Breast Cancer and Herceptin (Trastuzumab)

During my treatment for breast cancer, I was part of a medical trial in relation to the effecacy of the drug Herceotin (Trastuzumab). Herceptin is a drug that belongs to the group of drug treatments called targetted or biological therapies. It stops specific ways that breat cancer cells divide and grow. I was treated with Herceptin because my cancer cells were found to have a higher than normal level of the protein Human Epidermal growth factor receptor 2 (HER2) on their surfaces. That stimulates the cancer cells to breast-cancer-s10-photo-of-her-2-genegrow. Herceptin works by attaching itself to the HER2 receptors so that the cancer cells no longer grow. it also stimulates the body’s immune system to fight the cancer cells.

I am one of the 20% of breast cancer patients to benefit from Herceptin as my tumours were the fast growing ones that are HER2 positive. I was given the Herceptin along with chemotherapy after my surgery in order to reduce the chance of the tumours spreading or returning. If your breast cancer is not HER2 positive or, indeed, HER2 negative, Herceptin will not be effective to you.

The Herceptin treatment I was given for my breast cancer was given to me intravenously through my Hickman line on the same days as my other chemotherapy. I was treated every three weeks as an out patient. However, the days were long, as the Herceptin was given over 90 minutes with additional time taken to give me saline solutions and my chemotherapy. I had to stay in hospital for several hours in case I was allergic to the treatment. Luckily I was not. However, like all drugs, Herceptin has side effects.

The common side effects of Herceptin include: feeling like you have flu, nausea and diarrhoea. I had all of these. I felt pain in my muscles and joints and often felt breast-cancer-s2-breast-cancer-illustrationlike I had a temperature so I swung between feeling hot and cold. I also had to have treatment with anit-sickness drugs for the servere nausea I suffered. I also got medecine from the hospital to counter the diarrhoea that I suffered.

The trial I was part of was looking into reducing the period of time that women are treated with herceptin, to see if it makes a difference to the efficacy. The usual period for getting Herceptin is about a year. I was treated with it for 9 weeks. I found the hospital visits and the side effects very draining, so, although I had initially felt diappointed that I was only receiving the treatment for a shorter period, in the end I was quite glad to get to the end of the course of Herceptin.

Valerie Penny

 

 

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Information about Taxotere (Docetaxel)and Breast Cancer

During my treatment for breast cancer, one of the drugs that I was treated with was Taxotere. It is also known as Docetaxel. It was used for me to treat primary breast cancer that had not spread to other parts of the body. It was used in combination with other drugs in combined chemotherapy. Docetaxel is also sometimes used to treat breast cancer that has come back after treatment or spread, for example, into the lymph nodes.

It works by interfering with the development and growth of cancer cells. Docetaxel blockshickman line.jpg part of the cancer cells before they divide and grow. This makes the cancer cells die off at an early stage.

When I was given Docetaxel, it was gven to me intravenously through my hickman line. I had three weeks between each round of chemotherapy. So, just about the time I was feeling normal again, another dose of the drugs was given.

Docetaxel has side effects. All drugs have side effects. Some people are more suseptible to them than others.Amongst the common side effects of Docetaxel are: bone marrow suppression, hair loss and nausea.

The bone marrow supression was the side effect that worried me most, because this means that I had an increased risk of getting infections when my white blood cell count was low. As a result of this, I was unable to go out and mingle with friends or relatives after my treatment. It made me feel isolated and lonely. My resistance was lowest around 5-10 days after I had had my dose of Docetaxel. So for about one week in every three, I had to be particularly careful to avoid infection. I was warned that, if I did feel unwell during this time, or if my temperature ever did go up over 38C then I was to get medical help or go to the hospital.

I managed to avoid having to go into hospital, but I did find that I bruised more easily and had nose bleeds that were difficult to stop and did suffer from anemia.I did not need any blood transfusions, but I did take iron tablets to boost my red blood cells.

