The Road to Radiation

Now that my chemo is DONE and my port-a-cath is OUT, it’s time to begin the Road to Radiation.  Silver Lining: this is the LAST part of my treatment regimen. Yippeeee-do!

Why do I have to have radiation, you ask? (Heaven knows I asked!)

Let’s back up for a second. Please allow me to give you an analogy of the relationship between FBC cells (described to me by a Radiation Oncologist):

Imagine being at a ginormous family reunion, the kind were there are great aunts & 3rd cousins – some even once removed (I still don’t really understand what that means).  Ok.  Got the image?  Tons of people, some just barely related.

This is how some of the cells of breast cancer are related – just barely. All of the cells are NOT the same.  Some of the cells are 3rd cousins once removed. Shocker, right?  I have to tell you that I thought one FBC cell was just like the other.  Not the case.

 

Now, onto the treatment explanation.  I was told to think about FBC as a Forest Fire (a description which actually isn’t too far off. I’ve certainly wanted to evacuate my body on one occasion or another since diagnosis!).

In eliminating a forest fire, there are firemen (& women), police, search and rescue, etc. who play specific rolls.

OK, now, let’s tie it all in together.

Because one FBC cell is not like every other, the treatment modalities for FBC are multifaceted, just as they are in eliminating a forest fire.  Surgery, chemotherapy and radiation all serve different rolls.

The purpose of radiation is to decrease my risk that FBC will return in the area in which it began. Because of my young age and the fact that I had lymphovascular invasion (presence of one or more tumor in the lymphatic or vascular structure), my treatment plan warrants a full court press, including the “search and rescue” radiation team.

If I chose not to have radiation, the risk that this FBC will come back (yes, we have to address the big “R” for recurrence) is 20 – 25%. Those are percentages that I am NOT willing to take. If I have the radiation (which I’m going to do), then my risk for recurrence goes down to 5-6%. My preference would be a 0%; however, the lower numbers are so – oh so – much better than the higher numbers!

Wondering how radiation works?  It uses high-energy beams to kill cancer cells by causing the production of “free radicals”. This process changes the DNA of the cancer cells and prevents them from reproducing.  The cancer cells die when they can no longer multiply and the body naturally eliminates them.

The good news is that healthy tissues are spared the effects of radiation because after treatment is over, they can repair the DNA changes unlike the cancer cell.  In addition, normal tissues are shielded as much as possible while targeting the radiation to the cancer site.

 

 

When moving from chemotherapy to radiation, the primary doctor changes from a Medical Oncologist to a Radiation Oncologist (i.e., a cancer doctor who only does radiation).

I have decided to have my treatment done at UCSF (in San Francisco).  I have hired an extraordinary Radiation Oncologist.  The HOTY and I went through the same process in hiring this physician as we have done with all others since this nonsense began.

The reason that I have hired this physician is because she is  data driven.  In other words, her treatments follow research rather than existing protocols.  Some doctors follow research data.  Other doctors follow protocols. Protocols are great.  They are established, trusted medical practices.

However, having spent most of my clinical career in an academic institution, I tend to prefer treatment that is at the forefront of medicine.

The doctor whom I have hired  is at the forefront of research in breast cancer radiation treatment.  What this means for me is that I will intentionally stray from established protocol which suggests having my entire right breast region (the side where there was lymph node involvement) radiated. Rather, I will have more focused and fewer treatments.  This practice follows cutting edge research.

This is Silver Lining news because it means that with fewer treatments, I will have less radiation and therefore fewer side effects.

Now there are plenty of possible side effects:

1. Fatigue (already have plenty of that!)
2. Dryness, irritation and peeling of the skin within the treated area-particularaly under the breast and underarm
3. Increased pigmentation or darkening of skin within the treatment area
4. Temporary hair loss in the radiation field (can’t lose anymore when I’m already bald-bald-bald!)
5. Soreness or slight swelling to the treated breast and/or arm
6. Possible dry cough

I fully anticipate (based on my track record and my medical record that is the width of 3 bricks stacked on top of one another) having one if not all of the side effects.

This is not to say that I have turned a corner and am now gloom and doom.  On the contrary.  By now, you know my philosophy is:

Hope for the best, prepare for the worst.

My radiation oncologist said that, because of my extraordinarily high sensitivity to surgery and chemo, she fully expects me to have all of the side effects and plans to stay all over me to prevent them…and if not prevent, then reduce the intensity of them. How’s that for a Silver Lining? To know that I will be closely monitored and quickly treated gives me a tremendous peace of mind.

Another big arse Silver Lining here is that I do NOT – I repeat:  I do NOT have to have anymore crazy-insomnia inducing steroids.

Additionally, I will NOT – I repeat:  I will NOT have any nausea from radiation.  Those two NON-side effects alone are enough to make me jump – no, leap! – for JOY!

Now this IS radiation. And radiation is NOT good for us in general.  In fact, to even get an x-ray of my teeth I have to wear a leaded vest.  However, if it kills any potential errant FBC cells, then great. Fantastic.  Knowing that I will get the minimum possible to ensure that I am cancer free is also great.

I will have 25 treatments.  Radiation happens 5 days per week:  Monday – Friday for a total of 5 weeks.  The weekend permits the recovery of normal cells between radiation treatments.

On Tuesday, I am going to San Francisco for my preparation and simulation appointment.  I will let you know how it goes and will, of course, give you all of the details upon my return.

Thank you ALL for reading the blog.  For your support. For your encouragement.  For your love.  YOU are a Silver Lining in my life!

Poisons and medicine are oftentimes the same substance given with different intents.

~Peter Mere Latham