January 28, 2025 • 28 mins
Once you've had cancer, the thought of a recurrence or even a new cancer can frequently be in the back of your mind. But how do you know if your cancer is back? On this show, Karolyn and Lise talk about the real fear of cancer recurrence and what signals to look for. Catching a cancer recurrence or new cancer early can make all the difference in the world. If you are a cancer survivor, you won't want to miss this show!
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
Five To Thrive Live is broadcast live Tuesdays at 7PM ET and Music on W4CS Radio – The Cancer Support Network (www.w4cy.com) part of Talk 4 Radio (www.talk4radio.com) on the Talk 4 Media Network (www.talk4media.com).
Five To Thrive Live Podcast is also available on Talk 4 Media (www.talk4media.com), Talk 4 Podcasting (www.talk4podcasting.com), iHeartRadio, Amazon Music, Pandora, Spotify, Audible, and over 100 other podcast outlets.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
I always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:40):
Hello everyone, and welcome to Five to Thrive Live. I'm
Carolyn Gazella and I'm here with my co host and
good friend, doctor LESE. Olschuler. Hello, Lise, how are you.
Speaker 3 (00:51):
I'm very good. How are you, Carolyn?
Speaker 2 (00:53):
I'm great, good as usual?
Speaker 3 (00:58):
Yeah, as usual, you know, And I'm glad you're great
because there have been times when you haven't been feeling
so great, or maybe you are feeling good, but you're
worried about things. And that really is all about our
topic today, and I think it's something that we have
both experienced with both cancer thrivers or cancer survivors as
(01:21):
some people say. And we're going to talk about the
fear of recurrence and really some ways to something to
truly be watchful for for people who have been through
cancer before, because this is something that's on people's minds
a lot. So I think it's going to be a
really good, good topic. But before we dig in, Carolyn,
can we thank our sponsors?
Speaker 2 (01:40):
Absolutely? And I would agree with you. This topic is
so near and dear to both of us, So let's
thank those sponsors. And I would like to begin by thinking.
Cetria a patented form of glutathione clinically proven to raise
blood gluto thione levels. Gluteothione is the master antioxidant and
the body's primary defense against free radicals. It also helps
(02:01):
support respiratory health. For more information, visits Cetriagodethion dot com.
Also cognizance citicoline, which is nature's way of keeping the
brain's energy producing centers firing on all cylinders. If you're
looking for a way to enhance your brain function, including memory,
focused and attention, look for cognizant on the label or
go to cognizan dot com for more information. Prothriver's Wellness
(02:22):
Brain is a product that contains cognizant as well as
other brain supporting nutrients and herbs. You can find Prothriver's
Wellness Brain online at Pureformulas dot com. There's also Prothriver's
Wellness Sleep, which combines higher dose melatonin and other sleep
supporting natural ingredients specifically designed for thrivers. You can find
Prothriver's Wellness Sleep at Pure Formulas dot com and doctor
(02:46):
ohere is Probiotics. It's a best selling probiotic for more
than thirty years, and it contains twelve probiotic strains that
are shelf stable so no refrigeration is required because of
a unique three year fermentation process. It's a very effective yotic.
Learn more at doctor Ohira Probatics dot com. Well lease,
as you've mentioned, you know at least I don't know
(03:08):
if you remember this, but March is my cancer anniversary.
It will be thirty years that I will be cancer free,
which is pretty remarkable. But I have to tell you,
as you well know, over those thirty years, I've had
some scares. I've had some pretty significant fear of recurrence,
(03:32):
some pretty significant fear of new cancers. I don't know
if you remember when we were at the writing retreat
and we were working on one of our books and
I told you about a lump on my leg and
I had you look at it, and I was so
convinced that I had a soft tissue starcoma and that
I was going to die. And I mean, fortunately, all
of my scares have turned out just fine, But this
(03:53):
fear is real. And I'm just wondering, list if you've
ever personally had this issue as a case answer survivor,
and I imagine it's a pretty consistent issue with some
of your patients for sure.
Speaker 3 (04:05):
I mean, this is something I think that affects everybody
who's had really any kind of cancer. I've definitely had
this myself. There was a time when I had a
really persistent sort of discomfort in my hip and I thought,
you know, this could be a bone metastasis for my
(04:26):
breast cancer, and so I went and I had it checked,
and fortunately it was not. But you know, yeah, I've
definitely been through this. I get it.
Speaker 2 (04:36):
Yeah, absolutely, So let's start by building a foundation. Why
is it so important for us as cancer survivors to
be diligent about finding a recurrent or new cancer early.
Speaker 3 (04:52):
Well, you know the key is what you just said early.
I mean, the more opportunity we have to the sort
of the more the time, the longer the timeline is
for being able to apply treatments to a cancer, whether
it's a recurrent cancer or metastatic cancer, the better opportunity
(05:12):
we have to find treatments that really control the disease. Well,
so when we can diagnose something early, it gives us
a longer timeline, so therefore more opportunities to treat effectively.
And oftentimes an early diagnosis, particularly if it's an isolated recurrence,
could even be removed surgically, which is in some cases
(05:33):
kind of done, you know, it's the recurrence is sort
of done. So the earlier always better. Yeah, I would
agree that improves outcomes. So here's my question to you.
Speaker 2 (05:43):
I would think that that is true across all cancers.
Is that a correct statement? That is true across all cancers.
Speaker 3 (05:55):
Yes, I'm hesitating only because for some cancers the recurrence
is very occult, meaning it's really hard for a recurrence
found unless it's found sort of incidentally on a repeat
scan that's already scheduled. It just happens to have just recurred.
