A week later . . .
May. 26th, 2006 10:06 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
ar_wahanA week ago this hour, I was lying under a Gamma Ray or something (not an MRI) hoping that the radioactive tracer injected into my boob would find its way to the lymph node nearest the cancer cells in my body.
When I first learned I had cancer, my immediate and illogical thought was, "This is going to destroy our annual vacation on Cape Cod!" Indeed, normally the daily doses of radiation would still be going on during that week in July. (We booked our little house for a week back in January. It was the only week left at the time.) However, Dr. Smith (oh God, why did I just think of Lost in Space?) said I can talk to Dr. Stein, the radiation doctor, about delaying my treatment until we get back. She said studies have shown that delaying radiation up to 16 weeks has no negative effect. This would not be that long. Then I raised a question that had been in my mind before the surgery -- could I start the tamoxifen before I started radiation, just to get its protective effect? She thought that would make sense, although some radiation folks want to do their bit first.
So she wrote out a prescription for tamoxifen right then and there. "Let him in on the fact that you have a prescription, and that if you don't start radiation before your vacation, ask, 'Do you have any substantial objections to me starting this drug before radiation begins?'"
See why I like this woman? :p
As I posted that evening (I think that's when I posted), by the time I was being given anesthesia, it had NOT moved. But thankfully, it went to the lymph node and was happily residing there by the time the surgeon looked for it with a geiger-counter-like device while during a partial mastectomy (lumpectomy). When I woke up, she told me the quick test of the node was negative. Wednesday, I met with the oncologist for the first time. I had heard through the breast cancer grapevine that many women did not like her -- but it was for her manner, not her credentials. One woman, however, liked her very much. I decided to give Dr. Smith a try. I liked her quite a bit. She is not warm and fuzzy, but she has a dry sense of humor that I appreciate, she was respectful, she was not rushed, and she was very clear in her explanations. She had just received the pathology report. It showed no additional invasive cancer in the tissue removed Friday (there was invasive cancer in the biopsy taken last month). There was "spotty" DCIS (cancer confined to the ducts), there were "clear margins" around the edge of the lumpectomied bit 'o me, and best of all, the pathologist said the lymph nodes (more closely studied than during the surgery) were "really negative."
[I have learned that while most women seem to know why this last part is so important, not all do -- and men often do not. A positive lymph node would mean that the cancer cells had spread into my lymph system, and from there could spread throughout my body. This makes it much harder to treat -- and brings with it the curse of chemotherapy.]
She wanted to ask the pathologist to estimate the size of the invasive component. He told her yesterday that it was less than a centimeter -- "delightfully small," in her words.
While the biopsy and the later surgery appear to have removed the invasive cancer and the cancer in situ, it is possible some straggler cells remain. Women like me who don't have radiation therapy have a 30% risk of recurrence of cancer.
So I am going to have six weeks of radiation. Because my particular cancer cells are estrogen positive, I will also take tamoxifen for five years.
Dr. Smith warned me that some women will urge me to consider a newer, different estrogen-blocker, arimidex (and yes, I'm spelling it phonetically -- and yes, women have already urged me in this direction), but it is only useful in women who are 100% menopausal. I am not. She explained the different mechanisms of the two estrogen blockers. Tamoxifen keeps estrogen still in my system away from my cells' receptors by acting as a "blank key" that fits in the "keyhole" (the receptor) of the cell. The other drug helps menopausal women by turning off production of the small amount of estrogen that other parts of their bodies -- not the ovaries, which have gone of out business -- are still making.
Side effects of tamoxifen can be hot flashes and other perimenopausal symptoms. (One of the first questions Dr. Smith asked me was whether I was still having hot flashes ... I am. This told her I was not yet 100% menopausal.)
A really nice side effect is that in post-menopausal women -- which I should be fairly soon, given my menstrual track record over the last two years -- it strengthens bones. I am already at high risk of osteoporosis, based on my build, ethnicity, and family history.
So ... anyway, why no chemotherapy? Because what i'd feared -- 3-4 months of chemo, then radiation, then tamoxifen -- would have very little benefit over just radiation and tamoxifen alone. Any benefit from chemo would be outweighed in my case because it would cause an increased risk of infection ("A huge deal for diabetics," as she said). Chemo can also have a weakening effect on the heart (something I had not known). Diabetics are also already at increased risk for heart disease. And so ... (Drum roll, maestro ...)
"You'd need a much bigger benefit from chemotherapy to make a convincing argument for it."
My reply: "That's exactly what I wanted to hear!"
She logged on to a website oncologists used and we played around with numbers. Remember, as of Wednesday, she had not known the estimated size of the invasive cancer. She knew it was Stage 1, but that can be up to 2 cm. So we went with both worst case and best case. Now that we have an estimated size, she said (yesterday), the best case stats apply. And they say that with radiation and tamoxifen, my odds of being alive and cancer-free ten years from now are 84%.
I have an appointment with the radiation doctor on June 5.
[I have learned that while most women seem to know why this last part is so important, not all do -- and men often do not. A positive lymph node would mean that the cancer cells had spread into my lymph system, and from there could spread throughout my body. This makes it much harder to treat -- and brings with it the curse of chemotherapy.]
She wanted to ask the pathologist to estimate the size of the invasive component. He told her yesterday that it was less than a centimeter -- "delightfully small," in her words.
While the biopsy and the later surgery appear to have removed the invasive cancer and the cancer in situ, it is possible some straggler cells remain. Women like me who don't have radiation therapy have a 30% risk of recurrence of cancer.
