A Change in Plan

Earlier this week, I saw another oncologist for a second opinion – not because I’m unhappy in any way with my current doctor, but because we felt it was the prudent thing to do.

Dr P is the oncology department head at my hospital. He felt quite strongly that my cancer is systemic and felt that the surgery/radiation plan only treated the local tumor and surrounding area.  He pointed out that the tumor is in a lymph node and that it appears there is cancer in surrounding nodes. He was very concerned that there may be micro cancer cells elsewhere in my body that just haven’t started to grow yet.  He recommended starting with chemo (a different combo than last time) followed by surgery and radiation.

It became a difficult decision.  Surgery would get rid of the tumor and quickly treat the existing cancer.  There is no evidence of cancer anywhere else. I was ready to go.

But it is more likely than not that the cancer is in my system.  It will only be detectable when it starts to grow, and once there are tumors outside the localized area, it becomes a much more serious and difficult-to-treat proposition. Starting with surgery will only delay any systemic treatment and since this tumor has been so fast growing, there is a feeling of urgency to nip any stray cells quickly.  The cancer has already proven to chemo resistant, and there is no guarantee that the new chemo cocktail will work.  By leaving the tumor in place, we should see it shrink if the chemo is working, so it should serve as a sort of organic barometer of the effectiveness of the chemo.

The downside of the chemo is that if it doesn’t work, the tumor will continue to grow and there is likely to be some delay to let my body flush the chemo drugs out before surgery. The tumor could become too big to remove. There are the usual possibly nasty side effects to chemo, which this time includes the possibility of internal bleeding, hearing loss, and other unpleasant things.

So I asked my online support group for advice.  I talked to everyone in my family. I weighed and weighed the pros and cons. I talked it over with my oncologist. I prayed a lot and didn’t sleep much. What it finally boiled down to was wanting to pursue the most aggressive treatment possible, and having the ability to know one way or another if this chemo is going to work.

My oncologist came in early this morning to meet with us.  I told her that I wanted to do the chemo first, but we both agreed that the follow on surgery was a concern. So we got my surgeon on the speaker phone and discussed his willingness to do surgery quickly if the chemo doesn’t work.  He seemed open to the idea, so we got right to work on getting the plan together.

Right now, the plan is for me to do 2 three week cycles of chemo, then to have a surgery date scheduled for week seven if the chemo isn’t working.  I think that I will have another PET scan before the surgery. Dr S will monitor the tumor size.  I will be doing Carboplatin/Gemzar/Avastin chemo. The Avastin is a bit controversial, but I reviewed a bunch literature on it and it seems to boost the chemo effectiveness for triple negative breast cancer.

And once the decision was made, Dr S sprang in to action.  She actually ran down to Radiology to try to get me scheduled to have a PICC line put in for the chemo, and came back to say that they could get me in immediately, so off I went to get that taken care of. While I was having that done, she was scrambling to get me into chemo, which she was willing to start today.  Unfortunately, I can’t get in until Tuesday as I need a six hour slot for the initial treatment. I’m also supposed to stay close to the phone in case a slot opens up earlier.

Even though the plan has changed, I’m still moving forward. I’m not looking forward to going back to chemo, but I know that it’s doable.  I don’t want to have cancer, but I’m doing everything I can to fight it. I’m afraid of finding out that this new chemo won’t work, but I’d rather know than not know. I’m grateful for the support of my family and friends and medical team, which has been amazing.

Wish me luck this week, and keep those prayers coming.

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