever you place any pressure on that area. Exercise, lifting & moving objects, gardening, housework...and myriad other daily activities can cause your stomach to swell. Swell, isn't it?

And, an expanded abdomen = no clothes with a fitted waist=forget summer fashions and swimsuits.

No one forwarned me that I needed to invest in maternity clothes after this procedure. From the way my surgeon talked, I was going to be a runway model at 50. (Tip: surgeons lie.)

Therefore, I enlisted the help of my French water aerobics instructor, who is also a kickboxing intructor and personal trainer.

My surgeon endorsed my decision, saying that building my core muscles were key to getting a flat stomach. NOW he tells me.

So, last Saturday at 7:30 AM, I am in Helene's basement (aka, the torture chamber) punching boxing bags, throwing weighted balls, jumping rope, doing pushups...and then going outside in the freezing rain and sprinting up the hill in her front yard. Alas, what we do for vanity.

It was then that I discovered a critical insight -- I have no muscle strength. ZERO.

After a year of surgery in which most of the time I wasn't allowed to do any exercises except walk, my body weakened overall.

This means a long, hard road before me with lots of Saturday morning sprints up Helene's hill.

But I'm up for the challenge. After all--for all the pain and suffering that Helene inflicts, it doesn't involve needles and anesthesia and lack of food.