Chemotherapy helped cure Melinda Dutton's breast cancer, but it left her with a badly damaged heart.
Bruce Ogden, who survived prostate cancer that had spread to his bones, lives with feminizing changes to his body from drugs he took to block testosterone that would have accelerated the malignancy.
And Sally Coplin is almost totally deaf and can't produce saliva. Radiation treatment caused that, even as it rid her nasal passages of spiderweb-like tumors.
Stories like these are what keep stem cell scholar and medical student Joyce Ma up late, mulling theories she hopes will make traditional, often toxic cancer therapies obsolete one day.
"We are harnessing the power of the human body's ability to heal itself," said Ma, an M.D./Ph.D. candidate at UC Davis who has pending two stem cell-related patents. "If we help it recognize the bad cells, the body will take care of the rest."
The revolutionary concept is to target and eliminate cells that cause tumors to regrow, without harming healthy tissue. Ma's work represents an emerging focus of stem cell research: using cells to unlock the mechanism of diseases so they can be more effectively treated.
As a California Institute for Regenerative Medicine scholar, Ma was part of the first research team to identify specific stem cell markers in glioblastomas, the most common and deadliest of brain tumors -- the kind that Sen. Edward Kennedy now has.
It's esoteric and still in its early stages, for sure, but cancer researchers generally agree that strategies from emerging stem cell science could transform conventional cancer treatment.
"There has already been an enormous rate of progress in stem cell biology related to cancer, and we expect this to accelerate," said Dr. Arnold Kriegstein, director of the Institute for Regeneration Medicine at the University of California, San Francisco.
Most cancer survivors welcome such advances, even if those advances come too late to improve their own quality of life.
Side effects devastating
Melinda Dutton, 51, suffered a range of consequences from her cancer treatment. Beyond the heart damage from chemotherapy, she endured a surgery-related staph infection, wild mood swings and nonstop hot flashes from the drug tamoxifen.
"It's like you have a firing squad with 30 rifles aiming at one person and all the guns are loaded," she said of her therapies.
Although doctors and researchers are constantly looking for ways to cut out or kill more tumor cells and minimize collateral damage, principles of conventional therapies are the same as they have been for decades.
Chemotherapy's origins lie in the cell-killing properties of mustard gas used in World War I. Today, most of the drugs remain fairly indiscriminate poisons.
Radiation therapy damages genetic material in cells so they can't replicate. Although new technologies better aim the radiation, surrounding healthy cells cannot always be spared.
"It's a toxic disease that requires those sorts of therapies to do more damage to the cancer than to the person, hopefully," said Dr. Charles Loprinzi, an oncology professor at Mayo Medical School in Minnesota who researches ways to minimize chemotherapy side effects.
First diagnosed with breast cancer at age 40 in 1996, Dutton had a single mastectomy and four cycles of chemotherapy drugs Adriamycin and Cytoxan.
When she unexpectedly became pregnant with her second child six months after treatment, doctors urged her to abort, worried the drugs might have affected the viability of her eggs. After genetic testing, Dutton proceeded with the pregnancy and bore a healthy baby girl, Clare.
In January of 2004, Dutton discovered a lump in her other breast while working in New Orleans. Again, she had a mastectomy, then, as she described it, "I went back to the Barcalounger" for more chemotherapy.
A year later Dutton went into cardiac arrest at an Oregon airport. She was resuscitated by a nurse who happened to have a portable defibrillator.
Tests detected an enlarged heart, likely from the chemotherapy.
Even with medication to protect the heart muscle, two years later Dutton again suffered cardiac arrest, this time moments before a James Taylor concert at Sacramento's Arco Arena, where she had second-row seats.
"I had just been to see the oncologist in the morning and all my blood work was perfect," she said. "I was celebrating."
Today, she has a small defibrillator in her chest, which gives her a jolt of electricity when her heart rhythms go awry.
Dutton is grateful to be alive, but the Sacramento saleswoman said that if she hadn't had young children she would have skipped chemotherapy a second time.
Leslie Duket has heard that sentiment a lot. The clinical social worker oversees outpatient counseling at Sutter Cancer Center. Beyond the physical trauma cancer and its treatments induce, she said, are emotional scars.
"Often the cancer diagnosis affects them at the core of who they are," she said. "There is this looking back: Who am I, what was life like before? There can be an absence of joy."
Personality changed
Sally Coplin, 69, believes the long-term effects of life-saving chemotherapy and radiation treatment for nasopharyngeal cancer changed her personality.
Before her 1994 diagnosis, she was a vibrant wife and mother, tireless volunteer and globe-trotting scuba diver. Since then, Coplin said, she's felt alienated because of the hearing loss from radiation damage to the cochlea.
"It's very difficult to be in a crowded room," said the Carmichael woman. "I'll go wash dishes -- anything -- so I don't have to follow the conversations."
On a cruise with her husband recently, she felt left out of dinner talk; even with hearing aids she could not decipher what people were saying.
Radiation treatment also obliterated her salivary glands, the structures around the mouth and throat that produce saliva. The glands make chewing, swallowing and digestion seem like second nature.
To prevent dehydration, Coplin always carries a bottle of water. This, too, has created problems in certain places -- including secure areas at airports.
Entering a railroad museum with her grandson once, she was told water was not permitted.
"I stood there and I wanted to cry," she said, tearing up at the memory. "They wouldn't tell someone with a seeing-eye dog that they couldn't come in. We left."
Coplin said she has learned to live with the changes.
"They're little things, and you can't dwell on them," she said, smiling. "It's just different."
Every day is a gift
Bruce Ogden, 66, would agree after surviving what he was told in 1994 was terminal prostate cancer.
"It was like having a toothache all over your body," said Ogden of the pain from cancer's spread to his bones.
In addition to radiation, Ogden was prescribed two drugs -- Casodex and Lupron -- which are sometimes used for "chemical castration" of sex offenders.
The medications stop production of testosterone. The hormone fuels sex drive but sometimes promotes prostate cancer growth. For Ogden, the side effects were stunning.
He gained weight. His breasts grew. He suffered hot flashes day and night. And he lost the blanket of hair on chest, back and legs, only to see it regrow on his head.
"It really taught me that sympathy is a far easier emotion than empathy," Ogden said.
As for the loss of sex drive, he quipped, "You become an accomplished conversationalist."
And Ogden's wife, Marlin, herself a cancer survivor, told her husband she wishes she'd kept an unwashed shirt with his musky odor.
Ogden calls every new day a gift and is philosophical about prospects for more benign treatments.
"In the next 25 years we will look back and say how barbaric that was, how uninformed that was," he said. "But praise God that we're looking back at all."
Quest personal for doctor
Joyce Ma, the 33-year-old UC Davis physician-scientist trainee, wells with emotion when she thinks that one day she might help develop therapies that spare cancer patients the debilitating side effects.
Ma was 4 years old when she started tagging along to the hospital with her mother and older sister, who had stubborn, noncancerous facial tumors that made talking and eating difficult.
She had lots of questions for the doctors, who patiently explained to her the concept of cell growth. By fifth grade, Ma was poring over science books, memorizing the periodic table and imagining possible cures for her sister.
"Every time I see another patient who is sick, I think, 'I have to go back and work harder,' " she said. "The sooner we get this done, how many people will not have to suffer?"
Copyright (c) 2008, The Sacramento Bee, Calif.
