At age 35, Deborah Portzer got the news no one wants to hear: breast cancer. Thirty-three years and two recurrences later, her oncologist, Dr. Langerak, gave her better news. Here’s her story.
First Diagnosis
It’s 1989, and Deborah is working for an aerospace company in California and teaching ballroom dancing. She goes in for her first mammogram at age 35 because of a family history of cancer. The results aren’t good: she has an infiltrating ductal adenocarcinoma in her right breast, hormone receptor ER negative and node negative. During her scheduled lumpectomy, her doctor discovers the tumor is larger than he thought, and she ends up with a quadrantectomy.
“I was afraid and didn’t know where to go for help,” Deborah recalled. The hospital pointed her to the American Cancer Society. Shortly after, she became a volunteer for the organization and continued for a total of 14 years. “I went from fear to faith, worry to hope, letting go and putting God first, and helping to lift someone else’s cross, which I found was healing in my 33-year battle.”
Second Diagnosis
Fast forward eleven years. It’s the year 2000 and Deborah, now 46, is married to Jim, still working at her job in California and also enjoying volunteering with homebound elderly through her local Catholic parish. But there is bad news: the cancer is back in her right breast. Again, it’s an infiltrating ductal carcinoma, HER2 (3+ strongly positive), hormone receptor ER and PR negative. This time Deborah has a bilateral mastectomy followed by chemotherapy (Taxol & Adriamycin Cytoxan (AC)). She did not take Herceptin because the drug was still in clinical trials at the time. As a proactive step, she also had her ovaries removed, as her mother had died from ovarian cancer a year earlier.
“My mom Margaret is my hero who bravely fought her two-month battle with ovarian cancer. I honor her by walking at the American Cancer Society’s Relay for Life,” Deborah said. Deborah tested negative for BRCA 1 and 2 gene mutations.
Third Diagnosis
Deborah and Jim moved to Prescott, Arizona in 2001. Now with both breasts and her ovaries removed, Deborah did not expect another cancer diagnosis. However, in 2016, at age 62, the invasive breast cancer was found in her right hip and femur bone when she went in for a hip & femur replacement surgery. “Jim and I hugged, cried, prayed, and sat in silence for a moment. Then I immediately said ‘I’m not wasting another minute to let the cancer grow. I’m calling my oncologist now to get the ball rolling’.”
After surgery, Deborah was put on a daily chemotherapy pill (Ibrance) and an aromatase inhibitor (Letrozole). “It took seven months to walk and to do basic necessities,” she said. “My husband Jim is the love of my life, an angel and caregiver who keeps me smiling, laughing, and supported by his great love,” she said.
The Happy Ending
On March 4th, 2022, a day she’ll always remember, a total of 33 years after her initial diagnosis, Deborah went in for a CT and bone scan. The results showed no cancer at all in her body! She and Jim were thrilled and surprised and gave all the praise and glory to God. She remembers her oncologist, Dr. Langerak, expressing surprise as well, stating that this was very unusual for stage 4 cancer.
“This is a miracle from God, because doctors can’t scoop out cancer!” she said.
One of her care team members said, “What makes Deborah stand out from other patients is her upbeat and positive attitude towards her care, her willingness to learn about her disease, and her follow-through on her care.”
Deborah must continue to take a daily chemo pill, but she’s come to terms with that: “I’m doing well and find happiness every day and in everything, believing in miracles!”
Deborah’s Message
Deborah has a message for others who are on their journey:
“We all need HOPE to carry our cross or fight a battle!
Hope is the anchor of our soul and a lifeline to hang on tight and never give up.
Enjoy life…JUST BE in the moment and embrace it.
When you can’t do something… find a “new normal” that you can.
We are a blessing…helping lift each other’s cross while touching hearts.
May my testimony inspire your journey to fight and be proactive, to not be afraid to share what you’re going through and the roller coaster of emotions, to join a support group or activities, to find a buddy who keeps you smiling and laughing (the best medicine), and to look forward with hope to your healing of body, mind, and soul. You’re special and worth it!”
Most people have heard about genetic testing when it comes to cancer risk, but there is a lot of misinformation. Today, we bust the myths about genetic testing and share the facts.
