Let’s science the sh!t out of this.
My pathology report came in late on New Year’s Eve. All 3 lymph nodes were negative for cancer (WooHoo!) and the margins were clear (also WooHoo!). This is the best possible report and means that post surgery I am – or should be – cancer free. At least theoretically.
I am a non-Hodgkins Lymphoma survivor. I received radiation to my chest as part of my treatment. This puts me at higher risk for secondary cancer (especially breast cancer) than average. About the same risk as those who have the BRCA gene (I do not have this gene).
My breast cancer is triple negative invasive ductal breast cancer. This means it is negative for estrogen receptors, progesterone receptors, and HER2 (a protein receptor). Negative sounds like a good thing. Cancer is weird. Triple negative breast cancer is rare, harder to treat, and has poorer outcomes. This form of breast cancer is known for its aggressive behavior, as evidenced by the rapid growth of her tumor from 6 millimeters to 12 millimeters within a month. I have a mutation of the BARD1 gene. No one is completely sure what that means for my cancer but they think it is not good.
This means that we are talking about chemotherapy followed by radiation or just radiation. Ugh.
I’m going to be honest. The idea of more chemotherapy fills me with dread. The chemotherapy I had for lymphoma was exceptionally aggressive and it was brutal. While I did not suffer from the nausea that typically accompanies chemotherapy, I suffered from some peripheral neuropathy, crippling fatigue, serious chemo brain (cognitive fog), the loss of every hair on my body, and 2 seizures. I was left exhausted, weak, bald, and with MS. Do I want to do that again? No, I do not.
In our first conversation the oncologist explained that this would be “gentle” chemotherapy. It is a different set of drugs, but I have a hard time believing any chemotherapy is gentle. And I will likely lose my hair. Again. This chemo would be 4 21 day cycles. It would be outpatient – arrive in the morning, get the infusion, go home afterwards. So, 3 months of suck.
The radiation will be very different from my previous radiation. This will be partial breast radiation in 5 consecutive treatments in the prone position so that only breast tissue will receive radiation and all of the other tissue will be spared. This happens after chemo or sooner if I decided not to have the chemo.
Questions…I have so many questions.
If the surgery successfully removed all of the cancer tumor and the lymph nodes demonstrated that it has not spread, why are we even talking about chemo or radiation? The answer lies in what we can see – microscopic cancer cells lurking in the healthy tissue. The chemotherapy is intended to kill any and all microscopic cancer cells wherever they might be. The radiation is meant to kill any microscopic cancer cells that might be nearby the original tumor.
This one is tricky. There are no tests or scans that can show that there are currently any cancer cells anywhere in my body. And there are no tests or scans to show that chemotherapy and radiation were successful in eradicating those potential cancer cells. The only science available are the survival statistics from other patients with the same cancer who had surgery alone versus surgery and chemotherapy. The chemotherapy increases survival rate about 5%.
And then there are the things they can’t answer. Will this chemo make my MS worse? How much of the strength that I have spent the last 5 years building up will be lost? Will I be able to recover it?
I don’t have answers, but I have to decide whether or not to take this poison and hope it kills all the cancer and does not leave me worse off.
What would you do?