(06:15):
But some cancers are very difficult to find early. So yes,
that's ideal, and I just want to, you know, make
sure we understand that's not always the situation.
Speaker 2 (06:25):
That's good. So let me ask a follow up question
of that that might be a little bit more clear
than my last question. Let's talk about a new cancer
as a cancer survivor, if I get a new cancer,
if I catch that new cancer early, it doesn't matter
what type of cancer it is, early is always best.
Is that a true state? Sure? Okay, yeah, for sure? Okay, cool,
(06:49):
that's what I was wondering. Okay, So now I realized
that everyone is going to be different, and it's important
for us to know our own bodies. And as an aside,
I will will say that one of the reasons I
didn't catch my cancer back thirty years ago is because
I was not good at reading my body and understanding
(07:10):
the signals that my body was sending me. And that
is a lesson that I've learned. So we all need
to know our own bodies. However, I'm wondering if there
are some foundational health signs that all cancer survivors should
keep on their radar or keep in the back of
their head.
Speaker 3 (07:30):
Yeah, so you know things, All cancers are not the same,
and I love hope we have time maybe to dive
into some of the more common cancers and some of
the current things to look for specificed cancers, but generally speaking,
the most unfortunately, these are really generalized symptoms, meaning these
symptoms that yes, they indicate the presence of cancer, but
(07:52):
they can indicate so many other things too. These are
These are not if you have these symptoms you have
a cancer occurrence, even.
Speaker 2 (07:59):
If you have had history of cancer.
Speaker 3 (08:01):
These are just okay. You've had a history of cancer
and you start to experiencing these symptoms, then you know
you should be on the alert. And the key when
I go to this listening moment is that you want
to be sure that any symptom you're having, especially as
someone who had his cancer, if you have a symptom
that persistent, it's not getting better, it's staying the day in,
(08:24):
day out, or it's getting worse, that should be evaluated
no matter what. That's kind of the first bottom line.
So the kind of things I'm talking about generally would
be fatigue is a big one. So unexplained fatigue. Of course,
we all get tired for explained reasons, but an unexplained
fatigue that's persistent and gets worse, a persistent digestive disturbance
(08:50):
or a change in digestive function. So you're normally found
moving every day and then you start to experience constipation
and it just is very unusual. There's nothing else to
explain it. For example, unintentional weight loss is a big one,
and I have to say, in my practice, this is
probably the biggest trickster, because a lot of people are
(09:14):
carrying extra weight and when they start to lose weight,
they're happy about it and they find something to attribute
it to. Oh it was because I stopped eating the
ice cream I had every night, that must have been
the trick Or oh, you know, I added an extra
half a mile on my walk, that must have been it.
So yes, maybe, but it also in especially if it's
(09:35):
pretty significant weight loss that's not really hard to achieve.
That can be a sign of a cancer recurrence. And
just a couple of other ones I'll just know to
real quick. Is coughing. Any persistent cough that's not explained
by having an infection, maybe is not seasonal per se,
(09:56):
it's kind of non productive. That would be something to
keep an eye on. And then finally, any pain that
is present somewhere in the body that again is not
explained by an injury, and the pain doesn't go away,
and in fact, the pain might get a little bit
worse or is consistent day in day out. Those are
all some of the high you know, the highest flying
(10:18):
red flags.
Speaker 2 (10:19):
Yeah, those are great what about lumps and bumps, because
it seems like all my fears are around, like, oh
I felt something.
Speaker 3 (10:27):
Yeah, lumps and bumps for sure. So probably the most
common lump that people find as a sign of recurrence
is an enlarged lymph node. A lot of cancers spread
through the lymphatic system, and as the nodes collect the
cancer cells, they can get enlarged and so that can
(10:47):
be felt through the skin. So an enlarged lymph node
is a very especially one that is you know, shows up,
it starts to get larger, it starts to get harder.
Typically it's not painful, so that's not really a good
sign with lymph nodes. But anything that's kind of there
for no good reason and again gets larger, gets harder,
(11:09):
that's something that should get evaluated. And then there are
benign soft tissue lumps which can be very tricky and
can fool somebody without medical training, and those are commonly lipomas.
Those are they're just fatty tumors that can develop under
the skin. So it feels like a lymph node or
it feels like I mean, it definitely feels like a
(11:30):
mass that wasn't there, and they can kind of come
on relatively slowly. They can come on relatively quickly, so
those can definitely be tricky. And in that situation, yeah, absolutely,
just get that checked.
Speaker 2 (11:42):
Yeah, that's what I have. And as it turns out,
other people in my family can develop these lipomas and
I've had to have one removed, and so I have
to be mindful of that. When you were when you
were talking about the lymph nodes, are there commonplaces, I know,
like in the neck, But is it like your armpit
(12:04):
you're growing, or are there common spots for those? You know?
Speaker 3 (12:08):
It can be they can be anywhere, depending on really
where the to some extent, where the original tumor was,
but also just where those cancer cells are getting caught up.
I would say, like in some lymphomas, the neck is
a very common region for abdominal type of cancers like
or pelvic cancers, say ovarian cancer or colon cancer. Sometimes
(12:32):
the nodes that are palpated or they're internal, but if
they're palpable, and they're sometimes palpated very low, like almost
in the pelvic region or the lower abdominal region. So
I would say generally neck and lower pelvic regions are
probably the most common. And then of course the armpit
area for somebody who's had a history of breast cancer,
(12:54):
those would be the most common areas to feel in
large lymph nodes.
