While fog sweeps across the campus and car alarms blare from the street below, researchers at the world-renowned Helen Diller Family Comprehensive Cancer Center at University of California, San Francisco aim to grow understanding of tumors by discovering what treatments reduce them.
The university hospital is consistently improving research techniques or pioneering studies, and one particular clinical trial has a heavy influence from Lodi.
The trial, I-SPY 2, is led by UCSF and features the participation of 20 universities and hospitals. The study is designed to further knowledge the deadly disease through the analysis of tumors and combining medicines with standard chemotherapy treatments.
And five local women — Lana Carouba, Natalie Hansen, Kathy Martin, Roya Main and Wendy Buchanan — participated in it by receiving their cancer treatments from UCSF.
Typical protocol for breast cancer treatment is surgery to remove the tumor and then use chemotherapy to kill residual cells. The I-SPY 2 trial features patients receiving treatment for their tumor before a surgeon removes it. The approach enables clinicians and pathologists to understand how certain tumors react to specific treatments and what body chemistries are more prone to certain types of cancers.
The five-year trial is still in its infancy, so clinical research papers on findings related to the study are not yet available. But the five local women who participated in the trial, who are now either cancer-free or winning the battle against the disease, indicate the university is on the right path.
While there were logistical challenges presented to each of the women to participate in the trial, Carouba said the effort is worth it.
"People may think it's an inconvenience to travel to San Francisco to receive treatment," said Carouba, "but this is your life at stake. It's not an inconvenience; it's your life."
Wendy Buchanan: Guided by a guardian angel
The Montana native and history major at University of the Pacific served as a teacher at Vinewood Elementary School for 15 years and worked for the Lodi Unified School District for 35 before retiring in May 2010.
Her cancer was discovered in December 2010, after she felt a lump and scheduled a routine mammogram. She had a second mammogram, an ultrasound and a biopsy before receiving confirmation about her illness. She was lined up to have her surgery through Sutter Gould Network, but fate stepped in when she sought a second opinion.
A cataract had recently been removed from Buchanan's right eye by Dr. John Zeiter, and it was during a post-op visit she mentioned her diagnosis.
Zeiter happened to be friends with a top breast cancer surgeon, who was able to get her a referral to UCSF.
"He's my guardian angel," Buchanan said of Zeiter.
Buchanan, with the help of her husband, Don, chronicled her treatment through the website www.caringbridge.org, a patient-support forum.
Her chemotherapy began Dec. 28.
Despite the seriousness of the disease she faced, Buchanan used humor to get her through the trauma. She nicknamed her tumor "the lumpy monster," or "lumpy" for short, and shrugged off the loss of her hair and eyebrows as part of chemotherapy.
She also coined the nickname "awful crap" for chemotherapy drug Anthracycline and Cyclophosphamide — AC for short.
Despite her bright outlook, Buchanan's resolve was tested on several occasions. There were times when she could not receive her chemotherapy treatment because the blood platelets had not recovered from a previous round of therapy.
Her doctor even told her not to floss to prevent excessive bleeding. Her treatments would be delayed until her platelets recovered.
"I'm sick and tired of the chemo side effects. Water tastes like soap, food often has a metallic edge ... and, most importantly, I'm tired of being tired!" Buchanan wrote on March 8. "I WANT MY OLD LIFE BACK."
But even though she had her dark moments, Buchanan was able to pull herself out of the self-described pity parties.
Like other local women in the trial, Buchanan has been declared cancer-free and is finished with her treatment. She raved about UCSF and the clinical trial process, and said she hopes other women suffering from breast cancer can join the future rounds.
"I'm not the least bit sorry I participated," she said. "Even if they couldn't help me, I knew the knowledge gained from my participation could help somebody. I really hope this helps locals know about clinical trials available to them."
Roya Main: Lots of support — and high-protein snacks
Due to her genetic background, Main said she wasn't totally surprised when she was diagnosed with breast cancer last March.
"My mother had breast cancer when she was 55, so I knew I was at risk," she said. "I just didn't expect to get it so young."
Main, 34, had a 3-year-old and 1-year-old at home when she was diagnosed. Immediately her thoughts turned hostile over all the things she would miss — Christmases, birthdays, graduations and weddings — if cancer took her life.
"There was a chance of missing all those things; it was really difficult," she said.
The children's ages turned out to be a blessing.
"My brother pointed out that they're so young they wouldn't even know what was going on," she said. "It barely occurred to them that mommy was sick. I bought a wig when my hair fell out, and we joked about it and they played with the wig."
