Sentinel Node day 9/30/2009

If this post is not completely cogent, it's because I'm still a little woozy from the general anesthesia. Surgery was at 7:30, and thanks to good drugs, I was out before I got to the operating room. Upon waking, I met with my doctor who told me that they had taken 5 lymph nodes. Apparently, the cancer has spread beyond the breast, and into the lymph nodes in the body.

I will be taking "chemo teaching" on Friday, so I can learn the particulars of my treatment plan.
But I do know the drugs I will be taking:
Herceptin:
Cancer cells grow in an uncontrolled fashion. Herceptin works on the surface of the cancer cell by blocking the chemical signals that can stimulate this uncontrolled growth.
Genes are like instruction manuals that tell each cell of our body how to grow, what kind of cell to become, and how to behave. Genes do this by ordering the cell to make special proteins that cause a certain activity -- like cell growth, rest, or repair.
Some cancer cells have abnormalities in genes that tell the cell how much and how fast to grow. Sometimes the cancer cells have too many copies of these genes with abnormalities. When there are too many copies of these genes, doctors refer to it as "overexpression." With some forms of gene overexpression, cancer cells will make too many of the proteins that control cell growth and division, causing the cancer to grow and spread.
Some breast cancer cells make (overexpress) too many copies of a particular gene known as HER2. The HER2 gene makes a protein known as a HER2 receptor. HER2 receptors are like ears, or antennae, on the surface of all cells. These HER2 receptors receive signals that stimulate the cell to grow and multiply. But breast cancer cells with too many HER2 receptors can pick up too many growth signals and so start growing and multiplying too much and too fast. Breast cancer cells that overexpress the HER2 gene are said to be HER2-positive.
Herceptin works by attaching itself to the HER2 receptors on the surface of breast cancer cells and blocking them from receiving growth signals. By blocking the signals, Herceptin can slow or stop the growth of the breast cancer. Herceptin is an example of an immune targeted therapy. In addition to blocking HER2 receptors, Herceptin can also help fight breast cancer by alerting the immune system to destroy cancer cells onto which it is attached.
Herceptin causes flu-like symptoms in about 40% of the people who take it. These symptoms may include:

• fever
• chills
• muscle aches
• nausea

Side effects generally become less severe after the first treatment. Your treatment team will monitor you during your infusions, especially your first dose, and can adjust the infusion if you are very uncomfortable. If you are receiving Herceptin every 3 weeks, you may have stronger side effects. I am getting chemo every 3 weeks, and will take Herceptin every 3 weeks for a year.
Less commonly, Herceptin can damage the heart and its ability to pump blood effectively. This risk has ranged between 5% to 30%. The damage can be mild and result in either no symptoms or signs of mild heart failure, like shortness of breath. Less commonly, the heart damage is bad enough that people experience life-threatening congestive heart failure or a stroke. The risk of heart damage, especially severe damage, is greater when Herceptin is given along with other chemotherapy medicines known to cause heart damage. Adriamycin is an example of a chemotherapy that can cause heart damage.
Women who experience mild or more serious heart damage can stop taking Herceptin and start taking heart-strengthening medications. This often brings heart function back to normal.
Herceptin can rarely cause two possibly related serious reactions that interfere with breathing. One of these is a reaction during or shortly after Herceptin is being administered. This is like a bad allergic reaction, with symptoms that include hives, as well as wheezing and trouble breathing due to sudden swelling and narrowing of the airways. The other reaction, called pulmonarty toxicity, results in swelling of the lung tissue, low blood pressure, and possibly fluid buildup around the lungs (called pleural effusions).
The risk of these life-threatening reactions is rare -- much less than 1%. In most cases, these reactions happen during infusion or within the first 24 hours of the first dose of Herceptin. Less commonly they can happen within a week of the first dose. Only occasionally do these reactions occur with the second or later doses. The lung reaction can be more severe when lung disease, such as asthma or emphysema, already exists, or if the breast cancer has spread significantly into your lungs. If you are currently undergoing treatment with Herceptin and have been tolerating it well, you're unlikely to develop these serious reactions.
Taxotere
Taxotere info here.
Carboplatin
Carboplatin info is here. Sounds like fun, huh?

So that's all I have from here so far. Not to worry. As Alex used to say of me when he was little: I'm "one tough cream puff". And with all of your prayers and support, I'll come through this just fine.
When I know the chemo schedule, I'll post that.

Peace to all!

"So do not fear , for I am with you; be not dismayed, for I am your God.
I will strengthen you and help you; I will uphold you with my righteous hand." Isaiah 41:10

The schedule so far 9/21/2009

Today I had my colonoscopy--thank God for small favors, it was clean except for one very small polyp. All else looked fine.

I just heard from the surgeon's office and after a few more tests, I will have the sentinel node biopsy on the 30th, at which time my chemo port will be installed. Presumably chemo will start shortly thereafter.

The latest news 9/16/2009

We were informed this morning that the plan for treatment will be this: Chemotherapy first, Surgery next, then radiation. Because it is still unclear the nature of the involvement of the affected lymph nodes (are they lymph nodes associated with the breast, or systemic lymph nodes?), I will have a sentinel lymph node biopsy next week. I learned that the lymph nodes that spread out to the body from the armpit are separate from the breast lymph nodes (LN from now on). If the LN affected are body ones, then it is possible that cancer cells have spread to elsewhere in my body. If the nodes affected are breast ones, then it is possible that the cancer is contained there. There is a defined LN where the body type LN start. The biopsy will be on that (the sentinel LN). If the cancer is there, then it will indicate that the cancer may be elsewhere in my body. At least that's my understanding.

Because the tumor is very close to my chest wall, they want to shrink the tumor first with Chemo. Treatment will be through a port installed in my shoulder, once every 3 weeks for 6 treatments. (By my calculations, I should be done around 1/14-Ray's 60th birthday!!) Each treatment lasts 5 hours or so. Then comes surgery 3 weeks later, then radiation. My goal is to be done this mess by July so we can go west for 3-4 weeks. I should be able to work through all this, except for times when I feel reallly bad from the chemo. Fortunately, my work situation is flexible.

The drugs I will be administered are Taxotere, Carboplatin, and Herceptin. They sound so innocuous for the poisons that they are, don't they?

I will probably start chemo in 2 weeks. In the mean time, I will have a bone scan and cardiac echo on Friday.

They gave me a new packet of info on treatment which I was reading in the waiting room for a blood test (the first of many to come). I had reconciled myself to losing my hair (just another hair style to try!!), but I was struck by the text that you lose ALL hair--eyebrows, eyelashes--everything. Holy cow--I'll be one scary sight! Apparently, when my hair comes back in it will be darker, and curlier--another hair style!

The road goes on 9/16/2009

As an easy way to let everyone know what's going on, I will post to this blog regularly. You can get automatic updates by clicking on Follow Blog at the top right of this page, choosing Follow Anonymously, then clicking Follow.

Today Ray and I go this morning to meet with the oncologist to get all the low down on the cancer itself and the treatment protocol we will follow. I'll post later to bring you up to date.

Fingers crossed...