MYTH #1: Most Cancers are Genetic
FALSE. The majority of patients who develop cancer do not have a genetic predisposition. Genetic inheritance plays a role in approximately five to ten percent of cancers. When it comes to breast cancer in particular, five to ten percent of breast cancer patients have an identified gene, although another ten to 15 percent of patients will have a familial correlation, even though the gene is not present.
MYTH #2: Everyone Should Get Genetic Testing for Cancer
FALSE. Given the limits of genetic testing, it does not make sense for the general population to get tested. Genetic testing recommendations are established by the National Comprehensive Cancer Network (NCCN) and other organizations that look at the data and adjust guidelines on a yearly basis.
AO doctors add that the risk of cancer is more influenced by environmental factors and lifestyle choices (the largest threats being obesity and smoking) than it is by genetics. For that reason, the focus for the majority of the population should be on those preventable factors.
MYTH #3: BRCA gene mutations only relate to breast cancer
FALSE. Mutations in the BRCA 1 and 2 genes are linked to various cancers, including breast, ovary, prostate, pancreatic, and melanoma. People who inherit harmful variants of a BRCA gene have increased risks of developing one of these cancers, and also tend to develop cancer at younger ages than people who do not have a variant.
MYTH #4: If I have a BRCA1 or BRCA2 gene mutation, I will get cancer (and if I do not, I will not)
FALSE. Genetic inheritance is just a piece of the puzzle. Having an inherited genetic mutation in any gene can increase an individual’s lifetime risk of cancer, but does not guarantee an individual will get cancer.
The National Cancer Institute provides an example: “About 13% of women in the general population will develop breast cancer sometime during their lives. By contrast, 55%–72% of women who inherit a harmful BRCA1 variant and 45%–69% of women who inherit a harmful BRCA2 variant will develop breast cancer by 70–80 years of age.”
MYTH #5: Only women need genetic testing
FALSE. Many common cancers in men are genetically linked, specifically pancreatic, prostate, and colon cancer. By finding out their genetic profile, both men and women can take steps to reduce their risk in other areas and start cancer screening earlier, if needed, which could save their life. Cancer is not gender specific.
MYTH #6: Genetic testing is not accurate
FALSE. The companies performing genetic testing for cancer have standardized and accurate testing. No test is 100% accurate, but we have come a long way in our ability to identify inherited genetic mutations, and the field will continue to develop.
Genetic testing at its current stage has helped many people identify inherited gene mutations and take actionable steps to reduce their cancer risk and catch cancer early, if it does develop. The fact remains that genetic testing saves lives.
MYTH #7: I do not need a genetic counselor; I can order my own genetic test online
MOSTLY FALSE. It’s true that you can order direct-to-consumer genetic tests. However, without consulting a genetic counselor, you won’t know what information to take away from your results. Genetic counselors are crucial in helping to understand the results of genetic testing. They also provide recommendations about what to do if a mutation is identified, as well as how and what to communicate to other family members. A genetic counselor can also help you better understand your cancer risk if an inherited mutation is not identified through testing.
MYTH #8: Genetic testing is expensive
FALSE. With next-generation sequencing technology, the cost has dropped dramatically. Insurance covers testing for most patients who meet the criteria. If not, most companies offer a cash pay price of only around $250.
MYTH #9: If my results show a gene mutation, I will be uninsurable
FALSE. The Genetic Information Nondiscrimination Act (GINA), passed in 2008, prevents health insurance companies from using genetic information to make coverage or rate decisions. A genetic counselor can provide additional information prior to genetic testing.
MYTH #10: Genetic testing and genomic testing are the same thing
FALSE. Genetic testing helps to assess a person’s cancer risk. It consists of looking for a germline mutation, which is a gene mutation passed down from a parent to a child, and would be contained in just about every cell.
Genomic testing tests tumor tissue to look for genetic mutations that will determine a cancer’s likely behavior. It is used to help doctors choose which treatments will be most effective against that tumor.
At Arizona Oncology, we offer high risk cancer assessment services for our patients. Talk to your doctor to see if high risk cancer assessment and genetic testing might be right for you.
