A Farmer Removed His Own Skin Cancer With A Pocket Knife. This Is What Happened To His Brain.
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A Farmer Removed His Own Skin Cancer With A Pocket Knife. This Is What Happened To His Brain.


A Sunburned Man Found A Lump On His Arm. This
Is What Happened To His Brain. KC is a 45 year old man, presenting to the
emergency room with a 15 minute seizure. His wife, Jennifer, tells the admitting nurse
at admission that he had been developing a weakness on the left side of his body over
the last few days. You see, KC was a farmer in rural middle America.
Every year, he was sunburned for at least 3 months from working out in the fields. Didn’t
really care about anything for his health because he’d been ok his whole life. Several months ago, a sunburned KC found an
asymmetrical, pigmented lesion with irregular borders growing rapidly on the skin of his
right arm. Day after day, the lump would seem to morph into something new, grow larger and
ulcerated but without pain. He thought it might be cancer. A doctors visit was unnecessary,
he thought. Most of his farmer’s life was fixing things on his own. Whether it was parts
of his home, or his farm equipment, he lived a self-sufficient life. He always had the
tools to get the job done and in the case of his skin cancer, this is something he could
fix himself. Immediately after removing his own skin tumor,
KC thought that this story was over. Nothing more to be done here. Wrap it up with a cloth
and carry on, he thought. Over the next few months KC felt great, but
noticed there was a lump growing inside his right armpit underneath the skin. It was warm
to the touch, sometimes he could feel a pulsating sensation coming from it. Every morning he’d
wake up and put his hand on the lump, and feel his heart beat through it. His wife suggested he see a physician, but
KC joked to his wife that he’s his own surgeon now. He said he did it once, and if he has
to do it for the lump in his right Armpit, he’ll do it again. Except, a PET scan revealed
hypermetabolic lymph nodes in that region. Hyper meaning high. Metabolic referring to
cellular division. And lymph nodes denoting the structures in your body where white blood
cells from your immune system accumulate and drain. These kinds of lymph nodes indicate
that something is growing inside his right armpit. About a month ago, Jennifer started to notice
KC developing irregularities in his walk. It appeared to look like a limp that when
confronted about it, KC would deny anything. He actually couldn’t see himself deteriorating.
He started to develop a weakness on his left side and began developing headaches that were
so bad he’d feel as if someone were pushing from inside his skull against his eyes..His
entire family began to notice changes in his personality. A normally patient and down to
earth man, he would now get physically angry at everything until one day while working
out in the fields, he suddenly collapsed on a 15 minute seizure. An MRI finds multiple lesions developing in
several regions of KC’s Brain. Because there’s no indication of infection, cerebral bleeding
and signs of radiation damage to his brain and because these tumors don’t have the
characteristics of a primary tumor, it means that KC doesn’t have brain cancer, but that
theres tumors in his brain that are from cancers elsewhere in his body and they’ve spread to
his brain. Cells from his axillary mass lymph nodes were
examined. It wasn’t just a swollen red lump, it was widespread cancer growth. Looking at
the cells under a microscope, multiple markers were positive for a type of skin cancer based
on presence of the polymer that gives tissue color and pigmentation, something called melanin.
Even though KC had removed the cancer from the skin of his right arm, it appears that
the cells from that primary tumor are now growing en masse in his lymph nodes, and in
his brain. We can conclude here that KC has metastatic
melanoma. Melan referring to melanin. Oma meaning tumor, or irregular mass, describing
the type of cancer growing on KC. And metastatic meaning that even though he originally had
cut out the cancer himself, it has transcended its stationary site of origin, and has started
spreading throughout his body. If in a healthy person you wouldn’t normally
find skin cells growing in the brain, then how is it possible that KC’s skin cancer
spread to his brain? Well, there’s a bit of basic cellular biology to be known here. Cancer is a genetic disease at it’s core,
but its physical characteristics are something more. The genes in our body code for proteins, which
give us our physical form, but they also signal for our cells to do things. Proteins are made
of amino acids. Amino acids are sequenced together, dictated by our genetic sequence.
Changing that sequence, either by mistake, or from environmental damage like from radiation
from the sun, cause mutations. But most mutations are nonsense, happen less than 0.01% of the
time and usually get fixed. But sometimes, these mutations create proteins that signal
to the cell to grow, and there’s no signal to stop growing. To keep reproducing with
no signal to stop reproducing. To grow their own blood supply. And to survive in the circulation
and spread to other distant sites of the body. Cancer is more than just a genetic disease,
its an evolutionary step to highly successful cellular survival, at the expense of its host.
KC’s case gives us more evidence of this. A genetic test is done on his lymph node cancer
cells. A single point mutation was found specifically on chromosome 7, on the gene named BRAF, at
nucleotide 1799: where there should have been an A, there was a T, meaning for the protein
made by the gene BRAF, 1 amino acid at position 600 changed, creating something called the
V600E mutation. A normal functioning cell uses RAF, which feeds into a pathway of the
cell causing it to grow, with limitations, but BRAF V600E promotes unmitigated cellular
growth and uninhibited cellular division, which gives us a necessary condition for it
to be cancer, but there’s more. When you pee, some urethral cells will be
in that pee. Physics tells us for any flowing fluid, a shear stress will be produced along
the surface on which it flows. For biological systems, it means some of the cells can come
off when you urinate, but cells can also can come off when blood flows in to a tissue.