Speaker 2 (12:59):
Yes, okay, great, so again I realized that everyone is different.
But are there annual tests that all cancer survivors should
consider and potentially discuss with their doctor?
Speaker 3 (13:11):
Yeah, there are some, so for sure, just a general
every year, anybody with the history of cancer should get
what we call a cmper, a complete metabolic panel. That's
a very routine set of labs along with a CBC
which measures that's complete blood count, so that measures our
white blood cells, our red blood cells are platelets, and
(13:34):
all of those things should be checked every year because if,
for example, the white count is low and a certain
type of white cell, the lymphocytes, are low, that could
increase the risk or it could indicate the presence of
some sort of cancer recurrence. Sometimes platelets will get elevated.
(13:55):
There's another cell type called monocytes, which can be elevated. Anemia,
which can explain the fatigue associated with recurrence can be present.
That would be low red blood cells. So those would
be some things to look for in the CBC and
then in the chemistries there's some interesting labs that show up. Again,
(14:15):
this is routine screening, but that should be assessed.
Speaker 2 (14:18):
For example, there's.
Speaker 3 (14:20):
A in the routine screening we measure calcium levels, that's
circulating calcium. If that's elevated, about a third of all
people with cancer have elevated calcium levels, so that could
indicate a recurrence. And then there's some liver enzymes that
if those get elevated, because a common sight of recurrent
diseases in the liver, So if those enzymes get elevated,
(14:42):
then we would be a little bit concerned as well.
And then of course just blood glucose. People who have
elevated blood glucose. Again, lots of other reasons for that,
most of which are not cancer. But if the glucose
is elevated in context with a symptom, with some of
these other lab abnorm then we might be getting a
little concerned.
Speaker 2 (15:03):
And what about other things like colonoscopy, you know, for example,
if I did not have colon cancer, but should I
still be a little bit more diligent with my colonoscopies,
maybe start them earlier, or maybe have them more frequently.
And other types of tests like you know, obviously mammograms
(15:26):
for women, et cetera, but anything anything else along those lines.
Speaker 3 (15:30):
Yeah, So, you know, colonoscopy is an important test for
everybody to do it after the age of fifty and
some what are considered higher risk people. It's now down
to the age of forty five, and that might include
some cancer types beyond colorectal cancer that might have an
association with colorectal cancer or nowadays there's so many genetic
(15:52):
tests that are done in people with cancer, and sometimes
an underlying genetic mutation might also be associated with an
increased risk of correctal cancer. So for those people for sure,
and you'll ask or colonnesky every five years for at
least is important. If you've had a history of colorrectal cancer.
(16:13):
Most recurrences usually happen in the first two years, and
so that's like the time when there's most vigilance required.
And that's true for a lot of these cancers. There's
like this time period where vigilance is especially important. You know,
Breast cancer is a little bit different. Breast cancer has
(16:33):
two peaks. It tends to recur within the first like
three years, and then it's sort of there's fewer recurrences,
and then there's this late recurrence spike that's anywhere from
eight to you know, plus years later, So it depends
on the cancer type two.
Speaker 2 (16:50):
Got it, Okay, So now I'd like to try to
illustrate why this is so important by maybe telling a
couple of stories. And I'm going to start and then like,
maybe you to tell a patient story. So last year,
I hurt my arm playing golf. But it didn't seem
like it was a muscle thing. It just all of
(17:13):
a sudden, a lump on my arm popped out, and
I went to the doctor and I had it looked at,
and I ended up having to have an MRI, which
you know, showed a suspicious mass, which totally freaked me out,
and then I had to go to a specialist and
everything else. The reason I bring this up is it
(17:34):
might be someone's tendency to say, oh, I hurt my
golf my arm playing golf. I'm just going to not
play golf for a while, and I'm just going to
sit and let this heal and just watch it for
a while, and I'm not going to do anything about it.
Me being a cancer survivor and being afraid I did
(17:58):
in fact, I didn't want to just watch and see
how it went. I did want to be proactive. And
I think that that has been the lesson for me
over these thirty years, because all of the scares that
I've had, I've been very proactive. I've gone in, I've
gotten the right answers, I've talked to you, et cetera,
(18:21):
et cetera. And I think that that illustrates the need
for cancer survivors to be to be more proactive now
than they potentially have been in the past. So how
about you can you can you help illustrate patient stories
or your own experience, like why this is so important
(18:45):
to be so proactive and to be so diligent and
catch things early.
Speaker 3 (18:51):
Yeah, I mean, I think for a couple of reasons.
One is that, of course, we want to catch a
cancer recurrence, and that would be sort of the worst
case scenario, right important, as we mentioned earlier, to diagnose
that as early as possible in this scenario. But the
other thing is that a lot of these things that
might not be cancer might be other issues that need
(19:13):
to be treated as well. And really anything that's treated
earlier is going to have a better chance of being
treated well. So I think that's another argument to be
made for treating things earlier. I think, you know, one
of the things that's challenging with recurrences is that they
can be a little bit tricky, and that's because sometimes
(19:38):
the cancer tends to recur not in the sight of
the original tumor, and so people aren't really expecting something
somewhere else. So, for example, a breast cancer can recur
in the bone or the bones, which may manifest as
pain in let's say the hip or the back, and
(19:59):
so you may have back pain that can get it.
You know, you go to the chiropractor, you go to
the massage therapist, you take anti inflammatories. It sort of
feels better temporarily, but it always comes back. It never
really tends to resolve. And I have unfortunately had some
patients who have been in that situation and none of
their providers have said, you know what, we really need
(20:20):
to get this image to see what's going on there.