It’s no secret that being carrying excess pounds can lead to serious health consequences–but did you know that it can also raise your risk for certain types of cancer? National Health and Nutrition Examination Survey (NHANES) showed that in 2011–2014, nearly 70% of U.S. adults aged 20 years or older were overweight or obese.
Research shows that higher amounts of body fat can increase the risk for several types of cancer, including liver cancer, kidney cancer, colon cancer, rectal cancer, endometrial cancer, esophageal cancer, pancreatic cancer, gallbladder cancer, thyroid cancer, cervical cancer, ovarian cancer, and breast cancer (in women past menopause). Obesity also increases the risk for developing advanced prostate cancer, which is the most dangerous stage of the disease.
The Weight-Cancer Connection
There are several ways that excess body fat may increase the risk of some cancers, including:
Causing chronic low-level inflammation in various areas of the body, which can progressively cause DNA damage that leads to cancer.
Increasing levels of certain hormones, such as estrogen, that are linked to the development of some cancers when too much is present.
Overgrowth of factors that regulate cell growth, such as insulin and insulin-like growth factor-1 (IGF-1).
Excess weight affects the body’s functions that are designed to keep us healthy.Simply put, excess weight affects the body’s functions that are designed to keep us healthy. This can lead to various health problems, one of which can be cancer.
Making a Change
The good news is that it’s never too late to start living a healthier lifestyle! Many obesity-related cancers can be prevented–but it takes action.
The best way to start reducing your cancer risk is to decrease the calories you consume and increase the calories you burn.
How can you do this?
Be more physically active, aiming for 150 minutes of moderate activity or 75 minutes of vigorous activity per week
Pay attention to portion sizes
Eliminate added sugars, fried foods, and refined carbohydrates such as pasta, white rice, and soft sandwich bread
Avoid processed foods that include additives such as trans fats, monosodium glutamate (MSG), food dyes, artificial sweeteners, and preservatives
Increase your intake of antioxidant-rich fruits and vegetables, whole grains, beans, nuts, healthy fats, and lean protein (poultry and fish)
Limit red meat consumption to no more than 18 ounces (cooked weight) per week
Avoid processed meats like bacon, deli meats, and hot dogs
Alcohol, which contains unnecessary calories and sugar, should be drunk in moderation
While there is still much to learn about the link between weight loss and cancer risk, people who are overweight or obese should consider taking steps to lose weight. Losing even a small amount of weight can lead to better overall health.
Lymph nodes (also called lymph glands) are an important are part of your immune system. If your lymph nodes become enlarged or feel sensitive to the touch, that is their way of letting you know that your body is fighting an infection. In addition to that, they function as an early warning system for some types of cancer, including lymphoma, leukemia, and breast cancer.
What are Lymph Nodes?
The lymphatic system is a major part of our body’s immune system, which consists of lymphatic vessels and lymph nodes. Its primary function is to help rid the body of toxins, waste, and other unwanted materials. To do this, it transports lymph, a clear fluid containing infection-fighting white blood cells, throughout the body. As lymph flows through the lymphatic vessels, it passes through small bean-shaped filtering organs called lymph nodes. Some nodes are as large as an inch across, while others are as small as a pinhead.
Clusters of these nodes are located in various parts of your body, including at the sides of your jaws, neck and upper chest, under your arms, and in your groin on either side of the pubic bone.
If you’ve ever noticed “swollen glands” after developing an illness or infection, those are your lymph nodes working hard to defend your immune system from the waste products (such as bacteria and viruses) that your lymph system has detected.
The Connection Between Lymph Nodes and Cancer
There are two ways in which cancer can appear in lymph nodes:
It can spread to the lymph nodes from somewhere else
It can start in the lymph nodes
Cancer found in the lymph nodes does not always mean you have lymph node cancer. Lymph fluid carries cells around the body, therefore, cancers that start elsewhere sometimes spread to the lymph nodes. Additionally, lymph nodes can show signs of change even if the cancer has not spread to other organs. For example, if the diagnosis is breast cancer then the breast cancer cells may have traveled to the lymph system and the patient will be treated only for breast cancer.
Cancer that starts in the cells of the lymph system is called lymphoma, which is a type of blood cancer. Lymphoma can begin almost anywhere since lymph tissues are found throughout the body. There are two main types of lymphoma, which are called Hodgkin lymphoma and Non-Hodgkin lymphoma.
