Recovery is going well. While I’m still sore, I’m gaining more range in my arms which is nice. Sleeping on my back is still painful, but manageable.
I met with my Radiation Oncologist. The appointment went well – they were very punctual which is lovely. The Dr. first interviewed me on my background and situation, reviewed the file and pathology, and then did a physical exam. After that we went to the “conference room” (first Dr. I’ve seen with a conference room) and discussed his recommendation, which is – spoiler – to do radiation starting 11/26 for 6.5 weeks. Here’s my new plan – https://i2.wp.com/www.themammogrammemo.com/wp-content/uploads/2018/11/My-BC-Plan-FULL-1101.jpg
Here’s the details.
- Based on my case he recommends radiation because:
- I am Triple Negative which is aggressive and more likely to relapse
- While I’ve had a good response so far, I am young and I have longer to relapse
- There was residual cancer left (e.g. the chemo didn’t get all the cancer)
- While the margins of removal from the mastectomy were “clean” they were close (.1cm which isn’t much)
- There was some suspicion of the internal mammary chain node involvement and they don’t normally test those during surgery as they are hard to get to in the body
- 5% of people have nodal involvement that isn’t’ show during the surgery
- During surgery they inject you with a dye near the cancer and then see which lymph node the dye goes to. For me it was the one under my left arm. They then biopsy that node during surgery and test it. Mine came back with no cancer but he was saying 5% of people (I think that was the number) drain to a different lymph node than the dye shows
- Studies have shown (overall better survival rates for Post-mastectomy radiotherapy (PMRT) than those who didn’t get it (You had me at better survival rates). Here is the study he gave me https://europepmc.org/abstract/med/17855016
So needless to say, you don’t have to convince me. I’d rather do everything I can to feel more confident we’ve got the cancer.
So what did I learn about radiation:
- About Radiation:
- Success for PMRT = nothing happens so it’s hard to tell if it’s effective
- While neoadjuvant chemo therapy (chemo before surgery) treats the whole body, radiation is a local treatment (similar to the mastectomy)
- I also got a bit more insight from him on why they do the chemo before mastectomy – he was saying chemo will kill cells anywhere in the body so if you do the surgery first you have to wait months to start chemo which means you risk the cancer spreading during that time and secondly if you do it first you can see if the chemo is effective
- Radiation is painless and invisible XRAYS that penetrate bone, skin and tissue. They use high energy XRAYS to damage the DNA in the cancer cells – “Lethal double strand break” – there are two strands of DNA in the cancer cells we need to kill both otherwise the cells can repair one. Since cancer cells rapidly divide they are susceptible to injury with radiation.
- Our evaluation period is 5 years. Let the count down to 5 year cancer free begin.
- Based on my age and great reaction to chemo, he thinks I will do very well with radiation, apparently the machines are built for people my size which makes it easier
- Timing:
- Radiation will be 6.5 weeks (daily) starting after Thanksgiving – I should complete around the second week of January
- Apparently some cancers (not as much with breast cancer) will become more aggressive when they “notice the radiation” so it’s not good to start and then immediately take a break (e.g. holiday)
- We will do a planning session on 11/15. During this they will map my body to create my personalized radiation plan
- You can take 1-2 days off from radiation (e.g. tholidays) and if I need to travel they can do first thing in the morning and then late in the day the next day
- Area of treatment:
- They will treat the breast area including internal lymph nodes and the lymph nodes near my shoulder for 5.5 weeks
- They will then treat my scars for 1 week
- Expander Effects:
- We want to expand before starting radiation (currently have one scheduled for this Wednesday – we’ll put in 100cc’s (going to 350) then hopefully can do one the following Wednesday)
- Since the beam will go over my right breast to hit my left breast, I can only have my right breast expanded to 350ccs until after radiation
- The left breast will most likely be expanded to more than I want, because the skin may tighten, so if they put in extra it should net out. This means I will have two different size boobs for 7 weeks. Luckily I’m great at stuffing my bras.
- Side Effects – Immediate reactions:
- Temporary fatigue
- Skin redness, rash, dry flaking, limited blistering and tanning (he will prescribes a steroid creme which will apparently help with this – he said this works better than other cremes)
- Lowering of blood counts
- Occasional aches or pains in the treatment area
- Temporary hair loss in treatment area (e.g. armpits – unfortunately this is only temporary)
- Side Effects – Late Reactions Common:
- Sensitivity or discomfort in area
- Breast may become firmer, darker in color or smaller
- Mild swelling of breast that can last years
- Side Effects – Uncommon:
- Pleurisy and lung inflammation
- Scarring of the lung under the breast
- Fracture of ribs in 1% of cases
- Inflammation of lining of heart in rare cases
- Increased risk of heart disease – but we reduce this through special breathing
- Apparently when you are at the height of breathing in your heart drops down, so they map your breathing and body, and then only shoot the radiation when you are in that exact position.
Overall, I really like the Radiation Oncologist and want to do everything I can to ensure we got it all. I plan to live for many years to come so this is a no brainer and minor inconvenience.