So I think this is where we can be our
best advocate. And again, really the most important sort of
underlying thing to watch for is is this symptom unusually
persistent or getting worse over time. Those are the things
to really monitor.
Speaker 2 (20:41):
Yeah, yeah, I would agree. I'd like to switch gears
a little bit and talk about this fear because I'm
wondering if there are things that we can do as
cancer survivors, as thrivers to help us manage that fear.
And I don't even want to manage my fear. I
(21:02):
actually want to transform my fear and I want to
look at my fear as being Oh, my fear helps
me be proactive and diligent. But I'll tell you at
least sometimes my fear takes over and then that's when
I get into trouble. What advice do you have for
(21:23):
your patients? I mean, you want to encourage them be
diligent and certainly pay attention and bring things up, But
what advice do you have for them to help them
have the fear not become so consuming? Yeah, so we
call this sc anxiety.
Speaker 3 (21:42):
You know. It's this idea that people who have had
a history of a very serious disease who then have
to be kind of on the alert for it again
like the last thing people want us to have to
go through that all over and so it gets to
be very anxiety provoking.
Speaker 2 (21:55):
I have a couple of thoughts.
Speaker 3 (21:56):
On that and then I also want to come back
to something a little bit unres related, but slightly related.
But I think it's very important to if there's a
lot of anxiety around the fear of recurrence, I find
it very important that people do some therapy around that.
And I think emd R therapy is particularly helpful to
(22:17):
help people sub release the trauma that they're holding unconsciously
or subconsciously, and that kind of just frees up a
layer of the fear around monitoring. I think in general,
just you know, recognizing that no matter what the results are,
we just can't change what's happening. What we can do
(22:41):
is empower ourselves with information and so that we can
place ourselves in a position of being able to be
as active as possible as soon as possible. So I
think that if we can kind of try to reframe
the fear into hey, I'm doing this as a way
of empowerment, empowering myself, it can become a little less overwhelming.
(23:03):
But all of that requires a lot of sort of
focus and commitment to changing our thought patterns and our
processes around this. Yes it does, but in a way,
as listeners listen to this podcast, they become more proactive
(23:25):
in their risk reduction strategies because they're learning more and
doing more to help reach their risk So hopefully that
will also help them feel more empowered versus fearful. Right, Yeah,
And I just want to bring up something real quick.
I know we're almost at a time, but there was
There's one of the things my patients to ask me
a lot about is whether they should get any kind
(23:48):
of test on a regular basis that measures circulating tumor
cells or what's called self ree DNA, which comes from
tumor cells as a marker of biochemical recurrence are very
very early recurrence, and this is still very debatable within
oncology because there haven't been enough studies to show convincingly
(24:10):
that the presence of these fragments, these tumor fragments actually
in fact do correlate with cancer recurrence all the time,
because in some ways, we're all growing cancer cells and
our bodies are eliminating them all the time, and so
whether we catch that on a test or not doesn't
necessarily one hundred percent mean that there's some tumor brewing anywhere.
(24:32):
The other issue that a lot of conventional oncologists have
at these tests is if a patient comes back with
a positive but then they get scanned and there's no
obvious tumor, the oncologists don't really necessarily know what to do.
They don't have any approved treatments for treating a cancer
that might be there, but they can't see there yet.
(24:54):
So this is a challenge because of course, speaking of
diagnosing things early, if you can and get a blood
test that will tell you whether or not a cancer
is potentially there early, why not? And I would say that,
and there's also some anxiety around this. This can be
very anxiety provoking, which is another argument against doing this.
So I would say this is a very individualized decision.
(25:16):
It's not something every patient should do, every person should do,
but it is an option available for the patients I
have who decide they want to have this information. If
we get a positive test, there are integrative strategies that
we can employ to address a potential cancer or a
potential reforming of a cancer, very at this very early stage.
(25:40):
So I think it is actionable information in many cases,
and it's also I think important to alert downcologist, and
oncology is going to be changing. I think over time
we're going to start to see more and more therapies
that are useful for this very early presentation, but I
just wanted to give voice to that because that's a
really common common question.
Speaker 2 (26:00):
Yeah, I'm glad that you brought that up, and it
has come up as well, so I think that's that's
really good information. I think that your point about e
MDR and getting help is really significant because we know
from the studies that cancer survivors experience a form of
PTSD and that is trauma and grief. And finding ways
(26:23):
to process that trauma and grief, I think is really
important to get the freedom from the diagnosis and to
try to live proactively and you know, have a vibrant
life beyond your cancer.
Speaker 3 (26:36):
Absolutely, and just remember, you know, all of the things
that many of our past shows have focused on that
can help people manage their anxiety have a role to
play here. Just basic stuff like making sure we have
good quality sleep, that we're doing mindful breathing on a
daily basis, that we have a mindfulness practice, that we
(26:56):
have creativity in our life, that we have a solid
social support network of loved ones. These things all kind
of help us to reset our nervous system to be
more resilient to the stress and the anxiety that cancer
and monitoring for cancer can cause. So I think it's
always important to have that going on.
Speaker 2 (27:16):
Absolutely, getting out, nature, moving, being active, all of those things,
I would agree, Well, this has been a great show.
Once again, I'd like to thank our sponsors pro Thrivers Wellness,
Sleep Formula, Cetria glutathione the superior glutathion to support liver
and immune health, Cognizance Citicolly to help enhance memory, focus
(27:38):
and attention, and doctor Ohira's award winning shelf Stable probiotic.
