How's about a treatment update? Part I

Recently I came across a blog called the big scary 'C' word and realized two things. Number one: I've been a particularly lazy blogger. And number two: I haven't blogged much about what's next in the wacky world of cancer treatment. Namely, radiation and tamoxifen. This fellow blogger does a really good job of writing about both, pop on over to her blog to read up. Go ahead. I'll wait. 

Click HERE to read about radiation and HERE to read about tamoxifen.

Are you done yet? Okay, good. The first thing you may have noticed is that she refers to radiation as radiotherapy. The second thing you may have noticed is that she's British. Which should explain words like tumour and oestrogen. Both of which are driving my spell-check crazy right now.

Since I have been - as she puts it - foot loose and cancer-free since October, the new name of the game is preventing recurrence. Or - as the most recent radiation oncologist we met with calls it - a failure. There are two types of failures we're trying to prevent, local and distant. Local meaning the same breast cancer comes back in the same place, distant meaning the breast cancer pops up somewhere else. Like my bones. Which is apparently a popular spot for breast cancer to wander off. Perhaps cancer cells have sat through too many time share presentations. 

Now if you've been playing along at home, you're probably thinking "After a mastectomy, how can the same cancer come back in the same place?" Good question. All the breast tissue is gone, so where could the cancer come back...right? Right... a mastectomy significantly decreases the risk of local failure, and in turn greatly increases survivability. (Yes, yes MY survivability. Not the cancer's.) But local failure is still possible in the chest wall, the remaining axillary nodes, and internal mammary nodes. And for that we have a few lines of defense. 

Number one is the continued rounds of herceptin infusions I'll receive until next May. Lucky number 11 of 17 is coming up next week. 

Number two is adjuvant hormone therapy in the form of tamoxifen.The current plan is one pill a day for the next five years. But recent studies have found that ten may be more beneficial. Ten years that is, not ten pills. But that doesn't start until we know more about radiation. Which brings us to...

Number three. Radiation therapy. Rob and I met with a second rad onc (Dr. B) on Thursday. At the recommendation of the first rad onc (Dr. G). Dr. B was essentially in the same boat as Dr. G - though she did share with us some new information. New in that I don't recall having heard it before. Which is not to say that's actually the case as it's entirely possible that a few bits and pieces have slid past me in the last 8 months. Speaking of 8 months... tomorrow marks exactly 8 months of this wild ride. Are you all tired yet? 'Cause I sure am. Anyway... staging is the name of the game in the world of radiation oncology. Stage IIb breast cancer patients generally are not recommended for radiation because the potential benefits are not strong enough to out-weigh the potential risks. Stage III breast cancer patients, however, do see a benefit. Simple enough, right? Now what's the difference between IIb and III? Here's where it gets tricky.

Stage IIb involves a tumor between 3 - 5 cm and axillary node disease. Which I - for certain - had. Stage III also involves internal mammary node disease. Which - based on an MRI from April - is possible that I may have had. Because I've had both neoadjuvant chemotherapy and surgery since then, and all of the cancer is gone, there's really no way of telling now if there was mammary node involvement.So Dr. B neither strongly discourages nor encourages radiation. And Rob and I are left to weigh the pros and cons. 

But more on that later. For now, it's bedtime. And physical therapy comes awfully early in the morning. Round number five tomorrow!