In dance, timing is everything. It can mean the difference between catching one’s partner and letting her fall.
Cancer, too, obeys a cruel clock. Delays in diagnoses can be deadly.
No one knows this better than Helena Benítez, a medical technician living in Bogotá, Colombia. Originally trained as a bacteriologist, Helena now works at the National University of Colombia, bringing diagnostic radiology to remote regions of the Amazon, where access to healthcare is extremely limited.
In 1994, while traveling in California, I discovered a lump in the inner thigh of my right leg. Upon returning to Colombia, I was diagnosed with malignant melanoma. By this time, the cancer had spread to surrounding lymph nodes and my prognosis was dismal: I learned that the average 2-year survival rate for patients with metastatic melanoma is less than 25%.
I had surgery to remove the affected lymph nodes and began radiation and chemotherapy. The cancer went away for a time, but eventually it came back and had to be removed once more. This would become a painfully familiar process: over the next two years, I had nine surgeries to remove recurrent melanoma. When the cancer attached itself to her femoral artery, doctors told me they could no longer hope to spare my leg; it would need to be amputated.
“No. My leg is going to stay with me," I told them. "I don't have a problem with dying. For me, the problem is living and living well, and that means living with my leg.”
The same week that my doctors recommended amputation, I learned about a potential treatment alternative. A colleague had just returned from a medical conference where he heard an American researcher named Bruce Beutler, M.D., lecture on tumor necrosis factor (TNF).
Tumor necrosis factor is a molecule, released from immune cells, that causes tumors in laboratory mice to shrivel up and die. It was discovered in 1975 by former Cancer Research Institute medical director Lloyd Old, M.D., and colleagues at Sloan-Kettering Institute.
In the lecture, Beutler, who would eventually go on to win a Nobel Prize, explained that TNF was an incredibly powerful molecule, able to smite tumors practically overnight. Initially, doctors had high hopes that this molecule could become a miracle treatment for cancer. Unfortunately, those hopes were dashed when it was discovered that TNF is incredibly toxic; the doses needed to kill tumors would also be lethal to the patient.
I arrived at the Ludwig Institute in Lausanne, Switzerland, in November 1996. The Alpine surroundings lifted my spirits. Una absoluta belleza: the Alps right there, the Lausanne Cathedral, the lake … I looked at all that and I said ‘Lord, don't let me die now, I love this place.
I underwent a TNF limb perfusion procedure and was subsequently able to have surgery to remove the necrotic tumor and save my leg. When they finally took off the bandaging and I looked down at my leg, I saw that it was all worth it. It was a miracle.
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Rare and ultra-rare cancers affect around 20,000 people in the United States alone, according to Foundation Medicine, Inc. Immunotherapy research in some of the more common cancers and the identification of biomarkers that can predict patient responses is opening this new approach to cancer treatment up to patients whose cancers currently receive little direct attention.
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