Chemical marriage

 

As previously mentioned, my mammaprint risk assessment and clinical risk assessment both came back as “high risk for distal recurrence”. I met with my oncologist today to discuss the plan.

Sometime in the next couple of weeks, I will have to have an echo stress test (they will observe my heart working on a treadmill, not just monitor my heart rate). If anything is abnormal with my heart, I will not have the AC/T chemo as it can be dangerous.  If my echo is fine, then I have a choice between doing 8 rounds of AC/T, 4 rounds of TC (as was offered as a “compromise” by another oncologist) or, her new, additional option of 6 rounds of TC, which might be more effective than 4, but would mean more time. 8 rounds of AC/T will take 14 weeks. 4 rounds of TC would take 9 weeks. 6 rounds of TC would take 15 weeks.

If I do no additional treatment, my risk of recurrence is around 29%. If I do chemo, plus endocrine therapy, my risk is something like 9–13%. Radiation drastically reduces my risk of local recurrence (to the breast or lymph nodes), but only affects distal recurrence in the sense that preventing future cancer in my lymph nodes also prevents that recurrent cancer from spreading. However, if I have any micrometastases that have already wandered off to another body part, the radiation will not do anything to prevent that from turning into cancer in the future. So, the chemo and hormone blockers will be doing the heavy lifting on that front.

I will have to have port surgery sometime after my echo stress test but before I can begin chemo. Once the port is placed, chemo can start right away. I’m most likely looking at the middle of January to get started.

I have not yet decided which regimen I’m going to do. As I said, if there are any issues with my echo then the AC/T is not a choice, but then I would still have to decide between 4 or 6 doses of  TC. I have not been able to get a clear picture of how much “better” or “more effective” the AC/T is. I may reach out to the other oncologist to see if he can offer more perspective on this. The TC regimen has a higher risk of permanent hair loss, so that is something to consider, as well. She said that risk would be greatly mitigated if I were to do cold capping, but I’ve already resigned myself to the fact that that’s not practical for us. 

I might be bald, and the forced menopause will age me quickly, and the steroids and hormone therapy will most likely cause weight gain, but my long-term survival odds will improve and… I guess I’ll have a pretty spectacular rack?!

I really hate the idea of poisoning my body and going through all of this when I may not even have any cancer. For all we know, it was all removed during surgery! On the flip side, I hate doing all of this for there to be (up to) a 13% chance that it could come back, anyway!

I will be on a lot of meds. I’ll gain weight, but foods will taste bad. I may have extreme nausea or “digestive distress”… I may get sores in my mouth and nose. My hair will fall out- not only on my head, but all over, and my scalp will be sore. My fingernails and toenails might fall off. I may get random rashes or sores or bone pain or joint pain. One of the major concerns is neuropathy in my hands and feet. I can wear ice socks and mitts (sounds cozy, right?! 😐) but it is still common and it can cause lasting damage. My immune system will be completely wiped out, and I will have to monitor my temperature carefully. 

There’s just a lot of risk associated with both doing treatment and not doing treatment, which is overwhelming. But I am resigned to doing it all. I don’t know which plan, but I will do one of them, for sure.

I’ll let you know if I get any clarification from the other oncologist. Otherwise, my next steps are the echo and the port surgery.