Sunday, August 1, 2010

Grandpa Shaffer's "Bone Cancer"

I think I have previously mentioned the fact that not much is known about the causes of multiple myeloma, and that most of the usual suspects don't apply to me. I was never exposed (as far as I know) to Agent Orange. I was never employed in the manufacture of herbicides or pesticides. And so on. There is a genetic component, but again, as far as I know, I am the first member of my family to have myeloma. Or am I?

Some senior members of my family are under the impression that my paternal grandfather was killed by "bone cancer". I'm not sure where this notion came from, but it's very suspicious. True bone cancers are exceedingly rare. Most skeletal tumors are caused by cancers that arise elsewhere and then metastasize. But such tumors don't thus magically become "bone cancer"; a skeletal tumor caused by a metastasized breast cancer, for example, is still considered to be a breast cancer tumor.

The situation is even more misleading where multiple myeloma is concerned. Otherwise reliable medical web sites -- even a few sites dedicated solely to multiple myeloma -- sometimes mischaracterize myeloma as a bone cancer, or as a cancer of the bone marrow. But really it is neither. Yes, plasma cells originate in, and are mainly found in, the bone marrow, but they are also transported throughout the body by the lymphatic system. They are considered to be blood cells, not bone marrow cells. Cancers of the leukocytes that are actually considered to be constituents of the bone marrow, and which thus could be considered bone marrow cancers, are called leukemias. But in multiple myeloma, it is the plasma cells that are cancerous -- not the stem cells, and not the leukocytes that eventually become plasma cells. The fact remains that, when multiple myeloma causes tumors, they usually occur in the bones, thus possibly leading the underinformed observer to conclude that the patient has "bone cancer".

So: Did Grandpa Shaffer really have bone cancer? Or was it really some other type of cancer -- was it, say, multiple myeloma? The answer would, or should, be of more than just casual interest to the other members of my family, given the genetic aspect of myeloma.

So recently I undertook to obtain his death certificate from the Division of Vital Records of the Department of Health of the Commonwealth of Pennsylvania. For a fee, it is possible to obtain a copy of such a document; it can be ordered online. But not just anyone can get a copy of just anyone's death certificate. You must fall into one of the categories of individuals having a particular relationship with the deceased; in my case, "direct descendant". And you must have an approved reason for wanting the document; again, in my case, "medical history" was sufficient (but as an aside, mere genealogy isn't a good enough reason -- I have no idea why not).

My copy of the death certificate arrived in the mail a couple of days ago. Ultimate cause of death: "Metastatic Lung Carcinoma". I'm a little disappointed by this, as it sheds no additional light on my own case. But I'm certainly not surprised.

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