Next Steps

Okay. I know what (and when) my next steps are, so it's time for an update!

First of all, my skin is almost completely recovered from radiation. I have one tiny little spot that has a little bit of dry skin left that will probably peel away within the next couple of days. All of the other affected skin has completely healed. I look like I got a very strange and selective tan, but beyond that, my skin is like new. If you're wondering whether radiation leaves any scars, mine did not. Once the dead skin peeled away, I was pretty much left with my normal, albeit slightly tanned, skin.

Anyway, I met with my oncologist again last week, and we discussed once again whether I should get more chemo. This time, we really just kind of went through all the reasons for and against it.

Here are the reasons against getting more chemo:

1. Consensus guidelines are against it (for lack of evidence supporting it more than anything else).
2. My latest staging scans do not show any evidence of cancer (although microscopic cells wouldn't show up anyway).
   
3. There's no way to determine if there is any microscopic cancer cells in my body, so there's no way to determine if I need more chemo.
   
4. Since we can't see any cancer, there's nothing to measure to determine whether the chemo is effective.
   
5. Even if microscopic cancer cells do currently exist in my body, it's possible that I may have already gotten the maximum benefit from chemo that I'm going to get.
6. There's a limit of how much of the chemotheraphy drug (andriamycin) that you can receive before heart damage becomes a risk (although we will be staying well below that threshold).
   

Here are the reasons for getting more chemo:

1. There were still active cancer cells in the breast tissue and lymph nodes that were removed during my mastectomy.
2. Although this has not been proven conclusively, studies seem to indicate there's a chance that people with active cancer in the lymph nodes/breast tissue removed during surgery have a higher likelihood of cancer returning than those people for whom all the cancer cells were dead.
   
3. Inflammatory breast cancer is very aggressive and has a significantly higher risk of returning (or metastasizing) than other types of breast cancer.
4. Microscopic cancer cells wouldn't show up in the staging scans even if I did have it; tumors or cancer cell groupings need to be a certain size before they'll show up in scans. If I do already have cancer cells that have metastasized (spread beyond my lymph nodes), then I don't want to have to wait for them to show up to treat them.
5. If there were live cancer cells in 4 of the 5 lymph nodes that were removed, it's highly likely that some of the remaining lymph nodes (not removed) also had live cancer (although these cancer cells should have been killed off during radiation).
   
6. Some studies have recently shown that 6 rounds of AC (andriamycin and cytoxin) chemo treatment may be more effective than just 4 rounds (and I've only had 4 rounds so far).
7. There doesn't seem to be any "time limit" on when to receive the chemo. Two additional rounds will still have a cumulative effect based on the first four rounds I've already received.
8. I'm young and in good health, so the overall impact of additional chemotherapy is going to be minimal.
9. Given reasons 1-3, I think I will have much greater peace of mind knowing that I did everything I could to make sure I really got rid of the cancer.

Not only do I have more reasons to get chemo than to not, but the last reason kind of says it all for me. I think if I don't do this now, I'll constantly be worried that I didn't do enough... particularly if I ever do have to be treated again. I would constantly wonder if I could have prevented it simply by doing two additional rounds of chemo.

I believe that peace of mind will make a huge difference in my recovery, as well. I really believe that your attitude is a critical part of recovery. If I believe that I've done everything I can do to recover, then my peace of mind will create an environment in my body that is focused on recovery. But, if I'm constantly worried that I'm going to get more cancer, then I'd be creating an environment in my body that is more susceptible to getting cancer again. So, what's two extra sessions of chemo if I can gain that peace of mind?

So, for me, the answer was easy. More chemo. And, I want to be done with it, so I'm starting right away.

My first chemo session will be this Thursday. My last chemo session will be Friday, January 5. I don't have my surgery scheduled yet, but hopefully that will be scheduled by the end of January. Then, I will be able to get onto the next phase of my recovery.

After chemo is done, they'll put me on tamoxifin (or an equivalent) for 5 years. They have to take you off of tamoxifin after 5 years, but some of the newer drugs, they keep you on for 10 years. By the way, those timeframes have another significance in my recovery as well. If I get through 5 years without any cancer recurring, then my chances for survival increase significantly. If I get through 10 years with any recurrence, then my survival chances increase exponentially.

So, that's where I am now. As always, I'll keep you updated as I learn more.