The P Word

In cancer land, the “p word” also known as progression, is never good. I knew it was coming from the very first day of diagnosis. Progression is inevitable once you’re stage IV. Everyone’s experience is different. Some go years without progression and others only months. We know the cancer is in our bodies, but when and where it is going to show up is a complete mystery.

I had my PET/CT scan on Monday, March 24th. At my last oncology appointment in January, we debated about whether or not to do a scan. My blood work has been good and I haven’t had any unusual aches or pains to cause concern. But, we decided to do the scan and it was a good thing we did.

My oncologist called me (never a good thing!) to give me the results. There is some metabolic uptake on my T11 vertebral body that the radiologist noted as “suspicious.” The problem is, there is nothing that can be seen to biopsy. It probably means that the cancer is starting to grow, but is not big enough to actually show up on a scan or x-ray. That is good and bad. Good, because we have caught it early. Bad, because the question of how to proceed with treatment is sketchy.

We came up with a tentative plan. I will have blood drawn tomorrow to check tumor markers and for anything else that might be suspicious. I will most likely have a baseline MRI so that we can keep an eye on the T11 and watch for changes. That’s the easy part. The next question is whether to change treatment now, or wait until we can actually see the new cancer on a scan.

And that brings us to yet another issue. In order to change treatments, I need to be post-menopausal which I currently am not. So the choices are to go in and get monthly shots to shut down my ovaries or have them removed. I have no plans of using my ovaries so I think the choice is easy. Take them out! But of course that is a surgery, which by all accounts is a fairly simple procedure, but an inconvenience to say the least. I have been mentally wrestling with this decision for a long time, so the one positive is that I can confidently make the choice to have the surgery now.

Currently I take tamoxifen daily. The next drugs in the line of treatment are arimidex or aromasin. Both are aromatase inhibitors. They target estrogen to “starve” the cancer and keep it from growing. They are similar to tamoxifen but work differently. I could go into a detailed explanation, but you would probably be asleep by the 3rd sentence, so I will spare you the details.

I once read an analogy about stage IV breast cancer. It’s like playing “whack a mole.” I fondly remember this game from my many visits to Chuck E. Cheese as a kid. The mole pops up and you whack it with the hammer. Just as quickly as that mole disappears, another one pops up and you whack it back down. This disease is very similar. The cancer shows up, we “whack it” with drugs, radiation, surgery, etc. Then we wait for the next mole to pop up and do the same thing. I don’t know how long I will get to play the game, and, quite honestly, it’s not nearly as much fun as the game at Chuck E. Cheese. But I know I have a lot of whacking left in me. The game is far from over.

Although I am disappointed to be dealing with this, I know I must keep it all in perspective. Two years progression free is considered amazing in cancer land. I am so lucky to have gotten the time I did on tamoxifen. I am also very lucky that the progression was discovered early. Many discover progression through painful injuries or illnesses. I feel really good and am pain free.

I am not sure what the next weeks or months may hold, but I will keep my blog updated so those that want to continue to follow my journey may do so. I posted the news on facebook and I think within an hour had over thirty comments from my wonderful family, friends, and co-workers expressing words of encouragement and love. I am so truly blessed to have so many amazing people pulling for me. You inspire me, give me strength, and remind me that the fight is so worth it!

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