Sunday, April 1, 2007 1:55 PM, CDT

Hello,
I have another two parter…are you so sick of them??? Sorry!!!!
Part I
I’ve had so many questions in the last few days that I’m going to use today to try to clarify my diagnosis. It’s a weird one as we all know but I think maybe I haven’t done the best job explaining it. Some of you have heard this before, so I apologize for repeating myself.
I’ve been saying that I have colon cancer but in fact my actual diagnosis is Cancer of Unknown Primary. According to the National Cancer Institute (www.cancer.gov), a cancer of unknown primary (CUP) occurs when metastatic cancer is found but the place where the cancer began (the primary site) cannot be determined. In 2-4% of patients the primary site is never determined.
Anatomically, I have cancer in my lungs and my mediastastinum area, which is the area behind your breastbone. Lung cancer is broken into two types: small cell and non-small cell cancer. Smokers typically get small cell cancer. There are four types of non-small cell lung cancer: squamous cell carcinoma, bronchioalveolar carnicoma, large-cell undifferentiated carcinoma and adenicarcinoma (most common type of lung cancer in women and people who have never smoked).
The biopsy of my tumor revealed an adenicarcinoma tumor. Adenicarcinoma is a type of tumor that originates in glandular tissue and is not specific to only lung cancer. The following are only a few types of cancer in addition to lung cancer that are considered adenicarcinomas: breast, colon, prostate, stomach, pancreatic and cervical.
Because the tumor is in my lungs and is an adenicarcinoma, the initial thought was a primary lung cancer. However, tumors also contain certain proteins, or markers, that can help identify from where the cancer originated. My tumor tests negative for lung cancer proteins but tests positive for every singe protein found in a Gastric primary tumor and has a strong positive for colon cancer.
It’s important to know the cancer’s primary location because every tumor responds differently to different types of chemo. For example, a patient with breast cancer would receive a different regimen than I do—even if it’s an adenicarcinoma. A metastatic tumor in the lungs will respond to chemo from where the cancer originated instead of a regimen designed for lung cancer. And there is a saying at Dana Farber: “Treat the Meat,” which means treat the cancer based on where it originated instead of where it is located. Therefore, I am receiving the Folfox chemo regimen even though I have no cancer in my gastric area. If I had a primary tumor in my colon with a metastes to the lungs, the Folfox would attack both areas.
The regimen I was going to go on (the Cisplatin/Gemzitobene) is effective against lung cancer and gastric cancer. However, the only gastric cancer it would not have treated is colon cancer. Dr. Enzinger, my gastric oncologist (it must be hard for you to keep them all straight because it seems like I have an army of them working on my case!), firmly believes the primary cancer is colon and wants me on the Folfox.
How did this happen??? Dr. Enzinger believes I had cancer in my colon (or somewhere in my gastric tract) and my immune system killed it. However, it didn’t kill it before it had a chance to enter my bloodstream and find a nice cozy place to spread out in my lungs. Weird huh???!!
With any chemo regimen, the doctors will run a CT scan and/or a PET scan to see how the tumor(s) are responding. As I’ve said, my first checkup CT scan will be April 9. If the tumor has responded, I will remain on the Folfox and will stay on the same regimen for at least six rounds.
If the Folfox works (please let it work), I may fall into that 2-4% of people who never know where their cancer originated because, as I’ve said, the regimen attacks all GI cancers. And to tell you the truth, as long as I can get this cancer out of my system, I don’t care where it originated; I only care about remission (and I’m still hoping I can be cured)!
If you guys have any questions, please feel free to ask them. You can always email me directly. I really will not mind—at all.
Speaking of emails, thank you to all of you that have sent me direct emails. It’s fun to catch up with some of you that I haven’t seen or spoken to in years! As always, I also love the posts to my website.
Have I totally bored you all to tears?!?!?!