Oncology 101

posted Friday, 15 July 2005

Today was my first visit to an Oncologist. I met with Dr Cairoli, at Fox Chase Virtua Health, in Mt Holly. Annette met me there - thank goodness - as good as I was at navigating Princeton Medical Center, this place was a maze! Hem/Onc is on the 4th floor - I never would have found it. (Now, as hard as it was to find the oncology floor, it was even harder to find a parking spot! Annette told me to just ignore the signs across the street and park in the surgical lot...)
A nurse did my height/weight/bp (lost 3 pounds, which is a miracle, bc the "comfort foods" i've been allowing myself tend to be on the less than healthy side - think: cake, ice cream, doritos, mac & cheese... )
Dr Cairoli and I played 20 questions for a while (he had my records from Dr Dultz, but he wanted a full history as well). Next was a quick exam. According to Dr Cairoli, it appears that I am currently "cancer-free". Good news. He then outlined a brief history of breast cancer treatment, leading up to the current standard of care, which he recommends for me....
• STEP 1: Re-excision of the tumor site, to clear the margins
• STEP 2: Dose Dense AC (Adriamycin + Cytoxan) every 2 wks x 4 cycles (with Neulasta, which is a self-injection administered after chemo, to stimulate white blood cell production)
• STEP 3: Dose DenseTaxol or Taxotere Q 2 wks x 4 cycles (with Neulasta)
• STEP 4: Radiation Therapy (daily, for several weeks, following the chemo)
• STEP 5: Tamoxifen orally x 5 years post chemo (since my tumor was hormone receptive)
Everything sounds like something I can handle... except maybe the self injections. good thing I'm in good with the old "mayhem medic van"...
So it's interesting... basically, chemo works by seeking out rapidly growing cells (of which cancer is one type) and killing them while they divide. It is given in "cycles" because not all cells are dividing at any one time and we want to kill all the cancer cells. your body is given time to recover between cycles, because the cancer cells are not the only cells that chemo attacks. It also attacks your hair follicles, your digestive tract & your bone marrow (which are all fast growing cells)... this also explains the side effects associated with chemo (hair loss, nausea/vomiting & low blood counts/reduced immunity)... I consider myself fortunate that I am not going through this 20... or even 10 years ago... modern medicine is really a wonder. Not only has the treatment improved tremendously (rendering cancer a curable disease) but there are many treatments now that help negate the side effects (neulasta, anti-emetics, etc)
I have to go for one more test - a muga scan (MUltiple Gated Acquisition scan) is a noninvasive test that produces a moving image of the heart, which is used to assess the health of the heart’s major pumping chamber (the left ventricle). Adriamycin can apparently be toxic to the heart muscle, and careful monitoring is required. This will serve as a baseline - and actually there shouldn't be much worry because I am only getting 4 cycles of Adria... it's more of a precaution to make sure my heart is starting out strong (I know my heart is starting out strong. Despite the folks who have tried to break it, it keeps healing and coming back stronger than ever!)
So other than the heart thing, other potential side effects of the chemo include:
• hair loss (he pretty much guaranteed that i would lose my hair... including eyelashes, eyebrows, leg hair....)
• nausea & vomiting (though mostly just with the AC and hopefully controllable)
• fatigue (due to the reduced blood counts... and cumulative over time)
• low blood counts (though countered with the neulasta... could lead to reduced ability to fight infection)
However - Dr C said there are no restrictions on what I can or can not do... if I want to work - great! if I want to go to a crowded movie theater - fine! Travel - ok! So that makes me feel better- my life will not go on hold for this (slow motion, perhaps... but definitely not hold!) I will not let this run my life... it may change things, but I am still in charge.
Links
• MUGA scan http://heartdisease.about.com/cs/otherriskfactors/l/blmuga.htm
• Chemo (in general) http://www.breastcancer.org/tre_sys_chemo_idx.htmlhttp://www.headcovers.com/
• Dose Dense Chemo http://www.cancer.gov/newscenter/pressreleases/dosedense
• Feel free to give me suggestions for my new look (there is one called the "Linda Turban", but they look a little hot (perhaps that can be incorporated into my "fall look") (I also may need a cowboy hat for my trips to Prospectors)