Mr. T : “Cancer Ain’t for No Wimps”

Despite his “tough as nails” exterior, actor and professional wrestler, Mr. T, wants you to know that his cancer journey was the most difficult experience of his life. Last night on Dancing with the Stars, it was “Most Memorable Year” Night, which means that the celebrities dance to a time in their lives that left a lasting impression. For Mr. T, it was 1995, the year he was diagnosed with cancer.

Born Laurence Tero Tureaud, he acquired the nickname “Mr.T” in the mid 1970’s when he became of one of Chicago’s most infamous bouncers. To distinguish himself and build his reputation, he adopted his signature African Mandinka warrior hairstyle and wore piles of gold jewelry around his neck, claiming to have confiscated it from misbehaving customers. This lead to a career as a celebrity bodyguard, protecting stars such as Steve McQueen, Diana Ross and Mohammed Ali.

A chance meeting with Sylvester Stallone lead to his being cast as Clubber Lang, the boxer pitted against Rocky Balboa in Rocky III. This film appearance ultimately led to his best known role as Sgt. Bosco “B.A.” Baracus on the 1980’s drama, The A Team.

In 1995, Mr. T noticed a small sore on his ear. When it didn’t seem to be going away, he sought the opinion of a dermatologist. A biopsy lead to the diagnosis of a rare type of cancer called cutaneous T-cell lymphoma (CTCL, which is also known as mycosis fungoides). As he told Coping with Cancer magazine:

“Can you imagine that?! Cancer with my name on it — personalized cancer.”

As the cancer seemed localized to his ear, Mr. T successfully underwent the recommended four weeks of radiation therapy. However, eleven months later, the cancer returned:

“Cancer sores sprouting up on my body and I can’t stop it! I have no control over this cancer growing outside of my body on my arms, my back, my legs, and my stomach … It is cancer popping like microwave popcorn on my body. I am afraid at this point; no tough guy today.”

Mr. T underwent six weeks of high-dose chemotherapy, followed by interferon-therapy for one and a half years followed by additional low-dose chemo, radiation, then even more chemo as the cancer persisted over several years. In 2001, he was declared “in remission.”

Mr. T returned to acting, playing a number of cameo roles, had a reality show called I Pity the Fool, and even had a show on the DIY network in 2015 called I Pity the Tool.

Mr. T says his greatest lesson has been how to live with cancer. As he told Coping with Cancer’s Susannah Barba: “I pity the fool who just gives up. We all gonna die eventually from something or other, but don’t be a wimp. Put up a good fight. Don’t sit around waiting on death. We can be tough. We can be determined. Go out and have some fun and make death find you! We can be living with cancer, not dying from it. We can be cancer survivors.”

Unfortunately, Mr. T wasn’t a DWTS survivor. He had the lowest score and was eliminated from the competition last night. “I said I couldn’t dance, but I tried.” he quipped after the announcement.

What is cutaneous T-cell lymphoma?

Cutaneous T-cell lymphoma (CTCL) is a group of disorders characterized by the growth of cancerous T lymphocytes in the skin. Mycosis fungoides is the most common form of CTCL. A more aggressive form of CTCL, called Sézary syndrome, involves both the skin along with cancer cells in the blood (leukemia).

Normally, the bone marrow makes blood stem cells (immature cells) that become mature blood stem cells over time. A blood stem cell may become a myeloid stem cell or a lymphoid stem cell. A myeloid stem cell becomes a red blood cell, white blood cell, or platelet. A lymphoid stem cell becomes a lymphoblast and then one of three types of lymphocytes (white blood cells):

• B-cell lymphocytes that make antibodies to help fight infection.
• T-cell lymphocytes that help B-lymphocytes make the antibodies that help fight infection.
• Natural killer cells that attack cancer cells and viruses.

Blood cell formation from differentiation of hematopoietic stem cells in red bone marrow.

What are the signs and symptoms of mycosis fungoides?

A sign of mycosis fungoides is a red rash on the skin.

Mycosis fungoides may go through the following phases:

• Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years. It is hard to diagnose the rash as mycosis fungoides during this phase.
• Patch phase: Thin, reddened, eczema -like rash.
• Plaque phase: Small raised bumps (papules) or hardened lesions on the skin, which may be reddened.
• Tumor phase: Tumors form on the skin. These tumors may develop ulcers and the skin may get infected.

T.Krejsgaard et. al, Nature Publishing. Used with permission.

How is mycosis fungoides (CTCL) diagnosed?

CTCL can be a diagnostic challenge because there are currently no specific “biomarkers” for the disease. The following tests are usually done to help diagnose the disease but they are either non-specific or have limited sensitivity.

• Skin biopsies are viewed under a microscope by a pathologist to check for signs of cancer. However other benign conditions, such as psoriasis and atopic dermatitis, can mimic CTCL.
• Immunophenotyping is a process used to identify cells, based on the types of antigens or markers on the surfaces of cancer cells to compare these with normal cells of the immune system.
• T-cell receptor (TCR) gene rearrangement test checks for the presence of a T cell “clone,” that is a dominant population of cells which is a hallmark of cancer.

Recent discoveries concerning the genetics of CTCL are leading to advances in the diagnosis and treatment of this disease. For example about two thirds of CTCLs display a catastrophic genetic event in which chromosomes of the cells are shattered into many pieces by breaks in their DNA. This event has a technical name, chromothripsis, and it leads to cancer-causing mutations in many genes called oncogenes and tumor suppressors.

How is mycosis fungoides (CTCL) treated?

More specific diagnostic tests that could lead to targeted therapies are under development but not yet available for routine use. Therefore treatment is still somewhat of an art rather than a science and requires a multidisciplinary team of dermatologists, medical oncologists and radiation oncologists. The goals of treatment are relief of symptoms while minimizing side effects.

Many new treatments are under investigation and patients should be encouraged to participate in clinical research trials of these new drugs.

Sources:

• S. National Cancer Institute
• Genetics of Cutaneous T Cell Lymphoma: From Bench to Bedside
• Cutaneous T-Cell Lymphoma: A Review with a Focus on Targeted Agents