And thanks you. Thanks to you Lise for your insights tonight.
Speaker 3 (27:48):
And thank you Carolyn for sharing your stories asking great questions.
I really enjoyed it. And listener, may you experience joy,
left and love. It's time to throw have everyone have.
Speaker 2 (28:01):
A good night.
Speaker 3 (28:02):
Siscamomy lovescomy, good love, Excuga. Sastrami J.
Speaker 2 (28:15):
The City is a love, extremely good love, good love.
Any health related information on the following show provides general
information only. Content presented on any show by any host
or guest should not be substituted for a doctor's advice.
I always consult your physician before beginning any new diet, exercise,
or treatment program.
Speaker 2 (00:40):
Hello everyone, and welcome to Five to Thrive Live. I'm
Carolyn Gazella and I'm here with my co host and
good friend, doctor LESE. Olschuler. Hello, Lise, how are you.
Speaker 3 (00:51):
I'm very good. How are you, Carolyn?
Speaker 2 (00:53):
I'm great, good as usual?
Speaker 3 (00:58):
Yeah, as usual, you know, And I'm glad you're great
because there have been times when you haven't been feeling
so great, or maybe you are feeling good, but you're
worried about things. And that really is all about our
topic today, and I think it's something that we have
both experienced with both cancer thrivers or cancer survivors as
(01:21):
some people say. And we're going to talk about the
fear of recurrence and really some ways to something to
truly be watchful for for people who have been through
cancer before, because this is something that's on people's minds
a lot. So I think it's going to be a
really good, good topic. But before we dig in, Carolyn,
can we thank our sponsors?
Speaker 2 (01:40):
Absolutely? And I would agree with you. This topic is
so near and dear to both of us, So let's
thank those sponsors. And I would like to begin by thinking.
Cetria a patented form of glutathione clinically proven to raise
blood gluto thione levels. Gluteothione is the master antioxidant and
the body's primary defense against free radicals. It also helps
(02:01):
support respiratory health. For more information, visits Cetriagodethion dot com.
Also cognizance citicoline, which is nature's way of keeping the
brain's energy producing centers firing on all cylinders. If you're
looking for a way to enhance your brain function, including memory,
focused and attention, look for cognizant on the label or
go to cognizan dot com for more information. Prothriver's Wellness
(02:22):
Brain is a product that contains cognizant as well as
other brain supporting nutrients and herbs. You can find Prothriver's
Wellness Brain online at Pureformulas dot com. There's also Prothriver's
Wellness Sleep, which combines higher dose melatonin and other sleep
supporting natural ingredients specifically designed for thrivers. You can find
Prothriver's Wellness Sleep at Pure Formulas dot com and doctor
(02:46):
ohere is Probiotics. It's a best selling probiotic for more
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as you've mentioned, you know at least I don't know
(03:08):
if you remember this, but March is my cancer anniversary.
It will be thirty years that I will be cancer free,
which is pretty remarkable. But I have to tell you,
as you well know, over those thirty years, I've had
some scares. I've had some pretty significant fear of recurrence,
(03:32):
some pretty significant fear of new cancers. I don't know
if you remember when we were at the writing retreat
and we were working on one of our books and
I told you about a lump on my leg and
I had you look at it, and I was so
convinced that I had a soft tissue starcoma and that
I was going to die. And I mean, fortunately, all
of my scares have turned out just fine, But this
(03:53):
fear is real. And I'm just wondering, list if you've
ever personally had this issue as a case answer survivor,
and I imagine it's a pretty consistent issue with some
of your patients for sure.
Speaker 3 (04:05):
I mean, this is something I think that affects everybody
who's had really any kind of cancer. I've definitely had
this myself. There was a time when I had a
really persistent sort of discomfort in my hip and I thought,
you know, this could be a bone metastasis for my
(04:26):
breast cancer, and so I went and I had it checked,
and fortunately it was not. But you know, yeah, I've
definitely been through this. I get it.
Speaker 2 (04:36):
Yeah, absolutely, So let's start by building a foundation. Why
is it so important for us as cancer survivors to
be diligent about finding a recurrent or new cancer early.
Speaker 3 (04:52):
Well, you know the key is what you just said early.
I mean, the more opportunity we have to the sort
of the more the time, the longer the timeline is
for being able to apply treatments to a cancer, whether
it's a recurrent cancer or metastatic cancer, the better opportunity
(05:12):
we have to find treatments that really control the disease. Well,
so when we can diagnose something early, it gives us
a longer timeline, so therefore more opportunities to treat effectively.
And oftentimes an early diagnosis, particularly if it's an isolated recurrence,
could even be removed surgically, which is in some cases
(05:33):
kind of done, you know, it's the recurrence is sort
of done. So the earlier always better. Yeah, I would
agree that improves outcomes. So here's my question to you.
Speaker 2 (05:43):
I would think that that is true across all cancers.
Is that a correct statement? That is true across all cancers.
Speaker 3 (05:55):
Yes, I'm hesitating only because for some cancers the recurrence
is very occult, meaning it's really hard for a recurrence
found unless it's found sort of incidentally on a repeat
scan that's already scheduled. It just happens to have just recurred.
(06:15):
But some cancers are very difficult to find early. So yes,
that's ideal, and I just want to, you know, make
sure we understand that's not always the situation.
Speaker 2 (06:25):
That's good. So let me ask a follow up question
of that that might be a little bit more clear
than my last question. Let's talk about a new cancer
as a cancer survivor, if I get a new cancer,
if I catch that new cancer early, it doesn't matter
what type of cancer it is, early is always best.