So I am going to have six weeks of radiation. Because my particular cancer cells are estrogen positive, I will also take tamoxifen for five years.
Dr. Smith warned me that some women will urge me to consider a newer, different estrogen-blocker, arimidex (and yes, I'm spelling it phonetically -- and yes, women have already urged me in this direction), but it is only useful in women who are 100% menopausal. I am not. She explained the different mechanisms of the two estrogen blockers. Tamoxifen keeps estrogen still in my system away from my cells' receptors by acting as a "blank key" that fits in the "keyhole" (the receptor) of the cell. The other drug helps menopausal women by turning off production of the small amount of estrogen that other parts of their bodies -- not the ovaries, which have gone of out business -- are still making.
Side effects of tamoxifen can be hot flashes and other perimenopausal symptoms. (One of the first questions Dr. Smith asked me was whether I was still having hot flashes ... I am. This told her I was not yet 100% menopausal.)
A really nice side effect is that in post-menopausal women -- which I should be fairly soon, given my menstrual track record over the last two years -- it strengthens bones. I am already at high risk of osteoporosis, based on my build, ethnicity, and family history.
So ... anyway, why no chemotherapy? Because what i'd feared -- 3-4 months of chemo, then radiation, then tamoxifen -- would have very little benefit over just radiation and tamoxifen alone. Any benefit from chemo would be outweighed in my case because it would cause an increased risk of infection ("A huge deal for diabetics," as she said). Chemo can also have a weakening effect on the heart (something I had not known). Diabetics are also already at increased risk for heart disease. And so ... (Drum roll, maestro ...)
"You'd need a much bigger benefit from chemotherapy to make a convincing argument for it."
My reply: "That's exactly what I wanted to hear!"
She logged on to a website oncologists used and we played around with numbers. Remember, as of Wednesday, she had not known the estimated size of the invasive cancer. She knew it was Stage 1, but that can be up to 2 cm. So we went with both worst case and best case. Now that we have an estimated size, she said (yesterday), the best case stats apply. And they say that with radiation and tamoxifen, my odds of being alive and cancer-free ten years from now are 84%.
I have an appointment with the radiation doctor on June 5.
When I first learned I had cancer, my immediate and illogical thought was, "This is going to destroy our annual vacation on Cape Cod!" Indeed, normally the daily doses of radiation would still be going on during that week in July. (We booked our little house for a week back in January. It was the only week left at the time.) However, Dr. Smith (oh God, why did I just think of Lost in Space?) said I can talk to Dr. Stein, the radiation doctor, about delaying my treatment until we get back. She said studies have shown that delaying radiation up to 16 weeks has no negative effect. This would not be that long. Then I raised a question that had been in my mind before the surgery -- could I start the tamoxifen before I started radiation, just to get its protective effect? She thought that would make sense, although some radiation folks want to do their bit first.
So she wrote out a prescription for tamoxifen right then and there. "Let him in on the fact that you have a prescription, and that if you don't start radiation before your vacation, ask, 'Do you have any substantial objections to me starting this drug before radiation begins?'"
See why I like this woman? :p
![[identity profile]](https://www.dreamwidth.org/img/silk/identity/openid.png){kind=small}
no subject
Date: 2006-05-26 04:20 pm (UTC)Thanks for letting us in on the journey.
no subject
Date: 2006-05-26 04:20 pm (UTC)You are much braver than I am - I think I would take a different course of treatment, wisdom or foolishness notwithstanding.
Please take care. My thoughts and concern are with you.
MRI...
Date: 2006-05-26 04:39 pm (UTC)Are you saying you'd go with chemo as well as radiation?
no subject
Date: 2006-05-26 04:45 pm (UTC)no subject
Date: 2006-05-26 06:53 pm (UTC)And yes, I can see why you like this woman: she appears to be unsurprised that patients occasionally think for themselves, and while she doesn't do warm and fluffy much, does do clear-headed and sensible - which makes her a much more valuable resource for those of us who like to think for ourselves.
no subject
Date: 2006-05-26 07:02 pm (UTC)no subject
Date: 2006-05-26 10:07 pm (UTC)Awww, gee.... thanks, my dear!
I just got home from having the damn surgical drain removed, and *I just got to take a SHOWER!!!* (First one since May 18.) *And* shave my right armpit, which I could feel growing bristlier under the bandage every day...
*contented sigh*
no subject
Date: 2006-05-26 10:17 pm (UTC)We think alike...
Date: 2006-05-27 12:43 am (UTC)Now I'm back from taking my kid to a Russian Club concert (she played flute) and we will soon indulge in pizza.... (it cooled off a little on our long drive home.).
She's leaving for an anime convention in Boston tomorrow at 5 a.m. So an early night for both of us.
Re: We think alike...
Date: 2006-05-27 01:09 am (UTC)Re: We think alike...
Date: 2006-05-27 02:16 am (UTC)no subject
Date: 2006-05-27 09:48 am (UTC)Keeping the lymphatic system clear is always a good thing, but especially in your case. Please consider massage/lumphatic draining (which is a simple and painless massage technique), drinking lots of water and fresh fruit and vegs, and some visualization techniques.
I refused chemo/radiation, because they couldn't give me a firm benefit from it. My doctor told me it was "all they knew how to treat my cancer", and that wasn't a good enough reason for me, that they didn't know what else to do.
Glad to hear your doctor is very progressive and yet realistic. You're in good hands :)