Hodgkin and Non-Hodgkin involve different types of lymphocyte cells. Non-Hodgkin, which can start in lymph nodes anywhere in the body, is the more common of the two. Typically, Non-Hodgkin lymphoma is diagnosed only after it’s reached an advanced stage. Hodgkin lymphoma usually starts in the upper body (armpits, neck or chest) and is typically caught earlier. Because Hodgkin lymphoma is often diagnosed early, it’s considered a very treatable cancer.
Risk Factors
Risk factors for lymphoma include age, gender, ethnicity, family history or exposure to certain chemicals, drugs or radiation. Having a weakened immune system or autoimmune disease may also increase your risk.
Signs to Watch For
Even if you don’t have any obvious illness, you should see a doctor if you have swollen lymph nodes. This is especially important if your lymph nodes feel hard to the touch, and that feeling doesn’t go away after two weeks or so. Seek medical attention with your primary care physician when swollen lymph nodes are accompanied by any of the following symptoms, including:
Night sweats
Fever
Fatigue
Coughing, chest pain, or shortness of breath
Abdominal pain or swelling
Bruising or bleeding easily
Frequent or severe infections
Unexplained weight loss
Feeling full after eating just a small amount of food
Lymph Node Screening
Your primary care physician will feel the lymph nodes close to the surface. This checks for soreness or swelling. Many nodes, however, are too tiny or too deep in your body to be felt with the hands so additional imaging tests such as X-rays, MRIs, ultrasound or CAT scans are also used to spot any enlargement. Typically, a biopsy is also required as part of the diagnostic process. The biopsy will usually remove one or two of the nearby lymph nodes to see if they show any evidence of cancer.
If there is a strong likelihood that you are at an increased risk for developing lymphoma, or if cancer is detected by the screening test, you will be referred to an oncologist for further evaluation. To make an appointment with one of our oncologists please contact the location nearest you.
Lymph Node Treatment
After a cancer diagnosis, your oncologist will typically run tests to see if the lymph fluid shows evidence of cancer cells. These test results help identify what stage your cancer is in, which ultimately guides your cancer specialist in determining the type of cancer treatment you need, as well as how often you will need it.
Oncology social workers are licensed clinical professionals who all have master’s degrees and are able to assist patients and families when affected by cancer. They provide emotional support, counseling, and resource information.
March is Social Work Month. Kelly Huey LCSW, Manager of the Social Work department at Arizona Oncology, talks about how the social work team can be of assistance to patients and their families during this difficult time.
“Social workers have many roles here at Arizona Oncology. It is important we evaluate each individual patient as to their personal needs,” Huey says.
Social Work can assist with:
Patients struggling with depression from a new diagnosis or their struggles with cancer.
Advance Care Planning to help patients complete their living will and medical power of attorney forms. (“It is important for all of us to discuss with our family/significant others, so they are aware of our wishes,” Huey says.)
Assistance with Social Security/Disability, insurance changes, AHCCCS/ Medicaid, Long Term Care planning, employment issues
Supportive Counseling
Substance Abuse
Family /caregiver support resources
Community Resources
“At Arizona Oncology, we meet our patients where they are. When they are initially diagnosed, they may not be wanting to speak with someone or talk about issues. But maybe three months down the road or two weeks down the road, they may realize that they need that help, and we are there for them.” Huey says.
She adds, “Some of our patients don’t have family or anybody. They are by themselves, so we are their family. It’s nice to see them get well. It’s nice to see them progress through their treatment— the good times and the bad times. We’re there for them. That’s what families do. It is an honor to be involved with our patients on their journey.”
If you could benefit from the services of the social work department at Arizona Oncology, you don’t need to wait for a referral from your doctor, Huey urges. “Please reach out to the social work department at Aosocialwork@usoncology.com . We have an open referral system and patients can reach out to us directly with their concerns.”
Being a caregiver to someone with cancer can be difficult. This blog post is meant to be a resource for people helping someone who is going through cancer. If you are a cancer patient, you might want to share this information with the people closest to you who are helping and supporting you during this time.