Is that a true state? Sure? Okay, yeah, for sure? Okay, cool,
(06:49):
that's what I was wondering. Okay, So now I realized
that everyone is going to be different, and it's important
for us to know our own bodies. And as an aside,
I will will say that one of the reasons I
didn't catch my cancer back thirty years ago is because
I was not good at reading my body and understanding
(07:10):
the signals that my body was sending me. And that
is a lesson that I've learned. So we all need
to know our own bodies. However, I'm wondering if there
are some foundational health signs that all cancer survivors should
keep on their radar or keep in the back of
their head.
Speaker 3 (07:30):
Yeah, so you know things, All cancers are not the same,
and I love hope we have time maybe to dive
into some of the more common cancers and some of
the current things to look for specificed cancers, but generally speaking,
the most unfortunately, these are really generalized symptoms, meaning these
symptoms that yes, they indicate the presence of cancer, but
(07:52):
they can indicate so many other things too. These are
These are not if you have these symptoms you have
a cancer occurrence, even.
Speaker 2 (07:59):
If you have had history of cancer.
Speaker 3 (08:01):
These are just okay. You've had a history of cancer
and you start to experiencing these symptoms, then you know
you should be on the alert. And the key when
I go to this listening moment is that you want
to be sure that any symptom you're having, especially as
someone who had his cancer, if you have a symptom
that persistent, it's not getting better, it's staying the day in,
(08:24):
day out, or it's getting worse, that should be evaluated
no matter what. That's kind of the first bottom line.
So the kind of things I'm talking about generally would
be fatigue is a big one. So unexplained fatigue. Of course,
we all get tired for explained reasons, but an unexplained
fatigue that's persistent and gets worse, a persistent digestive disturbance
(08:50):
or a change in digestive function. So you're normally found
moving every day and then you start to experience constipation
and it just is very unusual. There's nothing else to
explain it. For example, unintentional weight loss is a big one,
and I have to say, in my practice, this is
probably the biggest trickster, because a lot of people are
(09:14):
carrying extra weight and when they start to lose weight,
they're happy about it and they find something to attribute
it to. Oh it was because I stopped eating the
ice cream I had every night, that must have been
the trick Or oh, you know, I added an extra
half a mile on my walk, that must have been it.
So yes, maybe, but it also in especially if it's
(09:35):
pretty significant weight loss that's not really hard to achieve.
That can be a sign of a cancer recurrence. And
just a couple of other ones I'll just know to
real quick. Is coughing. Any persistent cough that's not explained
by having an infection, maybe is not seasonal per se,
(09:56):
it's kind of non productive. That would be something to
keep an eye on. And then finally, any pain that
is present somewhere in the body that again is not
explained by an injury, and the pain doesn't go away,
and in fact, the pain might get a little bit
worse or is consistent day in day out. Those are
all some of the high you know, the highest flying
(10:18):
red flags.
Speaker 2 (10:19):
Yeah, those are great what about lumps and bumps, because
it seems like all my fears are around, like, oh
I felt something.
Speaker 3 (10:27):
Yeah, lumps and bumps for sure. So probably the most
common lump that people find as a sign of recurrence
is an enlarged lymph node. A lot of cancers spread
through the lymphatic system, and as the nodes collect the
cancer cells, they can get enlarged and so that can
(10:47):
be felt through the skin. So an enlarged lymph node
is a very especially one that is you know, shows up,
it starts to get larger, it starts to get harder.
Typically it's not painful, so that's not really a good
sign with lymph nodes. But anything that's kind of there
for no good reason and again gets larger, gets harder,
(11:09):
that's something that should get evaluated. And then there are
benign soft tissue lumps which can be very tricky and
can fool somebody without medical training, and those are commonly lipomas.
Those are they're just fatty tumors that can develop under
the skin. So it feels like a lymph node or
it feels like I mean, it definitely feels like a
(11:30):
mass that wasn't there, and they can kind of come
on relatively slowly. They can come on relatively quickly, so
those can definitely be tricky. And in that situation, yeah, absolutely,
just get that checked.
Speaker 2 (11:42):
Yeah, that's what I have. And as it turns out,
other people in my family can develop these lipomas and
I've had to have one removed, and so I have
to be mindful of that. When you were when you
were talking about the lymph nodes, are there commonplaces, I know,
like in the neck, But is it like your armpit
(12:04):
you're growing, or are there common spots for those? You know?
Speaker 3 (12:08):
It can be they can be anywhere, depending on really
where the to some extent, where the original tumor was,
but also just where those cancer cells are getting caught up.
I would say, like in some lymphomas, the neck is
a very common region for abdominal type of cancers like
or pelvic cancers, say ovarian cancer or colon cancer. Sometimes
(12:32):
the nodes that are palpated or they're internal, but if
they're palpable, and they're sometimes palpated very low, like almost
in the pelvic region or the lower abdominal region. So
I would say generally neck and lower pelvic regions are
probably the most common. And then of course the armpit
area for somebody who's had a history of breast cancer,
(12:54):
those would be the most common areas to feel in
large lymph nodes.
Speaker 2 (12:59):
Yes, okay, great, so again I realized that everyone is different.
But are there annual tests that all cancer survivors should
consider and potentially discuss with their doctor?
Speaker 3 (13:11):
Yeah, there are some, so for sure, just a general
every year, anybody with the history of cancer should get
what we call a cmper, a complete metabolic panel. That's
a very routine set of labs along with a CBC
which measures that's complete blood count, so that measures our
white blood cells, our red blood cells are platelets, and
(13:34):
all of those things should be checked every year because if,
for example, the white count is low and a certain
type of white cell, the lymphocytes, are low, that could
increase the risk or it could indicate the presence of
some sort of cancer recurrence. Sometimes platelets will get elevated.
