Cancer log 115: Chemo’s…

Cancer log 115: Chemo's over, and here's the results. This is a long one.

I admit I went in hoping they'd say, "Hey, we looked at your MRI, and your cancer's all gone! Whoopee!" And then the doctors and nurses and Kevin and I would all go out for sashimi and ice cream.

That didn't happen. But the overall result is still pretty decent. The MRI showed that my tumor, which was originally around 4.1 cm. has, after three months of Herceptin and two months of chemo, shrunk to 1.1 cm. In layman's terms, I'm thinking of this as having gone from stage 2a breast cancer to stage 1a (tumor under 2 cm).

So it's a good result, and the oncologist called it a very favorable response. I don't think my body could have taken a lot more chemo without getting pretty sick, but I do wonder what would have happened if the Herceptin had gone on for another two months. Hopefully they'll try something like that in the next iteration of my clinical trial. (Of course, two more months of an expensive drug is expensive, so maybe they won't. More important would be figuring out if they could get it to this stage with Herceptin without chemo at all; I hope they work on that.)

The next big question she had was a) whether I wanted a mastectomy or a lumpectomy, and if the latter, then b) whether there was enough breast tissue left that she thought she could do the latter, preserving skin and nipple and breast shape. Kevin and I had talked all this over beforehand, and I told her that if it seemed reasonable to her, I'd prefer lumpectomy. (Mostly because I like my nipple, and I'd like to hang onto it if possible. It has served me well over the years. There is nipple-sparing mastectomy, a newer technique, that is sometimes possible, depending on layout of tumor, etc., but clearly, a lumpectomy is a more minimal procedure. I generally think that with surgery, less is more. Or rather, less is better.)

So then she did a breast exam, and confirmed that yes, she thought a lumpectomy was feasible. Whew. I would've done mastectomy if she thought that would be much better for preventing recurrence, and if the cancer comes back, I imagine I'll have a mastectomy then. But not yet.

So that's the plan. In mid-September, four weeks after the last chemo (to lower the risk of excessive bleeding / infection), I'll have surgery, and she'll excise a roughly 4 cm cube of tissue. (It's that large because there were two other spots that were suspicious before, and though she thinks those are free of cancer now, she wants to excise them to confirm.) She'll also remove a few lymph nodes, to examine and confirm the cancer hadn't spread there -- she thinks not, but best to be safe. If the lymph nodes are negative, and if the margins (the areas of healthy tissue around the trouble spots) are clear of cancer cells, then I should be in good shape.

And, in fact, we'd be doing this exact same surgery even if the cancer had, in fact, reduced to zero. So while I'm disappointed not to be rid of the damn thing yet, the result doesn't actually change the course of action overall, so it's mostly just a mental issue, not a physical one. (They used to do surgery first, then chemo -- this new approach of neo-adjuvant chemo to shrink the tumor before surgery seems good to me, in the interest of less extensive surgery.)

Now, is this lumpectomy going to leave me lopsided? Maybe a bit. Any reconstruction, etc. happens later, with the plastic surgeon -- the cancer surgeon's concern is getting rid of the cancer, not aesthetics, which seems fair enough. Apparently insurance covers cancer patients' breast symmetry surgery these days (it's seen as being integral to women's mental health), so if there's a notable discrepancy in size between one breast and the other, and I want to either get an implant to bring one up to size or reduce the other, I can address that at a later date. (A reduction may not be possible, because at this point, the blood flow has already been limited by the original breast reduction I had several years ago (not cancer-related), but we'll figure that out later.)

It seems a little inefficient to have two separate surgeries, but on the other hand, the oncologist surgeon is going to take out what she needs to, send it out to find out what she has, and a week later call me to tell me whether she got it all or if we need to do more surgery, etc., so from that angle, it makes sense to me that you do whatever you need to do to deal with the cancer, and when that's all done, you worry about what the end result looks like.

(At this point in my life, I'm only a little distressed by what my poor battered breasts look like -- between stretch marks, reduction surgery scars, breastfeeding two kids, biopsy scars, gravity, etc., they are not going to win any beauty pageants no matter what the plastic surgeon does. Luckily, the people who see them naked seem to like them regardless. But it'd be nice to have them be symmetrical in clothes. And maybe a little smaller, so I could wear bras even less often than I currently do. We'll see.)

The whole thing was...rough. I had Kevin come with me, and I'm really glad I did -- I didn't quite trust that I'd be calm enough to take in all the information / make good decisions, so talking it over with him beforehand was very helpful, and having him there to check in with during the conversations. But more than that, I was just super-shaky, and on the verge of tears through a lot of it. I think a lot of that was just still feeling a fair bit of chemo exhaustion; my body is shaky. But some of it was pure stress. He held my hand; I leaned against his body at various points (waiting in line, sitting in the exam room), and that physical comfort was immensely comforting and steadying.

And after all that, we went and picked up sashimi and ice cream, which I promptly devoured, and I did feel better.

Chemo is done. Now I get a few weeks of rest and recovery and I am so glad to have a break from medical procedures, I can't tell you -- I really, really need it right now. I feel pummeled. I keep having fantasies of escape -- fleeing to Sri Lanka, or Paris (friends of mine are in both places and have been posting delectable photos), or just a tent in the woods.

But I don't actually have enough energy to put up a tent right now, so instead, I will rest here in my comfortable home. Next week, the semester starts, and I am actually looking forward to thinking about my students and their problems for a bit. On Tuesday, I get to teach Rudyard Kipling and Amal El-Mohtar. It sounds lovely.

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