I am often asked what cancer is, how cancer can be won, and why a battle with cancer is sometimes lost. I could, of course, resort to a game of definitions such as "cancer is a disease where abnormal cells grow out of control." But people usually learn from stories better than they do from cold, dry facts, so I decided to tell you a story about three people I know, and about their cancer.
I have never met the first person I am going to tell you about. Yet, I feel that I know him, because he is a celebrity, and as such, a person other people feel they know well. I read a book he wrote, "It's Not About the Bike, My Journey Back to Life." And then I watched a video clip of him riding a bike: he was working the pedals hard, his bicycles swaying under him.
He was riding up a steep hill. I could almost hear his heart pounding, his lungs puffing. And when he crossed the finish line, raising his arms into the air, his hands turned into fists, I could see that his face, his whole being, was before he won the Tour de France seven times, Lance Armstrong won over cancer, testicular cancer. His cancer, like every cancer, started with one of his own cells, a single abnormal cell, a cell that broke loose from its program, a cell that went rogue.
Shahar Madjar, M.D.
Normal cells contain information within their DNA, the genetic code that dictates their shape, function and behavior. This code also dictates the cell's life cycle. It tells the cell when to divide and multiply, it instructs the cell when it is time for it to die (it is natural for our cells to die and be replaced by newly formed cells).
But the cell that started Lance's cancer was different; it was defective. It carried the wrong information. It escaped the normal program every cell has. Instead of obeying the normal code of behavior, it started to multiply rapidly and uncontrollably. As a result, many abnormal cells were formed.
These cells possessed bad characteristics: they could invade tissues around them, they could travel into lymph vessels and lymph nodes, and into the blood vessels, carrying themselves to remote destinations. They could evade the natural process of cell death and escape the immune system.
Before long, Lance had a very serious condition: an advanced stage, metastatic, testicular cancer, with metastatic spread to his lungs and brain.
The news that Lance had cancer hit him hard. And Lance fought back. He consulted his doctor and then he got a second, and a third opinion. He studied the medical literature. He considered his treatment options and the side effects and complications involved with each of them. He examined which treatment option will give him the best chance to return to competitive bicycling. Considering his survival, he repeatedly asked himself: "What are my chances?"
The road to Lance's cure was long and tremendously painful. His cancerous testicle was removed by a urologist; his brain metastases were taken out by a neurosurgeon; his lung metastases were addressed by an oncologist using aggressive chemotherapy. And, beating almost all odds, Lance Armstrong won. In the winter of 1997 he was declared cancer-free.
In his book "It's Not About the Bike, My Journey Back to Life," Lance writes: "When you think about it, what other choice is there but to hope? We have two options, medically and emotionally: give up or fight like hell." And "pain is temporary... If I quit, however, it lasts forever."
For Lance, the battle against cancer is a competition, a war, a race that should be won.
But then he adds: "The question that lingers is, how much was I a factor in my own survival, and how much was science, and how much miracle?"
But I have a lingering question of my own: if facing cancer is a war and those who survive are winners, what should we call those unfortunate souls who succumb to the disease?
I promise to come back with my story, and to tell you about two more cancer patients I know, but before I leave, I would like to remove any doubt from your heart: losers is not the correct answer to the question above.
Editor's note: Dr. Shahar Madjar is a urologist at Bell Hospital in Ishpeming. Read and comment on prior columns by Dr. Madjar at DrMadjar.com.