Although Main was receiving her treatment more than a decade after her mother, the experience helped prepare her for treatment, Main said.
"I had been there through her treatment, so in a way I knew what to expect and I wasn't as scared of the unknowns," she said.
Main's mother now lives with them and was able to help her during treatment. She also received support from her husband, former chief of the Lodi Police Department David Main, who retired from the force to be by her side and recently joined Delta university as its police chief.
Main first discovered a lesion on her right breast as her 1-year-old was getting finished with breast feeding. Thinking little of it, Main reasoned that she had a regularly scheduled doctor's appointment in February and would bring it up then.
Two biopsies, two opinions and several weeks later, Main still wasn't sure if she had cancer and she was starting to get anxious. One doctor said she had cancer, the other diagnosed a pre-cancerous cyst. The one who diagnosed her as having cancer was ready to operate, but Main said something made her slow down.
For years she'd heard about UCSF and knew of it as a high-profile teaching hospital with state-of-the-art practices.
"They have an entire center devoted to breast cancer treatment," she said. "The oncologists, surgeons, it's all they do. The surgeon who originally wanted to do my surgery also does appendectomies and everything else."
She was intrigued by the idea of participating in a clinical trial, too. Being on the ground floor of innovative research would be rewarding because she could be part of something bigger than her individual battle with cancer, she said.
In fact, she found herself momentarily disappointed when she was informed that she was placed in the control group. She would still receive treatment from the college and its highly respected staff; she just wouldn't receive any experimental medicines.
"It was a disappointment, but it was fleeting," she said. "I wanted more than the standard treatment, but more than anything I just wanted to get started."
Her first round of chemotherapy, a drug called Taxol, was easier than she expected. Having mentally prepared herself for the treatment, Main fell into a false sense of security about the next phase.
"The treatments of AC were tough," she said. "The only way I can describe it is the worst morning sickness imaginable."
Although constantly nauseated and fatigued, Main took the advice of the UCSF workers and snacked on foods high in protein like nuts and hummus.
"They said even though you don't feel hungry, you have to eat stuff with substance; you can't just be eating crackers," she said.
Main has finished chemotherapy, is in remission and will have reconstructive surgery in September. She said the efforts of her mother, friends and husband helped her in her fight.
"I really couldn't have asked for a better set of circumstances if I had to get cancer," she said. "I really do feel lucky."
Natalie Hansen: Art, blogging and serendipity
An artist at heart, Hansen used her abilities and family's support to help her battle cancer.
She creates mixed media pieces (bracelets, necklaces, pendants and art prints) as both a creative outlet and coping mechanism.
Prior to being diagnosed, she took soldering and torching classes to hone her skills. Her pieces feature vintage designs and inspirational themes.
"Celebrate life" and "Serendipity" are among the words etched into the necklaces she sells on her website, www.serendipitybynatalie.com, and other online forums.
Serendipity definitely played a role in her cancer diagnosis and treatment, Hansen said.
Had her cancer been properly diagnosed when she first felt something was wrong in September 2008, she wouldn't have been part of the I-SPY 2 trial. Her radiologist was initially suspicious over her lesion but then told her after a test it was nothing to be alarmed about.
Six months later, the issue wasn't resolved and Hansen had another round of tests. Just like her previous appointment, her insurance company would not help her receive a sonogram test.
"They did more images, but I did not feel confident when I left," she said. "After I was diagnosed in April 2010, I thought if they had just done the sonogram in the first place I wouldn't have gone a year like this."
After her diagnosis, Hansen considered just having the tumor removed and enduring chemotherapy, but realized she didn't know what all of her options were.
UCSF was presented to her as an idea from a friend who was also suffering from cancer and receiving treatment at the university.
Even though her insurance plan did not cover treatment at UCSF, Hansen was able to get referred to the university for a consultation.
From there, the pieces fell into place, she said. She had an MRI and found she met the parameters for the trial.
She also learned a shocking bit of news after her MRI.
"The UCSF surgeon was immediately able to say the tumor was twice as big as had previously been diagnosed," she said.
While some patients seek solace in inundating themselves with information regarding their treatments, Hansen preferred to take it one day at a time. She didn't want to look too far ahead and get overwhelmed, she said.
But she still wanted to keep loved ones in the loop, so she chronicled some of her treatment on her blog, nataliehansen.typepad.com.
