February 5, 2013

Collateral Damage: Secondary Cancer[s]

28 Days [of] Heart

Day 5

MHYH’s passion is survivors, survivorship, [and] late effects of cancer treatment[s] such as secondary cancers are matters that weigh heavily on the hearts of individual survivors and those who love them; therefore, MHYH will carry this torch on behalf of those who will surely come behind us.

An untoward effect [or] a late effect of cancer treatment; call it what you will, but it IS what it IS: collateral damage, injury, or death to healthy cells, tissues, and/or organs resulting from radiation and/or chemotherapy used to CURE.

Stories of collateral damage abound on twitter, through FB comments, via direct email, phone calls, Q & A forums, [or] simply going about the business of doing LIFE. It is the rare day that I do NOT interface with an individual who is navigating the oh-so-deep waters of the late effects associated with survivorship.

That being said, I am privileged to introduce you to Cindy Graeff, a fellow traveler in this world of collateral damage. Cindy’s late effects story is unbelievably compelling as it includes a secondary malignancy, peripheral neuropathies, brachial plexopathy, and cardiomyopathy to boot.

Because I do NOT want any one of these late effects to get lost in a discussion of another, I have elected to share Cindy’s story of late effects through several post throughout our 28 Days [of] Heart.

Cindy was diagnosed with Stage II Hodgkin’s Lymphoma [HL] when she was 27 years young. Stage II HL means that 2 or more lymph node regions are involved on the same side of the diaphragm [above or below]; the treatment recommendation involved extended field mantle radiation alone to the tune of 33 individual treatments.

Cindy recounts reeling with questions about treatment, prognosis, [and] the seemingly unending list of side effects, acute [and] late. Her goal, of course, was to rid her body of the cancer no matter what the cost. The immediate cost[s] involved 2nd/3rd degree skin burns, rashes, mouth sores, nausea/vomiting, and hair loss. Unfortunately, time would prove that she had disease growing within her abdomen [and] bone marrow which ‘upstaged’ her to Stage IV. Along with the upstaging came the introduction of combination chemotherapy. I won’t detail out her regimen, but trust me when I tell you it was gut-wrenchingly relentless [and] the goal remained to rid herself of cancer while putting thoughts of late effects on the back burner.

Remission, No Evidence of Disease: every cancer patient’s dream come true. Cindy survived HL. Victory would prove to be bittersweet when she discovered a mass at the top of her right breast within the field of the radiation used to treat her HL 22 years prior.

The proverbial sucker punch of a radiation-related secondary malignancy called breast cancer. Secondary malignancy is discussed during the informed consent process, but seriously, is there REALLY any other option than to pursue therapy? Everyone one has to weigh the potential risks against the potential benefits or submit to an almost certain death.

Extended field mantle radiation includes both sides of the chest; therefore, it was likely that her left breast would eventually succumb to breast cancer as well. Cindy elected to undergo bilateral mastectomy followed by 8 cycles of chemotherapy which included Adriamycin [and] additional radiation to the primary tumor bed plus the right axillary region because she had positive lymph nodes.

The successful treatment of Cindy’s secondary malignancy led to deeper waters in terms of late effects which will be discussed in a subsequent post. For now, I’d like to highlight EXACTLY what placed her at risk for developing a secondary breast cancer.

Treatment-Related Risk Factors [for] Secondary Breast Cancer:

  • Chest Radiation as a child, adolescent, or young adult

  • Cumulative Total [of] Radiation >/= 2000cGy/rads

  • Total Body Irradiation Dose should be included in one’s cumulative total

Recommended Monitoring:

  • Monthly Self Breast Exam reporting any lumps or changes to your healthcare provider immediately

  • Clinical Breast Exam performed by your healthcare provider once a year until 25 years of age, then every 6 months thereafter

  • Yearly Mammogram [and] Breast MRI beginning at 25 years of age or 8 years from the date of your last treatment

For more information regarding long term follow up, Click HERE.


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