Nausea was a problem for me, however, I was given medication to control this. The anti-sickness tablets were very effective and I was grateful for that. I also noticed that the taste of many foods changed while I was on chemotherapy. Much tasted like tin. However, I am glad to say that my sense of taste has returned to normal since my chemotherapy cancer-101-s8-tnm-stagingtreatment has finished. I was told that I might suffer from diarrhoea, however, my body reacted differently and I suffered more from constipation than diarrhoea.

The other side effects I suffered when being treated with Docetaxel tiredness, fatigue and pain in my muscles and joints. I still suffer from these over a year after termination of my treatment. When the pain is severe, I take pain relief or anti-inflammatories, but I try to avoid them as far as possible. Common practice says that gentle exercise improves the fatigue. I find it merely replaces it with exhaustion!

All in all I found chemotherapy difficult, but it is miles better than the alternative: no treatment: no recovery.

Valerie Penny

2015 in review

The WordPress.com stats helper monkeys prepared a 2015 annual report for this blog.

Here’s an excerpt:

A San Francisco cable car holds 60 people. This blog was viewed about 1,900 times in 2015. If it were a cable car, it would take about 32 trips to carry that many people.

Click here to see the complete report.

Symptoms of Breast Cancer.

Breast_Cancer_1Breast cancer affects both men and women. However, breast cancer has been the most common cancer in the UK since 1997, but is rare in men. It is by far the most common cancer among women in the UK (2011), accounting for 30% of all new cases of cancer in females. In 2011, there were 50,285 new cases of breast cancer in the UK: 49,936 (99%) in women and 349 (less than 1%) in men. Female breast cancer incidence is strongly related to age, with the highest incidence rates found in older women. This supports a link with hormonal status. In the UK between 2009 and 2011, an average of 80% of breast cancer cases were diagnosed in women over 50. Indeed, around a quarter (24%) were diagnosed in women aged 75 and over. I therefore find it very frightening that many older women ignore the risks of contracting breast cancer and are ignorant of the symptoms of the disease, with the exception of finding a lump. Finding a lump may be the most common sympton of breast cancer, however, in many cases finding a lump will be one of the last symptoms to become obvious, especially if the tumour is seated deep in the breast tissue. This is important because the earlier the disease is treated,the more successful that treatment is likely to be.

Some of the signs and symptoms of breast cancer include:

1) a lump in the breast
A lump in the breast is the most common symptom of breast cancer. Most breast lumps are not cancerous. They are usually fluid-filled lumps,cysts or a fibroadenoma, which is made up of fibrous and glandular tissue. But it is important to get a lump checked by a doctor straight away. If a lump or other symptoms is caused by breast cancer, the earlier treatment is received the more successful it is likely to be.

2) a change in the size or shape of the breast
The warning signs of breast cancer are not the same for all women. One of the common signs are a change in the look or feel or size of the breast. Breast enlargement alone is not necessarily a sign of inflammatory breast cancer. I see a lot of women who are worried about a change in breast size, and inflammatory cancer is rarebreast size

3) dimpling of the skin or thickening in the breast tissue
You may become aware of dimpling or tethering of the skin of the breast during a self-exam. It is an important part of the self exam to look in the mirror and look for a dimple. The breast should be outwardly round—it should curve outward and not pull in. If you have had breast surgery before and you have some scars, you might find that the breast will pull in around a scar. Of course, this is a different situation. A dimple is a pulling in of the skin, and it may occur when you raise your arm or lean forward. When you lean forward and raise your arm, the breast should stay outwardly round; it should not pull back in. That may be a sign of cancer, and it should be checked.

4) inverted nipple, a nipple that’s turned in
Every body is different. Some people are born with inverted nipples. That is not a worry or unusual for them. However, if you notice a change in your breasts that result in development of an inverted nipple, so you were not born with one,and the nipple cannot be drawn out, this should be checked by a doctor. it may suggest a lump behind the nipple that is pulling it in.