She bought a "security wig" but never wore it. Instead, she used scarves and hats to cover her head when her hair fell out from chemotherapy.
"I put the wig on, but it didn't look like me," she said. "Looking back, I should've gotten it in a color that wasn't my natural shade so it would've been like a 'new me.'"
Now that her treatment is over, her hair is growing back. While she normally had a bob style to her hair, Hansen said she enjoys the shorter style she is currently sporting.
Sitting at House of Coffees in Lakewood Mall, Hansen reflected on her treatment and how UCSF helped her overcome a deadly disease.
"I never felt like I couldn't totally depend on them," Hansen said. "Having that trust helps clear a huge hurdle in your treatment."
Lana Carouba: 'I knew it was bad'
Carouba vividly remembers the look on her OBGYN's face on Nov. 15, 2010.
"I went to my OBGYN who delivered both my kids, and I could tell something was wrong just by her demeanor," she said. "I hadn't seen her since my last child was born because I always would see an assistant during my checkups; so I knew it was bad."
She was given an ultrasound and mammogram. Minutes after the tests were run, she received a phone call asking her to return the following day for a biopsy. The phone call was a harbinger of things to come, she said.
"When the health care system moves that fast, you know something is wrong," she said.
Frightened and vulnerable, Carouba didn't know where to turn. She had just opened Viola, a gift and souvenir store on South Stockton Street, with her sister shortly before the diagnosis. She didn't want to lose the business but knew she needed to attend to her health.
She asked her OBGYN for her recommendation, and without hesitating, the doctor recommended UCSF, she said.
Carouba received a referral to the university and was starting tests to see if she qualified for the I-SPY 2 trial before the end of the month. But the 11 days until she could get to San Francisco were pure agony, she said.
"Thanksgiving was a blur," she said. "All I could think about was starting treatment. The waiting was the hardest part."
Carouba had plenty of reasons to be worried. She had no history of breast cancer in her family and now had a 5.5-centimeter tumor on her body.
She received 16 rounds of chemotherapy. Although it helped treat her condition, she — like every other woman who received AC — has nothing positive to say about the drug's side effects.
"It's the red devil; it actually eats through your skin if it gets on you," she said. "It brings you down to almost death."
On top of the regular symptoms of chemotherapy, Carouba also described how she'd become forgetful or confused due to "chemo brain."
The attention to detail and care demonstrated by UCSF clinicians helped her feel at ease, she said.
"They make it so smooth. I don't know how they deal with that all day," she said.
Their confidence also brought her peace, she said.
"They aren't arrogant about it, but they've seen everything and they tell you 'We save people and we are going to make you cancer-free for the rest of your life,'" she said.
One of the reason for their confidence, Carouba said, is due to the communication on all levels at the university.
"They have this team they call the tumor board where doctors and oncologists go over each other's cases," she said. "Sharing the information with each other helps them figure out the best treatments."
Carouba was declared cancer-free a month ago.
"Thank God for smart people," she said.
Kathy Martin: A hellish regimen
Originally from Manteca, Martin has lived in Lodi for the past 23 years. She has worked at Erma B. Reese Elementary School for 20 years, and has three grown children and three grandchildren.
During a self-exam in December 2010, Martin found an abnormal growth that concerned her. She had a scheduled doctor's appointment in Lodi in the coming weeks and asked about it then.
She was given a mammogram and biopsy before receiving the results from her gynecologist in February 2011.
While she had the option to have the surgery and reconstruction at the same time, Martin said she wanted someone who dealt exclusively with breasts.
Enter UCSF. An acquaintance of Martin's had gone to the hospital and raved about it, she said. Carouba, whose children attend Reese school, also encouraged her to look at the university, she said.
After getting a referral to UCSF and heading there in early February, Martin found herself in the same trial as Carouba.
She is in the early stages of her treatment and is receiving the gut-wrenching AC treatment.
"Basically, it's a week of hell, a week of recovery and then another round of treatment," she said. "There's no way you could do it daily."
On top of suffering from breast cancer, Martin also recently sustained a spiral fracture in her left ankle. While the pain is manageable, Martin said it has made it harder for her to clean and vacuum, two activities that help give her comfort in a time of stress.
Once her chemotherapy treatment is over, Martin will receive radiation therapy for several weeks. While she could refuse the treatment, she said there is no reason to.
"Radiation is basically insurance," she said. "I already went through hell with chemotherapy; radiation is nothing."
Contact reporter Jordan Guinn at firstname.lastname@example.org.