Finally I got to meet with my oncologist. Now mind you, this is the second time I’ve been to the Cancer Center in Lewiston. The first time I pretty much “stormed” the building demanding that someone speak to me. I couldn’t understand why I had surgery scheduled, was being told I had to do genetic testing, that I would be doing chemo and radiation and I hadn’t even met my oncologist yet. So I went in to talk to someone, I needed answers! Fortunately the nurses are used to semi-hysterical patients (or so I’m assuming) as they were a very calming, reassuring voice. They were able to explain to me that although it seemed very backwards to do surgery first (including insertion of the chemo port) that if I met with an oncologist before I had surgery, it would be a pretty wasted appointment. The surgery would give them answers which would help direct my treatment. They would know stage and type of my cancer. And until that was known, they couldn’t forge a good path forward. However, the only treatment option for triple-negative breast cancer is surgery and chemotherapy (hence insertion of the port), but the type of chemotherapy and whether or not additional surgery would be needed could be answered by the results from surgery. I also spoke with several other women who have battled (and currently are battling) breast cancer, and it seems like everyone goes this same route. The surgeon, oncologist, nurses and even your family physician are in the background as a team working together. I just wish they would include the player in on their coaching strategy more often (and earlier).
So, enough of that background (and slight rant). I finally got to meet the oncologist, Dr. Morgan, on Tuesday November 14th. He informed me (as did Dr. Jones earlier), that the cancer was only found in the 1.7cm lump. That meant that I was at a stage IA, with type 3 cancer cells. Which is truly the best news we could’ve gotten. I really liked my doctor and feel very confident and comfortable working with him. He did a great job explaining risk/benefit of doing different options. I was all about go big or go home, until he explained that the going big (ie taking 3 different chemo drugs) would only slightly increase the benefit of reducing the odds of the cancer returning but would cause a greater risk of long-term complications from the drugs (heart issues, leukemia, etc). He felt that due to my age and the stage and size of the tumor that if I did a 12 week regime of 2 different chemo drugs that we would have just as great of a benefit then if I did a 5 month regime on 3 different chemo drugs. I always had the option of not doing any for those that are wondering. And my odds of it not returning are at 75% with just the surgery, but it moves in to the 90+ percentile by adding in chemo, and if needed, radiation.
I then asked how would genetic results change the treatment plan. Since I don’t have any children (at least no blood ones), the information they would gain seemed like all it would tell me is I’m more susceptible for cancer (no shit, since I already have cancer). But once again, the doctor was able to bring me off the mountain and explain that if I have the BRCA1 gene (or one of the others), the likelihood of cancer (not just the triple-negative BC) to recur is much higher. And although I essentially lost the cancer lottery by getting the worst type of breast cancer out there, in a way there is a silver lining. Triple-negative is treated by chemo only because there are no receptors on the cancer cells feeding it that can be treated through other medicines. The other types of cancers can be treated through different hormone therapies and drugs but my understanding is those are ones I would have to take for the rest of my life. And since I’m only 45, I would rather not take drugs for the next 45 years (or 55 years). Also, my risk for ovarian cancer is much higher and that is harder to catch early. So I wait to hear back on the results of those tests. If they come back positive we will discuss making me an It and removing all the girl parts. If it doesn’t, then I will look at doing 6 weeks of radiation, every day, once I complete my chemo.
So my first chemo treatment will be November 21st, two days before my birthday and Thanksgiving. I will go back every three weeks for 4 treatment cycles in all. The drugs (for those of you just itching to know so you too can Dr. Google this!) are: Cyclophosphamide and Docataxel (or Taxotere). The C drug will cause the hair to drop out, both will give me a chance at nausea, and the worst part is that I run the risk of gaining weight. Seriously? Having cancer isn’t bad enough, you have to poison my body and I get the added benefit of getting fatter. Thanks cancer! Sheesh, I can’t catch a break. But at least they can give me medicine to offset the nausea (both through IV that they give me at the same time as treatment and pills to take for 2 days following chemo). Plus I will get a shot of Nuelasta to help boost my white blood count since chemo drugs attack everything that is fast growing (hair, nails, lining of your mouth, white blood cells, etc).
So finally I have answers and a better understanding of what is going on and why were doing what we’re doing. The chemo port needed to be put in because the drugs are so toxic that they would destroy my smaller veins, whereas the port allows them to access my carotid artery and get the poison into my heart and dispersed (and diluted by my own blood) to my body faster. So let that sink in, this stuff is so toxic that it would eat through my veins in my arms, hmm.
Off to chemo school!
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