5) a rash on the breast or the nipple
Although tumors are the most common symptom of breast cancer, they are certainly not the only symptom. Women with a rare form of the disease called inflammatory breast cancer can develop a red, pink, or purple rash across part of their breast. The skin of the breast might also appear puckered, like the skin of an orange. If you notice symptoms like these, have them checked out by a doctor right away. Inflammatory breast cancer can spread quickly.breast cancer rash
6) discharge or bleeding from the nipple
Nipple discharge is a normal part of breast function during pregnancy or breast-feeding. It also may be associated with menstrual hormone changes. It appears spontaneously and involves a single duct. Although the bloody discharge may resolve on its own, this situation requires evaluation with an ultrasound of the area behind the nipple and areola. If the ultrasound shows a lesion, you may need a biopsy to confirm whether it is a papilloma or something more sinister. Although most often, nipple discharge stems from a benign condition. However, breast cancer is a possibility, especially if it is combined with one or more of the following: you have a lump in your breast, only one breast is affected, the discharge contains blood, yhe discharge is spontaneous or the discharge affects only a single duct.
7) swelling or a lump in the armpit
An armpit lump refers to the enlargement of at least one of the lymph nodes under your arm. Lymph nodes are small, oval-shaped glands that are located throughout the body and play an important role in the immune system. Most lumps are harmless and are usually the result of abnormal tissue growth. However, armpit lumps can be related to a more serious underlying health problem. Any unusual lumps should be evaluated by a doctor. Armpit lumps can occur in men and women of all ages. However, finding an armpit lump is most alarming for women because it may indicate breast cancer. Women should perform monthly breast exams and report any lumps to a doctor right away.Note that breasts undergo hormonal changes during the menstrual cycle, and may tend to feel more tender or lumpy during this time. This is completely normal. For the most accurate results, perform breast self-exams about one week after your period starts.

The advice you must consider is this: whether man or woman, old or young, if you become aware of a change in the area of your breasts seek medical attention sooner rather than later. Time is valuable: time is life.

Valerie Penny

Dealing with Cancer in the Workplace by guest author Ryan McChrystal

This article, Dealing with Cancer in the Workplace by Ryan McChrystal first appeared on Tuesday, 10 March 2015 in http://elitebusinessmagazine.co.uk/people/item/dealing-with-cancer-in-the-workplace

Serious illness – particularly cancer – can have a devastating impact on your employees and your business, therefore it is essential to have a plan in place that ensures the best way forward for all concerned

Dealing with cancer in the workplace

Cancer isn’t an easy thing to discuss. There is no shame in admitting that. However, with around 750,000 people of working age with some form of it in the UK – representing over a third of the 2 million people living with the condition – it is wise to think about your approach now before you, as an employer, have to deal with it. With people living longer and retiring later, the numbers of people in the workplace diagnosed are only going to increase. Cancer is just one – and certainly the most emotive – example of the serious illnesses that could impact on your employees, their attendance and productivity.

“The pressures put on an employee with cancer have a direct effect on their ability to manage or even recover,” says Elliott Hurst, director of health consulting at AXA PPP Healthcare, one of the biggest UK health insurance providers. The physical and emotional strain of a serious illness can be severe and, when you combine that with the potentially damaging financial impact, the result can be devastating. But that’s not to say a diagnosis automatically leads on to periods of absence.

“From an employer’s perspective, it is better to have your experienced and valued employees contributing to the workplace in some way, shape or form than not and with proper planning this can be achieved,” says Hurst. Therefore, an effective workplace policy should be in place to ensure you are best equipped to deal with cancer and other serious illnesses. As with all good policies, it is best to begin by amassing all the relevant information that’s available, including a full understanding of the law. As an employer, you are legally obliged to make workplace adjustments where appropriate, just as you would with any other disability. Access to Work is a specialist disability service delivered by Jobcentre Plus, which gives practical advice and support that may be able to help with the cost of making workplace adjustments.

“It is good to have a better understanding of the illness your employee is suffering from. Cancer, for example, is not a single disease with a single cause and a single type of treatment,” says Hurst. “Each cancer experience is different, but having a little knowledge can help you as an employer to better understand what the person is going through and how best to support them.”

