Wednesday, April 29, 2020

After the mastectomy - radiation? more chemo?

It's been 2 months since my double mastectomy. For the last couple of weeks I've felt like I am in limbo waiting for the next part of treatment. My oncologist recommended getting a second opinion from a doctor at Dana Farber about what followup chemo would be needed since I didn't have a pathological complete response. In Boston, they requested my slides (actual slices of my tissue/tumors) so they could examine the slides themselves, but they got lost on the way and it took at least a couple of weeks to receive and examine them. When I got the second opinion, the doctor clearly said that she can only give a recommendation for chemo, but is not sure if I need radiation. Back at home, it seemed like nobody could tell me either - my surgeon said to ask my oncologist, and my oncologist said she'd have to talk to the radiation doctor and surgeon. I started getting nervous that it was taking so long to get to the next step of treatment, but I also was grateful to have a little more time before I had to go into doctors offices in the COVID-19 era!

Anyway, I finally had a call with the radiation doctor today, and he said he would NOT recommend radiation for me. I did have some cells at the deep margin for one of my tumors, so technically my margin was positive. But when he talked to the surgeon, she was confident that she removed breast tissue all the way to the fascia (tissue between breast and chest wall muscles), so radiation would not be needed. He also expressed that radiation is a tradeoff, and since I am relatively young, he would be worried about the risk of secondary malignancy (cancer caused by the radiation) over a longer time outweighing the benefit of doing any radiation in this case.

So that's good news to not need radiation, but it also means I'll be jumping into more chemo soon - Xeloda. Normally this is a drug used for stage 4 cancer, but it performed well in a clinical trial for triple negative adjuvant chemo. Since a tiny bit of my residual cancer was HER2+, I'll also get Herceptin every 3 weeks through IV. Xeloda is a pill you take twice a day for two weeks, then have a week off. I'm nervous about the hit on my immune system with COVID-19 around, but of course I want to do anything I can to fight cancer! And at least I won't have to go into the doctor's office weekly for infusions.

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