Going Back to 10th Grade Biology Class

Remember 10th grade biology class?  Studying cell division under microscopes? Understanding chromosomes, cell membranes, DNA, mitochondria and cytoplasm? Do you remember any of it?  Yea, neither do I.

Mr. Jones, my 10th grade biology teacher, tried mightily to impart some of his wisdom, but we just weren’t hearing it.  My class was after lunch so therefore my attention span waned quite a bit.  My friends and I were really more concerned about who sat next to each other in the cafeteria and, horror of all horrors, why Thomas, my 10th grade boyfriend was sitting with *gasp* his ex-girlfriend!  My mom taught biology and you would think that with that kind of influence I would have scored better in science on my college aptitude test, but I didn’t.   Obviously, science wasn’t my best subject; it wasn’t my worst, but not my favorite either.  However, the past few weeks I have anxiously, academically, devoured any information I could get my hands on regarding cell mutation. I know that’s a weird and random subject and never did I think it would be one of extreme fascination for me. 

However, since my mom’s last doctor’s appointment, cell mutation is all I’ve been thinking about.  My mom recently had an appointment at UAB (University of Birmingham) Cancer Center at Kirklin Clinic. Her primary care physician in Louisiana referred her to UAB, mainly because it’s located in Birmingham, where I live and it’s an easier drive than M.D. Anderson in Houston.  And also UAB is an award-winning medical facility with miraculous stories to tell. Though my mom has been to M.D. Anderson several occasions, we felt it was time for a fresh perspective.  Besides, mom told her primary care physician she wasn’t ready to give up hope, even though her oncologist told her “We’ve exhausted all options”…like my mom was gonna accept that.  Ha!

So, after much preparation to get my parents to my house 5-6 hours from Louisiana (thanks to my uncles and aunties), we loaded up early the next morning after their arrival and headed downtown to UAB.  Of course I drove since I know the city and knew where we had to go. I was nervous and a little bit irritable and rightly so.  We didn’t know what to expect at UAB.  And quite honestly, I expected the calm, cool doc with the Puerto Rican accent (he resembles Ricardo Montalban aka “Mr. Roarke”, but with a mustache) to smoothly tell my mom her time was VERY limited here on Earth.  I expected him to say go back home because she’s wasting his time.  But that’s not what he did.  Instead he thought that it was interesting and quite miraculous that mom, who was diagnosed with Stage IV lung cancer in 2008 was still on this beautiful Earth.  Even though the cancer had spread to her bones and brain in the last six months, she was still quite aware and optimistic.  Even “Doc Rourke’s” nurse, a soothing and affable, curly red head, enthusiastically bobbled her head up and down at the fact that mom was doing well considering.  I started to feel like mom was some kind of experiment and that maybe one day someone would write an article about her.   If nothing else, maybe someone can learn something from mom’s case?  “Doc Rourke” saw in the medical history where mom had smoked for most of her adult life, but she had been cigarette-free for over 15 years.  That alone extended her life for more years than if she had still been smoking.  After tons of questions and reviewing previous chemo and radiation treatment schedules, Doc provided a tiny, tiny sliver of hope.

Like a small slice of sweet potato pie, his words were just enough to satisfy us.

He said that he didn’t want to get our hopes up, but he wanted to examine my mom’s original cells from her first biopsy.  He wanted to see if she had the anaplastic lymphoma kinase (ALK) gene.  He’s is essentially doing genetic testing on her cells.  If we broke it down like 10th grade biology, he basically wanted to know if her cells were mutated, funky-looking, weird.  A mutated ALK gene potentially causes certain types of cancers.  IF (big IF) she does have this mutation, he wants to set her up with the newly-approved drug, crizotinab (brand name Xalkori).  The FDA just approved the Pfizer-made drug in August 2011.  This drug works by blocking the ALK gene, though eventually the cancer could become resistant to the drug.

Just two weeks before my mom’s appointment I had just read about this drug and how it had produced excellent results in those who had been a part of the trial.  Never did I expect that mom MIGHT be a candidate for the drug.  So, ok, let me get this straight. If mom has abnormal cells, Doc wants to put her on this drug that, so far, has produced exceptional results in patients who had no other options remaining, like mom.   IF.  

The American Heritage Dictionary describes mutation this way: A change of the DNA sequence within a gene or chromosome of an organism resulting in the creation of a new character or trait not found in the parental type; The process by which such a change occurs in a chromosome, either through an alteration in the nucleotide sequence of the DNA coding for a gene or through a change in the physical arrangement of a chromosome; A mutant.

Did you get all of that?  Yea, basically, we’re waiting to find out if the ALK gene has caused mom’s cancerous cells to be like teenage mutant ninja turtles.  Now, it’s a very rare mutation.  Only about 7 percent of individuals with non-small cell lung cancer have this kind of mutation and it’s really only found in non-smokers or very light smokers.  Mom wasn’t a heavy smoker and given my mom’s history and her successful response to all previous treatments, they felt it was worth a shot.  Doc didn’t have to try this or even put forth any extra effort. But at this point, we have nothing to lose; it’s not gonna hurt to try.  

So now we wait.  Doc had to request the cells from the original facility that performed mom’s biopsy.  On October 17, mom is coming back to Birmingham for a day full of tests and scans. On October 19, she has a follow-up appointment with “Doc Roarke” and then we’ll find out if she is a candidate for crizotinab.  At first I didn’t think I could deal with waiting.  But now, waiting has been a blessing because we’re taking this time to enjoy the small moments.  Granted, she’s had some challenges in the last few weeks and each day is a different set of challenges.  But she’s surrounded by lots of love and support and for that I’m grateful.

I’m still learning about ALK mutations so my apologies if my 10th grade explanation isn’t quite as scientific or lacks specific information.  Remember, I wasn’t always paying attention in class when I should have been.