Wednesday, October 15, 2008

More News

I saw the oncologist today and got some interesting news....sit down, put your feet up and relax...this is going to be a long post. It includes some good news and some bad news. Here goes...

To make a long story somewhat shorter....I found out today that I will not be able to take the hormone therapy drug Tamoxifen. While I am estrogen/progesterone receptor positive (actually...very positive...100% and 96%), apparently this is not all there is to the story. My oncologist performed a DNA test on me called "CYP2D6" enzyme test. The bottom line is...this DNA test can determine a person's genetic ability to create levels of this enzyme. The more of this enzyme a woman has, the better she can absorb Tamoxifen and convert it...thereby avoiding a relapse of the cancer. About 7-10% of women (I am one of them) are "poor metabolizers" with absent or reduced levels of this enzyme. This means that my risk of a relapse is actually increased. I was very disappointed, however, he did give me some good news too that I think will end up better in the end.
I do have a couple of alternatives to the Tamoxifen. One is called Arimidex. This drug apparently works differently and doesn't require use of the CYP2D6 enzyme. Statistically, this drug has a better success rate (20 to 40% better) at reducing the recurrence rate. However, you can only take this if you are post-menopausal. My dear only 43....I have not begun menopause. In order to take the Arimidex...I have 3 options.

  1. Have radiation on my ovaries to shrink them into nothingness.
  2. Take an injection every 3 months for several years to render my ovaries...dead.
  3. Have them surgically removed.

I was not really prepared for talk of a hysterectomy. I cried the entire drive home. I realize that I'm 43 and Dan is 48. The probability of us conceiving again are decreasing with each birthday. I know too that this journey of cancer, chemotherapy and possibly radiation is also a huge factor in whether or not the blessing of more children are in our future. Did I mention that I'm 43 (will be 44 in January) and Dan is 48? Still, the thought of having something like "cancer" determine God's will is disturbing to me....on so many levels. It just seems unnatural. It just seems unfair and it really, really sucks. My decision needs to be made somewhere between my 3rd and 4th treatment. I'm leaning towards the just seems quicker and less traumatic.

I can't figure out why this is happening. I mean...cancer has taken a breast, it's taken my hair and now I'm going to have to part with my ovaries. What exactly is left that makes me a woman? Please know that I am willing to give it everything, if it means keeping my life. I understand how doing as much as I can to ensure I can be here to watch my children grow up is the ultimate goal. I just didn't expect it to be so hard. I'm not good at surrendering. I usually don't go down without a fight but I must confess, I'm willing to admit when I'm licked.

The oncologist also mentioned that radiation can't be totally ruled out because my tumor was over 3 centimeters in size. He said that he will refer me to a radiation oncologist who will go over all of the films, all of my pathology reports and try to determine if it will be beneficial to me. He said it would depend upon how close the tumor was to the chest wall. More decision making!

The other bit of good news is that since my DNA showed my poor metabolization of this enzyme (which has to do with how your liver processes these chemical compounds), he will have to reduce my dosages of chemotherapy. In other words, my body is not making good use of the dosages he's currently giving me. He said he would reduce them by 20% since my body isn't using that 20% to kill the cancer anyway. I don't know how much of a difference this will make in the severity of the side effects, but, I can only hope that this will make them more tolerable and leave my body quicker. I'll let you know.

One last thing...the oncologist mentioned that since my porta cath is not working at 100% (they can't draw blood from it), it would be of no use to me after my chemo treatments. Therefore, he's suggested that I just have it removed once they're done. Originally he said that I would need to keep it for at least a year after my last treatment. So, I might not have to live with this metal thing in my chest for very much longer.

Well...since I'm sure I've either bored you all to tears or depressed you...I think I'll stop now. I need to try to get to bed as I have to be at the hospital by 7am.

Thank you to all who have been praying and sending positive thoughts my way. I could not live without you. You are so special to me!


Therese said...

I will be continuing to pray. I cannot imagine how difficult the decision about your ovaries is, but I will pray you have peace no matter what you decide.

Having lived with both of my parents' battles with cancer, all I can say is keep the faith. God is leading you through this. Focus on the good news. God bless!

Christie Groth said...

I will most definitely have you close in my prayers. I had to have a hysterectomy due to a rare disease that along with extreme blood loss also brought a gross number of fibroids and caused my uterus to grow my leaps and bounds. While no surgery is easy and a part of me feels like they took my womanhood away, I truly feel so much better now. I have energy I had forgotten existed. I had a very talented dr that was able to do a laparoscopic surgery when everyone else said there was no way and that I also consider a blessing. I have a bad family history of cancer so I totally opted out of synthetic hormone therapy and the only thing I seem to need now is occasionally a rub of Progesterone USP cream and that totally relieves any hot flashes. Other than that, I have had no ill effects whatsoever.
I truly pray you find peace in whatever decision you choose. Blessings and prayers to you and yours!

Therese said...

I am so sorry you are going through this Nancy.

I have no advise for you but I will be praying for you.

Anonymous said...

Wishing you sunshine and roses in the days ahead! Heartfelt prayers being said for you here in TX!