A government white paper in 2011 suggested that employers need to do more about the health of their employees. Dr Gordon Wishart, a cancer surgeon and medical officer at HealthScreen UK has seen a major rise of employers offering cancer screening as part of their benefits packages. “Companies are engaging with us to explore early cancer detection for their employees, which in many ways is adding to the already existing employee benefits that are available through employers and in some cases that’s been completely sponsored by the company,” he says.

With most cancers, if you pick it up early it requires less treatment, which is a better outcome for employees and for the employers. “It means less time off work, and getting that employee back to their desk as soon as possible and back to being an efficient, productive member of the team,” says Dr Wishart. A screening by HealthScreen UK only costs around £100 and if it is paid for through a salary sacrifice, it becomes more tax efficient and an employee will only pay around £50-60, or about £5 per month.

Often a small business won’t think about the issue of cancer until it is raised by an employee, which can take managers and HR by surprise. Therefore they are often nervous and uncertain about what to say. Good quality conversations between employee and employer are essential to understand their requirements and plan for the best possible support.

“It is important for employers and managers have some kind of training or insight that allows them to understand how much a serious illness like cancer can really turn somebody’s life upside down,” says Dr Jill Miller, a research advisor at CIPD. “Have an awareness of the emotional and financial strain it puts on people and that how you respond and support employees has a huge impact on both their morale and on the rest of the workforce as they will see the organisation is a good place to work.”

There are a few things to bear in mind when having these conversations. “It is best for the manager, the employee and HR to get the expectations out at the beginning,” says Dr Miller. “It is important to talk about who the employee wants to know among the business and how they want other people to react. Do they want people to talk about it, or do they want them to act normal and talk to them as they always have done?”

Needs will differ from employee to employee and from cancer to cancer. Different cancers will have different paths and treatments will have different demands on people, so constant conversations with employees to get updates on their progress is essential to know what’s going on. “It’s important to think about what support and flexibility you can offer to help people stay in work,” advises Dr Miller.

Employers also need to understand that recovery is a process and that it takes time. Legally, they have a duty to make reasonable adjustments to support a return to work, which will depend on the circumstances, including practicality, cost and the extent to which an adjustment will be effective in alleviating any disability. Adjustments might include offering lighter duties or allowing extra breaks.

These days, many people are cured of cancer or are able to live with it for many years. Some people may have short or long-term side effects from the illness or its treatment. Therefore, they may continue to need support after their treatment ends. “Many people tell us that that work can help to restore a sense of ‘normality’ after a cancer diagnosis. Try to find out a little about the type of cancer your employee or the person they are caring for has and what the effects of treatment are likely to be,” recommends Hurst.

Work contributes to financial independence, provides a sense of purpose, creates structure in our lives and is a lifeline back to normality, wellbeing and recovery for those suffering. For Dr Miller, it is essential to make the transition back to work as easy as possible. “It is also important to think about employees caring for those with serious illnesses and how to respond to employees who are supporting a family member or close friend who has had a cancer diagnosis.”

There is comprehensive legislation in place to support a successful return to work. Together, the Equality Act 2010 and the Disability Discrimination Act 1995 provide protection from discrimination. Everyone with cancer is classed as disabled from the point of diagnosis for the rest of their life, and their employer or a prospective employer must not treat them less favourably for any reason relating to their cancer. All areas of employment are covered including recruitment, promotion, training, pay and benefits.

Coming back to work can be very difficult for a patient. A recent study by Macmillan, the cancer charity, showed that 57% of survivors who were in work when diagnosed had to give up their job or change roles due to their illness. This means the total loss in productivity of survivors unable to return to paid work in England was estimated, in 2008, to be as high as £5.3bn. You must be prepared for such a possibility because small businesses often rely on teams that, while few in number, are high in skills and experience, so the impact can be particularly devastating.

If an employee comes back to work, which is often the case, there are a number of steps that can be taking to make things easier. This includes implementing a standard, phased return to work plan. You should also provide regular catch-ups to check all is working well.

