Wednesday, June 6, 2012

A bit more information about how I am selecting my cancer therapy to consider the hip issues

Hi guys!

I have been through 2 of the 3 top notch cancer teams in the country for consults on my particular cancer.  As you know, I have grave concerns about two things:
(1) how did this cancer reoccur so quickly after my hip revision? Is there a relationship?
(2) What is going to happen when I dump the "chemicals" in my system to deal with the cancer on top of the metals. I use the word chemicals broadly here because "Chemo" as it is defined, does not work on renal cell carcinoma.    Renal cell carcinoma and melanoma are the two types of cancers that coincidentally respond well with Immune based therapy.

Here is the key concept I have learned:
  • "Cancer may develop when the immune system breaks down or does not function properly". By develop, it is possible that it can start  as a new cancer or it can re-appear after you are in remission or "cured" as was the case in my situation.  There is around a 2% chance, that once you have had a nephrectomy with a localised cancer in situ and a tumor around 2 Cm in size, of a recurrence which is why they call the nephrectomy (removal of the affected kidney) curative.
In my case, the carcinoma was not initially caused by the hip.  I know that to be the case.  I am not however satisfied at all that there is no relationship between the recurrence of the cancer and the hip.  I believe at this point, there is a relationship between the two. ( If my final consults disagree, I will share that with you.)

In fact, I am so convinced that there is a link that I will likely not opt for the standard of care for this cancer (Sutent for renal cell which is an anti angiogenic approach to the kidney tumor therapy.)  Currently, I am looking at all of the immune based therapies, most of which are in clinical trials.

I fell so confident that it was likely the immune reaction to the hip surgery that prompted this recurrence, that I will choose an immune therapy to deal with it.  I have a few other experts to discuss this with before I make my final decision and will try to share what I have learned.

This is not the same as saying the metals in the hip caused the cancer. I think based on what I have read, there is a good chance that the metals in the hip may over time but the long term studies have not been undertaken.  I do think at this point that my recurrence did have a lot to do with my hip revision.  If that is so, my tumor growths should respond really well to this therapy....I hope.

(1) We know the physiologic process that occurs when the metals are put into the system  (see below.)
(2) We know that revision surgery causes a surge in these metals to be dumped into the system because the surgeon is removing something that is very well entrenched in your body.  Revision surgery is not fun.  It entails a very traumatic cleaning (debriding) of the whole area and then removing the bad hip and replacing it with a new one.  Ouch! If any of you have partners who build things around the house, their workshop is what a surgical table looks like for a revision!
(3)  We know it is the immune system that comes into play when these metals are disbursed.  The body performs a number of  functions to rid itself of this metal debris.  (see below.)
(4) We know if the immune system is weakened significantly, cancer might appear at some point, but we don't seem to have a handle on the ability of  these metals to prompt a cancer patient who was "cured" or in remission, to  have the cancer re-occur.

These issues are being explored.  If my team and I  conclude that we are going to forgo the standard of care for immune based therapy, the  process undertaken by the hip to rid the system of these metals  will have been a major consideration in doing so.  like I said, I have two more consults to see.  Not everyone will agree but hopefully, I can get some level of consensus in the group on the choice of therapy.

If you want to see how the immune system works with the hip, you can look at these posts:


A great pictorial to illustrate the metal on metal oxidation process (5 of 5 in a series)

A separate series that is well written and very easy to understand.

Review of the Cell biology surrounding metal on metal hips (1 of x in a series)

Review of the Cell biology surrounding metal on metal hips (2 of x in a series)

Review of the Cell biology surrounding metal on metal hips (3 of x in a series)

Review of the Cell biology surrounding metal on metal hips (4 of x in a series)

Review of the Cell biology surrounding metal on metal hips (5 of x in a series)

Review of the Cell biology surrounding metal on metal hips (6 of x in a series)

Review of the Cell biology surrounding metal on metal hips (7 of x in a series)

Review of the Cell biology surrounding metal on metal hips (8 of x in a series)

Review of the Cell biology surrounding metal on metal hips (9 of x in a series)


While I know that the use of the metal on metal hips has dropped considerably, were I a patient who had cancer, especially renal or melanoma, personally, I would stay away from metal on metal.  I would opt for other materials. I don't believe the risk is worth it.  Maybe in 10 years, someone will perform a study.  Too late.

If I make very strong statements like this, I want to remind the readers of the following:
  • I am not a doctor
  • I am not a trained medical professional
  • I am not a medical professional in any way
  • I am well read in this topic
It really helps me to write these posts so that I have a good logic based questions  for my meetings with the consults.  I can surely tell you that these cancer guys (oncologists) are not trained in hips.  If you have concerns, it is your job as the patient to make the physician aware of your medical background or potential complications.  While the top consults do review all records prior to your arriving at  the consult, they are likely to gloss over things that they may not see connections to immediately.  You are your always your best advocate.

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