Amongst my multiple questions, I asked my oncologist yesterday why some people have surgery right away and then do chemo, and why others have chemo and then surgery, with radiation mixed somewhere in between. Was it related to research and new learnings, differences of opinions, different types of cancer? We were on the right track with our conclusions.
Enjoying my knitted cap and handmade blanket, given by charities to MD Anderson patients.
MD Anderson is at the top of the research food chain, and they have learned plenty in the past ten years. (Taxol wasn’t even around for breast cancer until around 10 years ago, and Herceptin was only recently discovered for HER2+ breast cancer as well). I’m only focusing on breast cancer, since that’s what I know best. She said they used to think “breast cancer – one treatment.” Now they know there are many different types of breast cancers, and many different chemotherapy regimes that work against each type of disease. Smaller tumors may be removed immediately, while larger tumors need to be shrunk with chemo to make sure the surgeon is able to “get it all.” My tumor was rather large, hence the chemo-first regime.
The downside to immediate surgery for those folks with smaller tumors she explained, “we don’t know if the chemo is working.” Once the tumor is gone, there is no evidence that the cancer shrinks due to chemo. So they shoot blind, so to speak, hoping the chemo does its thing. In my case, we know it is working as the mass has dropped from 9 cm to 4 cm after 12 rounds of Taxol. Dr. Coscio was very pleased with the already noticeable results, as are we!
“How do they know they got it all?” We asked a great question so our doctor proceeded to explain the pathology process after the breast is removed, but stopped herself and asked “do you want to know all this? Maybe it’s too much information?” If you don’t want to know the “gory” details, skip this paragraph. It was interesting enough and I wanted to know, so we nudged her to go on. I admit when I really thought about it later I was a little sad, to think about a part of my body going through the process of being sliced like a loaf of bread and examined under a microscope. The pathologist examines each slice under a microscope to make sure there is a border, so many millimeters thick, around each slice of cancer. If the cancer extends to the border, they have to go back and take some more. At this point she isn’t sure if I still have live cancer cells, so they will determine that as well. She is fairly certain the surgeon will be able to “get it all.”
Tomorrow we start on the next round of chemo. I will continue the Herceptin weekly, and every three weeks starting tomorrow, they will give me four bags of pre-meds to ward off side effects, my bag of Herceptin, and three bags of different chemotherapy drugs lovingly referred to as “FEC.” It stands for the three drugs: Fluorouracil, Epirubicin, and Cyclophosphamide. Apparently it’s low doses of the F and C, with higher doses of the E. They assure me side effects are manageable. I already have my anti-nausea medication ready to go, and I will take it regularly for at least the first three days. I have also taken off work on Friday…just in case. If I’m feeling great, it will be a great day for a motorcycle ride! About 7-10 days after the FEC, platelets drop and so does my immune system, so I have to be careful of catching anything. If I don’t come near you while you are coughing or sneezing, please don’t be offended. Apparently I’ll have about 2 weeks of feeling really good in between FEC treatments.
Now that we are “half-way” through the chemotherapy portion of my treatment (we don’t really count Herceptin, although it is a chemo drug), I want to say thank you to my friends who have stuck with me through this process. Thank you for reading my blog. For commenting. For sending me text messages and FB messages with words of encouragement. For the cards in the mail. And for your prayers, especially. ALL of these things are making me stronger through the process. Again – THANK YOU. We are half-way through this part of my treatment, and there is light ahead.
At times I know I blog some rather uninteresting medical information, which may have lost a few people along the way. (Part of the reason I include so much info is so I can remember, but also to inform). There is a lot of information to process, and since my “chemo brain” is not firing on all pins, writing it down helps me remember. This has been a real learning activity for me. I think I have the facts straight, and then I learn something new and have to correct myself. You have been patient with me. (For example, in the beginning, I thought I would be on Taxol the whole time, and now we are finished with Taxol. I also thought I would be on Herceptin weekly for an entire year.) I learned yesterday that once we finish the FEC, Herceptin drops to once every three weeks. That was HUGE news. Thank you Lord for that piece of information! It gives us hope for a more “normal” life, as we will not be tied to the IVs at MD Anderson every week for the second half of 2013.