More than anything, a clear policy is key to coping with cancer in the workplace. But it’s important to remember that with the devastating effects of serious illness on employees, there are no quick fixes.

Ryan McChrystal

How Cancer Will Affect Your Business by guest author Professor Gordon Wishart

gordon wishartProfessor Gordon C Wishart MB ChB MA MD FRCS FRCS FRCS is a graduate of The University of Edinburgh, Scotland and consultant breast & endocrine surgeon at Addenbrooke’s Hospital, Cambridge, England.

It is calculated that, currently, one in three people in the UK will get cancer of one type in their lifetime. Cancer charity Macmillan estimate this will rise to one in two by the year 2020.

New methods used by Cancer Research UK to calculate these figures, however, suggest that the 50 percent level of cancer incidence may already be upon us. A recent survey conducted by Cancer Research UK also revealed that cancer is now the UKs number one fear, ahead of being in debt, old age, being the victim of knife crime, car accidents, having a heart attack or losing a job or home.

This, of course, is not good news for anyone – but some employers may still be wondering what this has to do with them. The fact is, whether employers choose to take action or not, cancer is going to have a serious impact on them, their workforce, and their business. The NHS has identified that around 13,000 men and women die every year from work-related cancer – but the impact is not limited to areas of work that specifically put workers at higher risk. Of the 325,000 people diagnosed with cancer each year, over 100,000 are of working age, and estimates suggest that over 750,000 people of working age are now living with a diagnosis.

Alongside this, we need to consider the friends, spouses and families of employees. One does not have to be personally diagnosed with cancer to be hit by its effects; having to care for a loved one under these trying circumstances – not to mention the psychological impact of a cancer diagnosis – can also mean increased downtime among employees who are otherwise healthy.

Little wonder then that the Department of Health is asking employers for help to fight the massive cancer burden. On the positive side, there is a lot that employers can achieve, if they choose to act. The key is cancer screening and awareness in the workplace.

About Check4Cancercancer microscope

Check4Cancer Ltd. (previously known as International HealthScreen Technologies Ltd) started its existence in Cambridge in 2006 when the two founders Prof Gordon Wishart and Troels Jordansen met. The first BreastHealth UK clinic started at Spire Cambridge Lea in April 2008.

Today Check4Cancer offers 6 innovative different services for early detection of cancer. The services are:

BowelCheck BreastCheck GynaeCheck
LungCheck ProstateCheck SkinCheck

Above 6 services cover 90% of all new cancer incidence in the UK every year.

The services are supervised by a Board of Clinical Advisors; please click here for more details. All advisors are nationally renown  experts within each cancer area.

Throughout a network of over 80 clinics across the United Kingdom private individuals and companies can access these services. 2 of the life saving services (BowelCheck and GynaeCheck) requires no clinic but are based on home sampling.

Besides services for early detection of cancer Check4Cancer also operates the largest independent network of genetic counsellors and test. GeneHealth UK offers several cancer genetic tests ranging from gold standard BRCA 1&2 tests to innovative cancer panels. Pre-conception testing is being introduced during 2015.

Breast_Cancer_1With around 1 out of 2 Britons getting cancer over their lifetime cancer is a very serious issue for individuals and companies. On this background Check4Cancer is proud to be working with some of the leading companies to offer affordable services for early detection of cancer and cancer awareness services. Please click here for a list of such companies.

Check4Cancer is working according to ISO9000 and ISO270000, regulated by CQC, complies with the requirements of the Cyber Essential Scheme, registered with ICO is very proud to have 93% of our clients rating us ‘Very Good’ to ‘Excellent’.

Gordon Wishart

Life on Letrozole After Breast Cancer

letrozoleAfter completion of my chemotherapy and just as my radiotherapy started I required to start taking letrozole: just one 2.5mg tablet per day. A 2.5mg tablet each day for 5 years. This is because my breast cancer wasa type that needs the hormone oestrogen to grow. In women who have been through the menopause, the main source of oestrogen is through the change of sex hormones called androgens into oestrogen. An enzyme called ‘aromatase’ is needed for this change to occur. Letrozole works by inhibiting (or blocking) this enzyme. This reduces the amount of oestrogen in your body, which slows the growth of the cancer cells, should they recur. It is my fervent hope that they will not.

