Biology determines everything

Now, let's see if I can get this right - and I'm going to ramble:

I attended an advanced training course for peer navigators yesterday. A medical oncologist spoke to us about all things breast cancer. The thing that stood out most to me was his statement: "biology determines everything" - getting cancer, response to treatments, whether one has a recurrence, etc. He said that while type, stage, and grade does tell them a lot prognostically - it doesn't determine what your particular outcome will be. And they don't understand why. Ok, knew that - that's why we all have followups, right?

What surprised (maybe that's not the right word) most in the room was his statement that whether a cell or two develops the ability to travel from the original tumor site is not related to clear lymph nodes, clear margins, stage or grade. The ability of a cancer cell to break away and travel is a different mechanism than hanging around in the hood and replicating itself - and they don't know what that is or when or what makes that happen. I didn't know this. I thought there just got to be so many cells, some of them had to go somewhere else. This sort of explains why there is never any guarantee that surgery "got it all". They hope it did and they do know that certain types are more likely to metastasize than others. So years down the road if someone develops metastasis in a distant organ, was it there since the getgo even if nodes and margins were clear and/or how/why did it put on its walking shoes and go traveling and plant itself wherever it did? They figure breast cancer takes about 10 years to develop into a tumor that is palpable or that shows up on a mammogram. How long did that stray cell sit in that distant organ before it replicated enough times to cause havoc? And if someone dies at age 100 of old age who had breast cancer a gazillion years previously, was she actually cured or would it have recurred when she was 101?

He said that passage of time is good in terms of recurrence statistics, but they always say "in remission" because they don't understand how one's individual biology effects the stupid cancer cells. There was a 26-year survivor in the group who commented that she'd always thought of herself as cured. He said "No, you're in remission, but please, continue to enjoy your life!". There was a 3-year IBC survivor whose docs have no idea why she has not had a recurrence. A 6-year survivor who developed leukemia from the chemo. Swell. A 10-year triple negative survivor. And on and on and on.

He didn't think it would happen in his practicing lifetime, but down the road as they learn more, patients won't be diagnosed with breast, lung, colon, etc. cancer but will be diagnosed with cancer qrsxyz or abcdef in a breast, lung, or whatever. Treatments will be targeted specifically to qrsxyz or whatever. He also said that didn't mean there wouldn't be side effects . .

He was an excellent teacher, able to teach at our level.

I thought of Eileen and her 22-year remission and response to treatment for her recent recurrence. I thought of Linda and her all-too-soon recurrence. All the individual types, stages, grades, ages and treatments on this board. All individual journeys in spite of seemingly the same diagnosis and prognosis.

And our friends and loved ones have the audacity to say things like "is this all you talk about"? Most of us are naive at diagnosis, and they have no reason but to remain naive. I'm sure I would have had I not had cancer. I wouldn't know as much or be involved in some of the activities I now am if I hadn't had cancer. I wouldn't know you if I hadn't had cancer. Cancer sucks - and it changes us and it can broaden our horizons as well. This is where I am today and today it's more than ok with me.

Suzanne