As melanomas grow thicker and deeper into the skin, the chance of metastasis becomes
higher and higher. We call this high risk disease because then melanoma cells can break
off from the primary tumor and float around in the blood. The blood vessels going into the brain have
a special biology, called the blood brain barrier. It prevents certain substances from
going in, and allows others in. This blood brain barrier has proteins on it’s
surface. Melanoma cells also have an overexpression of proteins on its surface, meaning if a skin
cancer cell can break off from the tumor, live in the blood circulation, when it gets
to vasculature of the brain, it can adhere onto the proteins at the blood brain barrier,
and begin to grow and multiply, forming a brain metastasis. Melanomas are the 3rd most common cancer
to spread to the brain. Breast and lung cancers have a higher incidence of brain metastasis,
but data shows that 40 to 50 percent of patients who have a melanoma that spreads somewhere
in the body, will eventually have it spread to the brain.
The massive headaches. The paralysis on one side of his body. The 15 minute seizure. If
this continues unchecked, the brain masses growing inside KC will eventually rupture
the blood vessels in the brain, causing fatal damage through the cerebral cortex. Ultraviolet radiation from the sun is known
to cause cellular damage. Because the sun doesnt shine directly on KC’s brain, nor
his lymph nodes, but it shines on his skin, and skin cancer is known to spread to the
brain and lymph nodes, we know where these tumors originated from. Case reports of people who for years, worked
in an environment where the sun shined on one half of their face revealed the extent
of damage possible to skin tissue. Queensland Australia, where the UV index is often high,
and people with light colored skin who are not genetically adapted to the harsh sun contribute
to the melanoma capital of the world with an incidence rate of 71 cases per 100,000
people, three times that of the United States. The metastatic propensity of malignant primary
tumors is a recurring theme when it comes to causes of mortality in cancer. Colorectal
and stomach cancers commonly spread to the liver first as the shared blood supply make
it one of the first organs of contact. Bone cancers typically go to the lungs first. Breast
cancers commonly spread to the lungs, liver, bones and brain, and lung cancers typically
to go the brain first as blood passes through the lungs to be oxygenated, pick up cancer
cells as the fluid produces a shear stress along its interface, enter into the left ventricle
into the aorta into the carotid arteries to the brain. And uveal melanoma, a cancer of
the melanocytes in the eyes, which is a different kind of melanoma than the skin, typically
spread to the liver first, despite the eyes being right next to the brain. For KC, removing his own primary tumor meant
very little, because at some point either before or after he removed it, the cancer
had already started to spread all throughout the body. There’s a few things that can be done, but
the prognosis, or the predicted outcome of his disease at this late stage is grave. Once
melanoma has metastasized to the brain and produce symptoms like a 15 minute seizure,
historic data from multiple studies show that median survival, the time at which 50% of
patients are left alive, is less than 5 months. That by 18 months after diagnosis, about 10%
of patients are still alive. Throughout any clinician’s career, over the many patients
one will see, statistically, there will be those few patients who live with stable disease,
but those patients are the exception and not the rule. At the time KC was diagnosed in early 2011,
multiple treatment modalities were available for KC. Traditional chemotherapies in metastatic
melanoma had fallen by the wayside by the time he presented to the emergency room, as
they were known to have little to no effect on brain metastases. KC was offered brain surgery in an attempt
to prevent more seizures, prevent the tumor from causing a brain bleed, and minimize neurologic
dysfunction. He declined and elected for radiation therapy, which irradiates the cells, thereby
damaging their DNA sufficiently to prevent them from reproducing, but it appeared that
KC presented to the emergency room too late as additional seizures and intracerebral hemorrhage
ensued before any treatment was initiated. At autopsy, KC’s brain masses were found
to have the same V600E mutation as the mass in his right armpit and because it’s not
likely that both of those sites each simultaneously and independently mutated the exact same gene,
with evidence of melanocytic immunomarkers present, this was a case of advanced melanoma
with multiple metastases to the brain. Sunscreen is a must for anyone who spends
long periods of time outside. It shields one from the harmful UV radiation from the sun
that damages the DNA of skin. Early detection, along with going to a surgical oncologist
for consultation instead of removing the skin tumor himself, could have prevented this outcome
for KC. Prevention with sunscreen, sitting in the shade, and limiting one’s sun exposure
during the summer months is still the best approach to one’s health in this context. The Ancient Chinese had a character for cancer.
It is based off the word for rocks, implying a burden carried by one’s body. The character
has a formality to indicate illness on the right as it resembles a bed turned sideways,
and on the left is a symbol for a primary tumor, spreading throughout the body as multiple
smaller metastases, that continue to spread, to infinity. Treatment modalities in early 2011 when KC
presented to the emergency room were better than what ancient humans had. The treatments
today improve response rates, progression free survival, and overall survival. But they
can and will be better yet with time. And even after all of these centuries, cancer
is still a burden on humanity. Thank you to the Griffith Family of Greenock
Road, Lothian Maryland, for allowing me to record on their farm and thank you so much
for watching. Take care of yourself. And be well.

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