What kind of cancer should I give my character?
June 11, 2010 8:53 PM Subscribe
What kind of cancer should I give my character?
I've been idly toying with an idea for a novella for --- well, far too long --- and I'd like to get it done. One of the things which has stymied me: It is necessary for the purposes of the plot for the main character to suffer a lengthy illness at a fairly young age --- something which seems nearly certain to kill her, but which she is able, surprisingly, to recover from.
Cancer seems like the obvious choice. But what kind of cancer? Bearing in mind these conditions:
age: late 20s/early 30s
sex: female
setting: U.S. late 90s/early-to-mid 2000s
NB: character bears child after her recovery
What type of cancer might fit these parameters? I'm open to other diseases, of course, but had a tough time thinking of something for which a big innovation happened in that time period, that could account for her surprising recovery. Whereas, from my layman's understanding, in that same period there have been advances in treatment for individual cancers or strains of cancer which might plausibly account for the plot path.
I suppose, reading the above, you might ask why I don't just make it up. I could, but I'd like to have a firm grounding in the real for this piece, both 'cause I think it will make me write better and because I wouldn't want to be disrespectful or flip in writing about something that's a harrowing and profound experience for all its sufferers. This period of illness is a central event which influences everything else that happens. The last thing I want do is have the character's affliction turn into a soap opera disease.
So, docs and nurses and patients: Got any ideas for a variety of cancer that might hit a young woman and was quite likely to be fatal, but for which helpful treatments have been developed in the past 10-15 years?
I've been idly toying with an idea for a novella for --- well, far too long --- and I'd like to get it done. One of the things which has stymied me: It is necessary for the purposes of the plot for the main character to suffer a lengthy illness at a fairly young age --- something which seems nearly certain to kill her, but which she is able, surprisingly, to recover from.
Cancer seems like the obvious choice. But what kind of cancer? Bearing in mind these conditions:
age: late 20s/early 30s
sex: female
setting: U.S. late 90s/early-to-mid 2000s
NB: character bears child after her recovery
What type of cancer might fit these parameters? I'm open to other diseases, of course, but had a tough time thinking of something for which a big innovation happened in that time period, that could account for her surprising recovery. Whereas, from my layman's understanding, in that same period there have been advances in treatment for individual cancers or strains of cancer which might plausibly account for the plot path.
I suppose, reading the above, you might ask why I don't just make it up. I could, but I'd like to have a firm grounding in the real for this piece, both 'cause I think it will make me write better and because I wouldn't want to be disrespectful or flip in writing about something that's a harrowing and profound experience for all its sufferers. This period of illness is a central event which influences everything else that happens. The last thing I want do is have the character's affliction turn into a soap opera disease.
So, docs and nurses and patients: Got any ideas for a variety of cancer that might hit a young woman and was quite likely to be fatal, but for which helpful treatments have been developed in the past 10-15 years?
Leukemia.
posted by drpynchon at 9:11 PM on June 11, 2010 [1 favorite]
posted by drpynchon at 9:11 PM on June 11, 2010 [1 favorite]
Leukemia (acute lymphocytic) will keep her in treatment for about 3 years and the treatment will likely affect her fertility. But is highly cureable if she has it in her teen age years.
Leukemia (acute myelogenous)-shorter treatment, 6 months or so, but less likely to be cured, and sicker going through treatment.
Chronic leukemias are more for older people, unless you want to give her a bone marrow transplant or put her on gleevec for the rest of her life.
Lymphoma is also a good option. 6 months or so of treatment, pretty high likelihood of cure.
Hodgkin's disease would be even more likely to be cured within that time frame though.
posted by SLC Mom at 9:17 PM on June 11, 2010 [1 favorite]
Leukemia (acute myelogenous)-shorter treatment, 6 months or so, but less likely to be cured, and sicker going through treatment.
Chronic leukemias are more for older people, unless you want to give her a bone marrow transplant or put her on gleevec for the rest of her life.
Lymphoma is also a good option. 6 months or so of treatment, pretty high likelihood of cure.
Hodgkin's disease would be even more likely to be cured within that time frame though.
posted by SLC Mom at 9:17 PM on June 11, 2010 [1 favorite]
Fiddling around on this page from the National Cancer Institute, I found that the five-year survival rates for leukemia for women in your age range have been climbing upward dramatically since the mid-1970s, with a definite uptick in the mid-late 1990s. (Sorry I can't link to the actual data output itself, but you can play around with it to see the numbers yourself, and can even break down the statistics more specifically by leukemia types and subtypes.) My google-fu is failing me in terms of finding out exactly what the developments were during your time frame, but my sense is that the 1980s-90s saw big advances in chemotherapy drugs.