Challenges of Being a Caregiver
It can be physically and emotionally challenging to provide care to a person with cancer, especially if they will be in treatment for a long time. While you may feel dedicated and up to the task at first, over time many caregivers begin to feel the weight of the important work they are doing. It’s common to experience emotions such as anger, grief, guilt, anxiety, or depression, and it can be helpful to work through them with a professional therapist or in a support group setting with other caregivers. It is also common to experience both hope and hopelessness in varying degrees.
While all of this is normal, it can be emotionally exhausting. And while you may be tempted to put your own needs aside during this time, it’s important to acknowledge that you, too, may need help and support.
Remember— taking care of yourself allows you to take better care of your loved one.
Asking for Help
Many caregivers, looking back, wish they had asked for help sooner rather than taking everything on themselves. If you find the task of asking for help daunting, here is a list of some things others might be able to do to help you. Consider asking one person to help with one of these things. Then maybe you can ask someone else to help with another.
Be very specific when asking for help. Many times people will not understand how much you need their help unless you ask for it directly. A vague request may not be enough. Some things you might ask people to help with include:
Household chores, such as cooking, cleaning, shopping, childcare, or yard work
Driving your loved one to medical appointments
Shuttling children to school or activities
Setting up a website where volunteers can sign up to provide meals (there are many free ways to do this online)
Being the contact person for keeping others updated on your loved one’s situation
Staying with your loved one so that you can take care of other obligations or just get a break
Here are some things to remember regarding asking for help:
Some people may say no. People say no for a variety of reasons. They may be busy with problems of their own. They may not be emotionally able to deal with cancer. If this happens, try not to take it personally. Don’t give up. Ask someone else. If you don’t have anyone in your inner circle, consider turning to a faith community or agency in your area for help.
Asking for help doesn’t have to mean sacrificing privacy. You do not have to give specifics about your loved one’s medical situation. Simply saying, “he’s sick” or “she’s not feeling well” is enough of an explanation.
It’s not necessarily a burden to ask someone to help you. Many people want to help but don’t know how. Many people would want to help if they knew help was needed. Put yourself in their shoes. If someone you cared about needed your help, would you want to do what you could for them?
Make Time for Yourself
You may feel like this is not a time to focus on your own needs. Or perhaps, once you’ve taken care of obligations and your loved one’s needs, you don’t have any time left for yourself. You may even feel guilty if you try to enjoy things that your loved one can’t right now. These are all valid feelings, but if you are to carry on and be strong for your loved one, you will need to care for your own emotional health.
Caregivers need time to recharge in body, mind, and spirit. Of course, this looks different from person to person, but here are some ways you can care for your own needs, hopes, and desires so that you have the strength and resilience to better care for your loved one.
Include things you love to do in your schedule. This may be as simple as reading a book while you wait for a loved one at a medical appointment, taking a regular walk, playing cards, listening to music, or having a warm cup of tea in the afternoon.
Cut back on personal activities, but don’t cut them out completely. Attending a group or playing a sport twice a month rather than weekly will help you to remain involved.
Delegate some of your own responsibilities. Ask your spouse, parent, or children to help with responsibilities that you normally take on, such as household chores, errands, pet care, driving, or planning events.
Find easy ways to connect with friends. With today’s technology, it’s easier than ever to keep in touch with friends. Even a lighthearted text interaction now and again with a caring friend can do a lot to lift your spirits.
Find a caregiver support group. Talking with others who understand what you are going through can help you work through your feelings and feel less alone.
Arrange for larger chunks of “off-duty” Finding respite care from a family member, friend, faith or community organization, or agency will allow you to focus on your own needs.
Here are some things to remember when considering your own needs:
Taking care of yourself doesn’t necessarily mean being away from your loved one. You can recharge with an online yoga class, a good book, and a warm beverage, working on a hobby, or gardening.
Don’t forget about your own health needs. Sometimes you can get so focused on your loved one’s health that you forget to take care of your own. Make it a priority to keep up with your medical appointments, take your medications, eat healthy, exercise, and get enough rest.
Find meaning during cancer. Cancer causes many caregivers to look at life differently and focus on what they value most. It might help to read or listen to uplifting materials, spend time in a spiritual or faith community, or to pray or meditate.