(13:55):
There's another cell type called monocytes, which can be elevated. Anemia,
which can explain the fatigue associated with recurrence can be present.
That would be low red blood cells. So those would
be some things to look for in the CBC and
then in the chemistries there's some interesting labs that show up. Again,
(14:15):
this is routine screening, but that should be assessed.
Speaker 2 (14:18):
For example, there's.
Speaker 3 (14:20):
A in the routine screening we measure calcium levels, that's
circulating calcium. If that's elevated, about a third of all
people with cancer have elevated calcium levels, so that could
indicate a recurrence. And then there's some liver enzymes that
if those get elevated, because a common sight of recurrent
diseases in the liver, So if those enzymes get elevated,
(14:42):
then we would be a little bit concerned as well.
And then of course just blood glucose. People who have
elevated blood glucose. Again, lots of other reasons for that,
most of which are not cancer. But if the glucose
is elevated in context with a symptom, with some of
these other lab abnorm then we might be getting a
little concerned.
Speaker 2 (15:03):
And what about other things like colonoscopy, you know, for example,
if I did not have colon cancer, but should I
still be a little bit more diligent with my colonoscopies,
maybe start them earlier, or maybe have them more frequently.
And other types of tests like you know, obviously mammograms
(15:26):
for women, et cetera, but anything anything else along those lines.
Speaker 3 (15:30):
Yeah, So, you know, colonoscopy is an important test for
everybody to do it after the age of fifty and
some what are considered higher risk people. It's now down
to the age of forty five, and that might include
some cancer types beyond colorectal cancer that might have an
association with colorectal cancer or nowadays there's so many genetic
(15:52):
tests that are done in people with cancer, and sometimes
an underlying genetic mutation might also be associated with an
increased risk of correctal cancer. So for those people for sure,
and you'll ask or colonnesky every five years for at
least is important. If you've had a history of colorrectal cancer.
(16:13):
Most recurrences usually happen in the first two years, and
so that's like the time when there's most vigilance required.
And that's true for a lot of these cancers. There's
like this time period where vigilance is especially important. You know,
Breast cancer is a little bit different. Breast cancer has
(16:33):
two peaks. It tends to recur within the first like
three years, and then it's sort of there's fewer recurrences,
and then there's this late recurrence spike that's anywhere from
eight to you know, plus years later, So it depends
on the cancer type two.
Speaker 2 (16:50):
Got it, Okay, So now I'd like to try to
illustrate why this is so important by maybe telling a
couple of stories. And I'm going to start and then like,
maybe you to tell a patient story. So last year,
I hurt my arm playing golf. But it didn't seem
like it was a muscle thing. It just all of
(17:13):
a sudden, a lump on my arm popped out, and
I went to the doctor and I had it looked at,
and I ended up having to have an MRI, which
you know, showed a suspicious mass, which totally freaked me out,
and then I had to go to a specialist and
everything else. The reason I bring this up is it
(17:34):
might be someone's tendency to say, oh, I hurt my
golf my arm playing golf. I'm just going to not
play golf for a while, and I'm just going to
sit and let this heal and just watch it for
a while, and I'm not going to do anything about it.
Me being a cancer survivor and being afraid I did
(17:58):
in fact, I didn't want to just watch and see
how it went. I did want to be proactive. And
I think that that has been the lesson for me
over these thirty years, because all of the scares that
I've had, I've been very proactive. I've gone in, I've
gotten the right answers, I've talked to you, et cetera,
(18:21):
et cetera. And I think that that illustrates the need
for cancer survivors to be to be more proactive now
than they potentially have been in the past. So how
about you can you can you help illustrate patient stories
or your own experience, like why this is so important
(18:45):
to be so proactive and to be so diligent and
catch things early.
Speaker 3 (18:51):
Yeah, I mean, I think for a couple of reasons.
One is that, of course, we want to catch a
cancer recurrence, and that would be sort of the worst
case scenario, right important, as we mentioned earlier, to diagnose
that as early as possible in this scenario. But the
other thing is that a lot of these things that
might not be cancer might be other issues that need
(19:13):
to be treated as well. And really anything that's treated
earlier is going to have a better chance of being
treated well. So I think that's another argument to be
made for treating things earlier. I think, you know, one
of the things that's challenging with recurrences is that they
can be a little bit tricky, and that's because sometimes
(19:38):
the cancer tends to recur not in the sight of
the original tumor, and so people aren't really expecting something
somewhere else. So, for example, a breast cancer can recur
in the bone or the bones, which may manifest as
pain in let's say the hip or the back, and
(19:59):
so you may have back pain that can get it.
You know, you go to the chiropractor, you go to
the massage therapist, you take anti inflammatories. It sort of
feels better temporarily, but it always comes back. It never
really tends to resolve. And I have unfortunately had some
patients who have been in that situation and none of
their providers have said, you know what, we really need
(20:20):
to get this image to see what's going on there.
So I think this is where we can be our
best advocate. And again, really the most important sort of
underlying thing to watch for is is this symptom unusually
persistent or getting worse over time. Those are the things
to really monitor.
Speaker 2 (20:41):
Yeah, yeah, I would agree. I'd like to switch gears
a little bit and talk about this fear because I'm
wondering if there are things that we can do as
cancer survivors, as thrivers to help us manage that fear.