(On preview: jinx, I guess!)
posted by scody at 9:41 PM on June 11, 2010
(On preview: jinx, I guess!)
posted by scody at 9:41 PM on June 11, 2010
Best answer: Thyroid cancer, papillary or follicular. The prognosis is determined by the tumor size. Give your character a large enough tumor and the prognosis will be bad. 11cm is pretty damned large and enough to make doctors go "holy shit, this doesn't look good".
Follicular is angioinvasive, so it spreads through the blood vessels and people can develop metastases in the lungs and other major organs while papillary typically stays in the lymph nodes in the neck. And you may be one of the lucky ones who gets the one-two punch of a large papillary tumor on one hemisphere and a very large follicular tumor on the other.
The process for receiving radioactive iodine treatment for ablating remaining tissue after a thyroidectomy is a serious bitch as it involves a special low-iodine diet and going off of all thyroid hormone for a few weeks. It's a horrific thing to go through. Thyrogen shots are a fairly recent advancement that eliminates the need to go off of the hormone for more than a couple of days (though some docs insist on the old method.)
Even with a good prognosis, recovery can easily be a year, though it's a continuing process of medication adjustment for a long time. Often, as a preventative for cancer for the first year, the patient is put on a very high dose of thyroid hormone to keep the pituitary gland from producing TSH (thyroid stimulating hormone). While it helps prevent cancer recurrence, it's hard in the heart and bones. And as with any other cancer, there's issues of recurrence and the anxiety associated with it. I have a friend who was diagnosed with a very small tumor 3 years ago and is still undergoing treatment with external beam radiation.
posted by Cat Pie Hurts at 9:42 PM on June 11, 2010
Follicular is angioinvasive, so it spreads through the blood vessels and people can develop metastases in the lungs and other major organs while papillary typically stays in the lymph nodes in the neck. And you may be one of the lucky ones who gets the one-two punch of a large papillary tumor on one hemisphere and a very large follicular tumor on the other.
The process for receiving radioactive iodine treatment for ablating remaining tissue after a thyroidectomy is a serious bitch as it involves a special low-iodine diet and going off of all thyroid hormone for a few weeks. It's a horrific thing to go through. Thyrogen shots are a fairly recent advancement that eliminates the need to go off of the hormone for more than a couple of days (though some docs insist on the old method.)
Even with a good prognosis, recovery can easily be a year, though it's a continuing process of medication adjustment for a long time. Often, as a preventative for cancer for the first year, the patient is put on a very high dose of thyroid hormone to keep the pituitary gland from producing TSH (thyroid stimulating hormone). While it helps prevent cancer recurrence, it's hard in the heart and bones. And as with any other cancer, there's issues of recurrence and the anxiety associated with it. I have a friend who was diagnosed with a very small tumor 3 years ago and is still undergoing treatment with external beam radiation.
posted by Cat Pie Hurts at 9:42 PM on June 11, 2010
Best answer: Not just leukemia, chronic myelogenous leukemia with the bcr-abl fusion gene. This disease is caused when parts of two chromosomes join together in a such a way that a new oncogene (or cancer causing gene) is made that allows certain types of white blood cells to divide out of control. Imatnib (or Gleevac) is a drug specifically designed to turn this gene back off again and for patients with the right version of the mutation it can be a miracle cure. It was FDA approved in 2001 and from what I've read it totally changed how this disease is handled.
The disease starts off often symptoms then adds in things like fatigue and aches and pains. It has a chronic phase followed by an acute phase so you can drag it out then make it get worse fairly quickly, and it is often fatal when untreated (eventually). You also have the option of giving her a bone marrow transplant (which can also be a cure) if that fits with your story at all. Technology for those has also increased dramatically in recent years, so it's more feasible now that prior to your time period.
Downsides: CML is usually diagnosed in those over 60 although young people can certainly get it. There are other cancers positive for the bcr-abl fusion though, so you could find a different one if that works better (wikipedia has pretty good articles for all this by the way). I don't know how it would affect her fertility. Chemotherapy usually does have an effect but the point of Imatinib is that it's targeted, so only affects the disease cells, so it's probably better than other chemo's in that regard. You'd be able to find out with not too much digging I think.