I am ashamed to say that I never read the information given with medication, although I know I should. The manufacturer’s leaflet will give more information about letrozole and a full list of the side effects which may be experienced from taking it. I have to take other tablets daily as well. So I take one 2.5 mg tablet of letrozole each morning with my other medication, although you may take letrozole at whatever time of day you find easiest to remember, but try to take your doses at the same time each day. This will helps to avoid missing any doses. You can take the tablets before or after your meals. If you forget to take a dose, take it as soon as you remember. If you do not remember until the following day, skip the missed dose. Do not take two doses together to make up for a forgotten dose. I suppose one tablet out of 5 years will not make much difference.

However, along with their useful effects, most medicines can cause unwanted side effects although not everyone breast-cancerexperiences them. If you have read other articles in this blog, you will realise, that my primary mind set is always that these things cannot happen to me. Of course, sometimes they can and they do. That is just life. Also, because I do not read the manufacturers leaflets, I did not know the side effects to expect. However, Letrozole has a raft of side effects and I seem to have been blessed with most of them. The common side effects are as follows:

1) Hot flushes and sweating: yes, I get this one! I thought it was my time of life, but no, I owe this joy to Letrozole so I try to keep cool by wearing light, airy clothes or in winter, I wear layers, so I can take them off as required.
2) Headache, muscle or joint pain: oh wow! I have this one in spades. You can ask your doctor or pharmacist to recommend a suitable painkiller but I do not like to take any more tablets than I have to, so I try to manage the pain with rest, hot water bottles or ignoring it before I give in to the painkillers. The dull ache of the joint and pain is a persistent, nagging pain that drains the drive and strength out of me. It is inescapable.
3) Feeling tired, weak or dizzy: Oh, you guessed, I find this side effect really, really debilitating. I simply cannot do all that I did before I got ill. Some days I cannot get up, some days I have to take a nap, sometimes I just cannot move. I get so indescribably weary and tired. I get cross with myself and irritated but it does not explain this side effect to say that I get tired. The tiredness makes me bone weary. My limbs feel heavy, my concentration is affected. My eyes cannot stay open. At other times I cannot sleep at night, so that makes me tired too. I do not drive or use tools or machines until I feel fit enough to do that.
4) Feeling or being sick, indigestion, abdominal pain: Hurrah! I do not get this one! I stick to simple meals, generally avoid rich or spicy foods and I am very careful about my diet.
5) Constipation: I occasionally suffer from this one but I try to eat a well-balanced diet and drink several glasses of water each day.I also drink copious amounts of tea, mostly English Breakfast tea, sometimes Earl Grey.
6) Diarrhoea: Nope, I do not get this one: if you do, remember to drink plenty of water to replace the lost fluids.
7) Appetite changes, weight changes, feeling depressed, hair loss, skin rash, swollen legs or feet, vaginal bleeding: I am blessed with some of these, the most immediately obvious is that my hair has become very thin. Sometimes I wear a hat because my head gets cold, my hairdresser is a magician and always makes me look and feel like a million dollars. The other one of these side effects that I have to cope with is depression. I have suffered depressionfrom depression for many years any way and now it is reasonably well controlled. It is just difficult having another potential source of that mental health problem.
8) High blood levels of cholesterol or high blood pressure. I do not suffer from either of these. I am lucky in that my blood pressure sits fairly low anyway and my doctor also arranges for me to regular have tests to check that these side effects are not rearing their ugly heads.

As I suffer with so many side effects of Letrozole, I have been offered the opportunity to change to another tablet. However, I have declined to do so. I know what the side effects of Letrozole are and I can cope with them, more importantly my long suffering husband knows what they are and he can also cope with them. So for the remainder of the 5 year period, I will cope and I will be grateful that I am being successfully treated for breast cancer. I am a lucky woman.

Valerie Penny

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