And I don't even want to manage my fear. I
(21:02):
actually want to transform my fear and I want to
look at my fear as being Oh, my fear helps
me be proactive and diligent. But I'll tell you at
least sometimes my fear takes over and then that's when
I get into trouble. What advice do you have for
(21:23):
your patients? I mean, you want to encourage them be
diligent and certainly pay attention and bring things up, But
what advice do you have for them to help them
have the fear not become so consuming? Yeah, so we
call this sc anxiety.
Speaker 3 (21:42):
You know. It's this idea that people who have had
a history of a very serious disease who then have
to be kind of on the alert for it again
like the last thing people want us to have to
go through that all over and so it gets to
be very anxiety provoking.
Speaker 2 (21:55):
I have a couple of thoughts.
Speaker 3 (21:56):
On that and then I also want to come back
to something a little bit unres related, but slightly related.
But I think it's very important to if there's a
lot of anxiety around the fear of recurrence, I find
it very important that people do some therapy around that.
And I think emd R therapy is particularly helpful to
(22:17):
help people sub release the trauma that they're holding unconsciously
or subconsciously, and that kind of just frees up a
layer of the fear around monitoring. I think in general,
just you know, recognizing that no matter what the results are,
we just can't change what's happening. What we can do
(22:41):
is empower ourselves with information and so that we can
place ourselves in a position of being able to be
as active as possible as soon as possible. So I
think that if we can kind of try to reframe
the fear into hey, I'm doing this as a way
of empowerment, empowering myself, it can become a little less overwhelming.
(23:03):
But all of that requires a lot of sort of
focus and commitment to changing our thought patterns and our
processes around this. Yes it does, but in a way,
as listeners listen to this podcast, they become more proactive
(23:25):
in their risk reduction strategies because they're learning more and
doing more to help reach their risk So hopefully that
will also help them feel more empowered versus fearful. Right, Yeah,
And I just want to bring up something real quick.
I know we're almost at a time, but there was
There's one of the things my patients to ask me
a lot about is whether they should get any kind
(23:48):
of test on a regular basis that measures circulating tumor
cells or what's called self ree DNA, which comes from
tumor cells as a marker of biochemical recurrence are very
very early recurrence, and this is still very debatable within
oncology because there haven't been enough studies to show convincingly
(24:10):
that the presence of these fragments, these tumor fragments actually
in fact do correlate with cancer recurrence all the time,
because in some ways, we're all growing cancer cells and
our bodies are eliminating them all the time, and so
whether we catch that on a test or not doesn't
necessarily one hundred percent mean that there's some tumor brewing anywhere.
(24:32):
The other issue that a lot of conventional oncologists have
at these tests is if a patient comes back with
a positive but then they get scanned and there's no
obvious tumor, the oncologists don't really necessarily know what to do.
They don't have any approved treatments for treating a cancer
that might be there, but they can't see there yet.
(24:54):
So this is a challenge because of course, speaking of
diagnosing things early, if you can and get a blood
test that will tell you whether or not a cancer
is potentially there early, why not? And I would say that,
and there's also some anxiety around this. This can be
very anxiety provoking, which is another argument against doing this.
So I would say this is a very individualized decision.
(25:16):
It's not something every patient should do, every person should do,
but it is an option available for the patients I
have who decide they want to have this information. If
we get a positive test, there are integrative strategies that
we can employ to address a potential cancer or a
potential reforming of a cancer, very at this very early stage.
(25:40):
So I think it is actionable information in many cases,
and it's also I think important to alert downcologist, and
oncology is going to be changing. I think over time
we're going to start to see more and more therapies
that are useful for this very early presentation, but I
just wanted to give voice to that because that's a
really common common question.
Speaker 2 (26:00):
Yeah, I'm glad that you brought that up, and it
has come up as well, so I think that's that's
really good information. I think that your point about e
MDR and getting help is really significant because we know
from the studies that cancer survivors experience a form of
PTSD and that is trauma and grief. And finding ways
(26:23):
to process that trauma and grief, I think is really
important to get the freedom from the diagnosis and to
try to live proactively and you know, have a vibrant
life beyond your cancer.
Speaker 3 (26:36):
Absolutely, and just remember, you know, all of the things
that many of our past shows have focused on that
can help people manage their anxiety have a role to
play here. Just basic stuff like making sure we have
good quality sleep, that we're doing mindful breathing on a
daily basis, that we have a mindfulness practice, that we
(26:56):
have creativity in our life, that we have a solid
social support network of loved ones. These things all kind
of help us to reset our nervous system to be
more resilient to the stress and the anxiety that cancer
and monitoring for cancer can cause. So I think it's
always important to have that going on.
Speaker 2 (27:16):
Absolutely, getting out, nature, moving, being active, all of those things,
I would agree, Well, this has been a great show.
Once again, I'd like to thank our sponsors pro Thrivers Wellness,
Sleep Formula, Cetria glutathione the superior glutathion to support liver
and immune health, Cognizance Citicolly to help enhance memory, focus
(27:38):
and attention, and doctor Ohira's award winning shelf Stable probiotic.
And thanks you. Thanks to you Lise for your insights tonight.
Speaker 3 (27:48):
And thank you Carolyn for sharing your stories asking great questions.
I really enjoyed it. And listener, may you experience joy,
left and love. It's time to throw have everyone have.
Speaker 2 (28:01):
A good night.
Speaker 3 (28:02):
Siscamomy lovescomy, good love, Excuga. Sastrami J.
Speaker 2 (28:15):
The City is a love, extremely good love, good love.
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