It's the discovery of a very specific cure that makes this disease fit your description (to me at least), not many diseases went through something so revolutionary during that time frame.
posted by shelleycat at 9:52 PM on June 11, 2010 [1 favorite]
The disease starts off often symptoms then adds in things like fatigue and aches and pains. It has a chronic phase followed by an acute phase so you can drag it out then make it get worse fairly quickly, and it is often fatal when untreated (eventually). You also have the option of giving her a bone marrow transplant (which can also be a cure) if that fits with your story at all. Technology for those has also increased dramatically in recent years, so it's more feasible now that prior to your time period.
Downsides: CML is usually diagnosed in those over 60 although young people can certainly get it. There are other cancers positive for the bcr-abl fusion though, so you could find a different one if that works better (wikipedia has pretty good articles for all this by the way). I don't know how it would affect her fertility. Chemotherapy usually does have an effect but the point of Imatinib is that it's targeted, so only affects the disease cells, so it's probably better than other chemo's in that regard. You'd be able to find out with not too much digging I think.
It's the discovery of a very specific cure that makes this disease fit your description (to me at least), not many diseases went through something so revolutionary during that time frame.
posted by shelleycat at 9:52 PM on June 11, 2010 [1 favorite]
but my sense is that the 1980s-90s saw big advances in chemotherapy drugs.
I'm betting Gleevac accounts for a big part of this.
The other one would be her-2 positive breast cancer and herceptin, but I don't know when herceptin was FDA approved, how/if it effects fertility, and there are other well validated treatments for breast cancer (whereas pre-Gleevac-CML didn't have that so much).
posted by shelleycat at 9:55 PM on June 11, 2010
I'm betting Gleevac accounts for a big part of this.
The other one would be her-2 positive breast cancer and herceptin, but I don't know when herceptin was FDA approved, how/if it effects fertility, and there are other well validated treatments for breast cancer (whereas pre-Gleevac-CML didn't have that so much).
posted by shelleycat at 9:55 PM on June 11, 2010
The disease starts off often symptoms
Arg, that should be symptomless or asymptomatic. Sorry.
posted by shelleycat at 9:57 PM on June 11, 2010
Arg, that should be symptomless or asymptomatic. Sorry.
posted by shelleycat at 9:57 PM on June 11, 2010
Given her age this is less likely, but her parents could have given birth to a sibling who could donate bone marrow for any number of diseases. Preimplantation genetic diagnosis, to ensure(?) a match, seems to have started working correctly in 1989.
posted by acidic at 10:08 PM on June 11, 2010
posted by acidic at 10:08 PM on June 11, 2010
Best answer: I'm betting Gleevac accounts for a big part of this.
As sexy as it sounds, imatinib and its sibling drugs are not curative therapy. They really only control CML (and not indefinitely). In the rare younger patient with CML, the focus of therapy would not by imatinib, but stem cell transplantation, as this is really the only option of therapy for curative intent.
posted by drpynchon at 10:13 PM on June 11, 2010
As sexy as it sounds, imatinib and its sibling drugs are not curative therapy. They really only control CML (and not indefinitely). In the rare younger patient with CML, the focus of therapy would not by imatinib, but stem cell transplantation, as this is really the only option of therapy for curative intent.
posted by drpynchon at 10:13 PM on June 11, 2010
Brain tumors/cancers and the like hit the younger set more frequently than some of the "older person" cancers. I personally can think of two people (friend and friend-of-friend) who succumbed to this while in their 20s. I don't know how the treatment's progressed, however, or really anything medically relevant, but I'm sure people do survive.
posted by cgg at 10:14 PM on June 11, 2010
posted by cgg at 10:14 PM on June 11, 2010
Actually harvesting cord blood stem cells would make more sense with an infant. But basically the same idea.
posted by acidic at 10:15 PM on June 11, 2010
posted by acidic at 10:15 PM on June 11, 2010
Huh, cool. I should have mentioned that I was reading about Gleevac mostly in the early 2000's when it was probably hoped to be more of a wonder cure than it ended up being. If the story was set when it was new would that change how it was used?
