The Plan

My first appointment at the Cancer Agency was with the medical oncologist who would be governing my chemotherapy treatment plan. He started off by discussing what we knew and what had happened until this point: how I first got diagnosed, surgery, results, etc. The lump removed was 4.5cm when initially thought it was only 2.2cm and the type of breast cancer I had was called invasive lobular carcinoma.

Ductal carcinoma is the most common type of breast cancer found in about 80% of cases, whereas lobular is the second most common type found in about 10% of cases. The cancer was also estrogen and progesterone positive, but HER2 negative which was a good thing as it was more common and treatable. The concern however was that 3 out of 4 lymph nodes removed tested positive for cancer. He told me there was the possibility of having more surgery to remove additional nodes which the radiation oncologist would discuss with me further.

The oncologist then went over the plan in terms of chemo. Since I was young and healthy, they wanted to put me on the “best of the best” treatment which was also the worst of the worst on the body. I would be on chemo for a course of 16 weeks with each treatment cycle occurring once every 2 weeks (8 treatment cycles in total). It is called Dose Dense because whereas normally they would give the treatment once every 3 weeks, it would be given once every 2 weeks so that the cancer cells don’t have an opportunity to divide. By giving it so frequently, though, the body’s white blood cell count is depleted and cannot replenish itself before the next treatment. In order for my white blood cell count to come back up again, I would require 7 days of subcutaneous Neupogen injections after each treatment cycle. The Neupogen helps stimulate the bone marrow to produce more white blood cells. This stuff isn’t cheap either at $1400 for 7 days’ worth of injections. Thankfully, it would be covered under my extended health benefits; however, there is also a relief program that assists those who don’t have coverage so that they don’t have to pay for this out of pocket.

Chemo would be starting quickly. I was advised that if I couldn’t get into the cancer clinic in Nanaimo right away, we may be looking at doing 1 or 2 cycles in Victoria to get things going as quickly as possible. I was grateful that I could do the treatments in Nanaimo as it would mean less of a commute for me. In the meantime, the oncologist was going to order some further tests including an MRI of my liver and a bone scan to see if the cancer had spread further. The thought of what the results may show made me nervous. I could handle battling breast cancer, but what would I do and how would I react if it had spread? I would also need to get a heart function test done to see how healthy my heart was as one of the chemo drugs could have temporary or permanent damaging effects on the heart. If my heart wasn’t strong enough, I wouldn’t be able to take this particular type of chemo drug.

I was also being referred to a genetic counsellor to determine whether I carried the BRCA1 or BRCA2 gene mutations, two mutations that, if carried, increases a person’s risk of developing breast cancer. In my case since I already had breast cancer, they wanted to see if I carried the gene mutation as I would be at a high risk of breast cancer recurrence and recommendations would likely be put in place for a bilateral mastectomy (removal of both breasts) in order to lower or eliminate that risk. There was also a possibility of having to undergo an oophorectomy (removal of the ovaries) as I would be at an increased risk of ovarian cancer as well. It was a lot to take in, but at this point I was ready to do what I needed to do to get rid of this thing.

I got the call from a clerk at Nanaimo hospital the following day after my appointment with the oncologist with a list of appointments for the following week: check-in appointment with the GP Oncologist on Tuesday at the Cancer Clinic in Nanaimo, heart function test on Wednesday, bloodwork Thursday, chemo on Friday, MRI of the abdomen and liver on Sunday, and then a bone scan in a couple of weeks. I never had so many tests done in my life!  I was grateful though that I could do everything so close to home rather than have to travel the extra distance to Victoria.

Three days later, I went to see the radiation oncologist to discuss the remainder of my treatment plan. She discussed the importance of having more surgery to remove additional lymph nodes as there were concern there could be residual cancer cells in some of the lymph nodes. She explained that studies found that if 2 out of 4 lymph node tested positive for cancer, there was no benefit to additional surgery. However, when 3 out of 4 tested positive for cancer, it was highly recommended to remove additional nodes as a precautionary measure. I already had 4 sentinel nodes removed from below my armpit and this surgery would be to remove the axillary nodes which are located to the right of the breast. The surgery would take place 4-6 weeks after chemo to allow for the chemo drugs to be completely out of my system and for my blood counts to revert back to normal.

I would then be moving onto radiation therapy everyday (Monday to Friday) for four weeks in Victoria at the Cancer Agency. Radiation therapy would entail using high energy external radiation of the lymph nodes and breast to kill any remaining cancer cells. The radiation can cause damage to normal cells including the skin which can suffer sunburn like damage from the rays. It can also cause lung problems, particularly blood clots, so it was important to watch for any redness, swelling or discomfort in my legs while undergoing radiation therapy. Since it would be awhile until the radiation started, my oncologist encouraged me to just focus on one thing at a time and not think too far ahead into the future.

Now onto the next step in my journey, chemo!

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