Lots of news, mostly good; 3rd and final treatment plan

Good news - results from the CT and bone scans showed NO signs of cancer spread! Still possible it’s out there as there are more tests outstanding, but this is of course a very encouraging development. I had a sentinel node biopsy of a lymph node today (more on that below) and might still need biopsies of the last 2 Sons of Chucky found in my original MRI, but maybe not. Additional radiologists have been reviewing my MRI films today so I should know about the final recommendation in a day or two.

It’s been a whirlwind of doctor visits all week and the pace will continue next week. However my life will reduce in stress slightly as my last day at work will be Friday March 7th. Subsequently I will be out on disability leave, and I’m not sure exactly when I’ll return. I found it was impossible to be functional mentally at work at the level that my projects and wonderful colleagues deserve when all I could focus on was my diagnosis and the endless tests, procedures, etc. It’s been such an emotional roller coaster, feeling sad, worried, resigned to my fate, determined to kick Chucky's ass, overwhelmed, sad again. I need to allow myself to concentrate solely on healing, and when I have some extra strength, be there for the kids. Luckily Fidelity has a fantastic disability leave policy, so I will be paid most of my salary while I am out. I could not be more grateful to them for treating me so well.

This week began with a visit to a new surgeon, at Mass General, for a second opinion. She was highly recommended by a friend, and is part of a breast cancer specialty group there. She did concur with the plan to do chemo first, but went a step further. She recommended me for a clinical trial they are conducting, which is specific to my type of cancer. The fact that I’m negative for this cancer to react to all 3 hormones is called “triple negative” and occurs in 10-15% of breast cancer. It tends to be more aggressive, which I’ve heard from many sources now. Researchers feel the triple negative breast cancer has similar characteristics to other types of cancer (lung, others) when looked at under the microscope, and hypothesize that it will therefore react well when treated with the chemo drugs that are usually used to treat those other cancers. In stage 1 of the trial, of the 26 women who were given the drug Cisplatin before any other treatments (before surgery or other chemo), the tumor disappeared in 14 of them and shrank in all the rest. Now they are at stage 2 of the trial, in which Cisplatin will be paired with another drug, Avastin, to see if that makes it even better. Neither of the drugs are new, as they’re already in use for other purposes. The surgeon introduced me to the medical oncologist who is actually leading the study, who was rather excited (in a reserved, doctor-y way) to meet me. Enrollment for this study has been open for a year and a half, their goal is 40 patients, and I’ll be #29. I imagine she did a little jig when she was back in her office out of sight. I felt sad about leaving behind my first oncologist, as participating in the study requires treatment at Mass General, but I spoke to her about it that evening and she enthusiastically endorsed the clinical trial plan. She said she would have recommended it herself if she’d been aware of it. She knew about the first round results and has a very high opinion of Cisplatin for my situation. This encouragement made the decision much easier for me. Doing the study does not mean I’ll be taking a risk by not doing the normal treatment. In fact, I will be getting the standard protocol chemo, surgery, AND this bonus round of chemo. That’s right, I’ve gone from dreading chemo to voluntarily signing up for an additional few months of it. Crazy? Yes, but I feel I should do everything I possibly can now to minimize the chances of future recurrence, as I fully intend to live at least 50 years more, and I don’t want to have to go through all this ever again. We’ll throw the book at it, to quote another friend. So it looks like I’ll be spending a good chunk of 2008 bald.

Signing up for the trial has led to a bunch more tests to do, including a brain MRI, heart function tests, another biopsy of Chucky so they have lots of fodder for their microscopes, and hearing test. These will all be next week. Then I’ll start the first round of the trial chemo on March 17th and expect to feel bad for a whole week afterwards. Fortunately my mother will be visiting that week to take care of me.

Today was a sentinel node biopsy, which in the very first treatment plan would have been done as part of the lumpectomy. This is where they inject a radioactive tracer into the breast, see which lymph node it goes to first, and then remove that one to see if the cancer has spread there. The result won’t change the chemo plan, but could change what happens in surgery later, to see if they need to scoop out more lymph nodes or not. Since my other biopsies so far have been done with local anesthesia and while fully awake, I was expecting that again. I was quite surprised when I arrived at the hospital and learned I would have general anesthesia. When I was wheeled into the operating room and told to scoot myself from the wheeled bed to the stationary one, I mentioned to the nurses that on “ER” (the TV show) the staff always carries the patient from one bed to another. They laughed and suggested that I could go to a real ER for that treatment. I shut up, scooted, and breathed deeply into the mask. It was quick, only about 45 minutes to do the surgery, and now I have a sore armpit. We need a week to get those results.

That’s about it, will keep going as more tests happen.

P.S. A lot of people who know a little bit about cancer treatment (far too many of you are in this camp, I’m sad to say) have asked me which chemo drugs I’ll get later. I will look up all the names and share them in a future post with a detailed treatment plan.