And a bone marrow transplant still takes time to arrange right, so could still be used as a plot point.
posted by shelleycat at 10:16 PM on June 11, 2010
And a bone marrow transplant still takes time to arrange right, so could still be used as a plot point.
posted by shelleycat at 10:16 PM on June 11, 2010
Mesothelioma has a median life expectancy from diagnosis of about 8 months. However, it's got a really long tail on the right side of the curve, and there are people who are outright cured. (E.g. Stephen Jay Gould)
posted by Chocolate Pickle at 11:01 PM on June 11, 2010
posted by Chocolate Pickle at 11:01 PM on June 11, 2010
shelleycat beat me to it, but I'm also suggesting the chronic myelogenous leukemia with bcr-abl mutation.
I was diagnosed with it last December (at age 42), went through the chemo, went onto Gleevec and I'm doing great. Blood counts are great, no side effects and only one pill a day. Just about the definition of a miracle drug, imho.
posted by darkstar at 11:17 PM on June 11, 2010
I was diagnosed with it last December (at age 42), went through the chemo, went onto Gleevec and I'm doing great. Blood counts are great, no side effects and only one pill a day. Just about the definition of a miracle drug, imho.
posted by darkstar at 11:17 PM on June 11, 2010
Best answer: If you do go the CML route, I'd be happy to share the details about my diagnosis and treatment. Also, I teach chemistry at college and love to talk about the awesome biochemistry of imatinib, so you'd be giving me an excuse! :)
posted by darkstar at 11:30 PM on June 11, 2010
posted by darkstar at 11:30 PM on June 11, 2010
Since you're writing a novel, you should take the opportunity to make the cancer some kind of cosmic justice or some kind of Ironic thing. So for example she could have been promiscuous, come down with HPV and gotten Cervical Cancer like Jade Goody. Goody was born in '81, became a reality TV show star, and died in 2009. Bonus points: she was informed about her cancer on reality TV.
Or you could make it Ironic: She was virginal but got HPV from a rusty nail at an abstinence rally or something.
Another possibility, obviously is AIDS. in the 1990s (as I recall) AIDS was a death sentence for most people, but by the end the drugs worked well and people thought of it as a lifelong thing.
Or you could make it a disease like Chrone's disease or Diabetes that is OK if managed, but she lost track and ended up with limbs amputated because she was careless. You could have your character love sweets, get diabetes, ignore it, and end up without her arms.
You could have her in a ski accident and become a paraplegic, only to be cured by stem cells or something.
Don't fall into the trap of "what's the most realistic thing". People die from common diseases (like the Flu) every once in a while, and rare diseases crop up to. Make the disease you chose fit the story.
posted by delmoi at 11:59 PM on June 11, 2010
Or you could make it Ironic: She was virginal but got HPV from a rusty nail at an abstinence rally or something.
Another possibility, obviously is AIDS. in the 1990s (as I recall) AIDS was a death sentence for most people, but by the end the drugs worked well and people thought of it as a lifelong thing.
Or you could make it a disease like Chrone's disease or Diabetes that is OK if managed, but she lost track and ended up with limbs amputated because she was careless. You could have your character love sweets, get diabetes, ignore it, and end up without her arms.
You could have her in a ski accident and become a paraplegic, only to be cured by stem cells or something.
Don't fall into the trap of "what's the most realistic thing". People die from common diseases (like the Flu) every once in a while, and rare diseases crop up to. Make the disease you chose fit the story.
posted by delmoi at 11:59 PM on June 11, 2010
FWIW, IRL I had a friend, born in the early 1960s, who came down with Type I diabetes at the usual childhood age, decided, "Hey, screw it, I'm only going to live until my early 30s at best, no children possible, I'm just going to party it up and live like I'm going to die young anyway."
Then as she got into her 20s & 30s with the gradually improving insulin treatments available her health actually improved, she ended up realizing she might live 30 or 40 more years than she planned. She she ended up getting married, having kids, and basically having the life she had spent the first 25 years of her life thinking she would never have.
posted by flug at 9:07 AM on June 12, 2010 [1 favorite]
Then as she got into her 20s & 30s with the gradually improving insulin treatments available her health actually improved, she ended up realizing she might live 30 or 40 more years than she planned. She she ended up getting married, having kids, and basically having the life she had spent the first 25 years of her life thinking she would never have.
posted by flug at 9:07 AM on June 12, 2010 [1 favorite]
This thread is closed to new comments.
I would suggest leukemia. Even the very treatable versions take, like, a year to get through, and then there's a five-year window (common to most cancers, actually) in which you're still not really in remission. I think you usually have to take oral chemotherapy during that whole time. A friend of mine went through this in the last few years and is doing very well, but she had some rough days and nights.
posted by Madamina at 9:10 PM on June 11, 2010