I just got back from meeting with my surgeon and the pharmacist who will be administering my chemo. The regime I’m on is called “AC” which stands for Adriamycin and Cytoxan (the two types of drugs I will be given). We went over all the side effects, etc. and it’s all pretty standard; low blood count, hair loss, nausea and vomiting, poor appetite, etc. My nadir for both these drugs will be 10 – 14 days, which is the low point during my chemo cycle when I experience low blood counts. It will be during this time that I am most prone to infections and when they will be monitoring me the closest. I will be given 5 different types of medicine to control (and hopefully alleviate) my nausea. Those are Emend, Ondansetron, Dexamethasone, Aprepitant and Prochlorperazine. Now, this doesn’t mean much to most (me included), but I’m putting it in here for my sister! As most of you know, she’s in her second year of pharmacy school and so I want her to know what all they are giving me so she can help keep track of the more clinical side of it. :o)
The plan as of now is to still follow the 21 day cycle that was originally set up, however, that very possibly could change. The results of my MRI came back and while we already know that my cancer is dividing and changing very rapidly, the MRI confirmed that it’s doing so at an even faster pace than originally thought. My left breast is still cancer-free; however the tumor in my right breast has grown significantly and has grown some “arms” into the ducts which are acting as additional small tumors. On 9/3/10 when the original biopsy was done, the tumor measured 2.2 x .9 cm in size and the MRI which was done on 9/10/10 showed that the tumor is now 7 cm in diameter. Because of this, Dr. Burt is considering doing a rapid advanced chemo treatment where I would be given the same 4 sessions, but they would be administered every 2 weeks instead of every 21 days. The upside of this would be that they could kill the tumor faster before it has a chance to grow anymore. The downside is that it will be incredibly hard on my body. The typical regeneration cycle for cells is 21 days and by doing the treatments every 10 – 14 my body won’t have a chance to recover between cycles. The most severe of these side effects would be the toll it will take on my bone marrow and white blood cells. To help counteract that, I would receive weekly injections of Neulasta in my stomach. This drug would help regenerate the bone marrow and white blood cells. She said I wouldn’t necessarily notice a difference in my level of nausea or appetite vs. the 21 day cycle, but my hair will obviously fall out quicker and I will be much more tired and lethargic.
My tumor was tested for several things; estrogen receptors, progesterone receptors, HER-2/NEU 4B5 and Ki-67. My scores for the estrogen and progesterone receptors were 100 and 95 with the normal range being between 0 – 5. This is what I explained in my previous post about the tumor being highly hormone related. My score for the HER-2/NEU 4B5 was 1 and the normal range is 0 – 1 so I am really good on that one. A normal range for the Ki-67 is 0 – 10 and mine is 93. What makes the Ki-67 so scary is that typically high levels of it indicate an aggressive tumor and predict a poor prognosis. The risk of recurrence is higher than average and the survival rate is shorter. Because of all this, they have put my cancer at a stage 3 instead of the stage 2 they initially thought I was in. However, since I’m young and healthy, my doctor is confident that that it will respond very well to chemotherapy and that long-term survival is achievable.
Up until now, the plan for my surgery was going to be to remove the tumor unless the genetic test came back positive; however with the results of the MRI, Dr. Balanoff said that I will now have to have a full mastectomy on my right breast. Assuming the genetic test comes back negative, I can still keep my left breast, however I think I may go ahead and have it removed as well since the percentage is so high for a woman my age that it will return (in addition to my high Ki-67 score). They will do the mastectomy on my right breast as soon as my chemo treatments are over but they won’t do the reconstruction until my entire cancer treatment is complete (probably a year to a year and a half from now), so I will wait and have the mastectomy and the reconstruction on my left breast done at the same time as the reconstruction on my right. It will be a long year with no hair and one boob, but hey, I figure lots of girls who are not well-endowed wear padded bras so I will just have to do the same! :o)
I’ve got a cool picture of my cells that I’m going to try to scan and add to this post (it kinda helps to have a visual) but my scanner is not behaving so it may be tomorrow before I can get it attached. Feel free to check back to see the picture, or if you’re reading this after tomorrow then hopefully it’s already here! :o)