Moving on to Chemo

[paranoidpartner]

I have not written since my partner was making her decision concerning ALND, which has been about a month ( Dec. 11).  She made the decision to have the surgery after the SN came back positive with a 3mm cancer.  Everything went very well with the surgery and P's (my partner) recovery from the surgery.  They took 16 nodes and found 1 positve.  There was NO sign of extracapsillary extension, and though a result of zero  nodes would have been nice, the results did make for a very nice and thankful Christmas.

This leads me to my next paranoia and question...chemotherapy.  We head in to the Onc on the 7th and I was interested in having some background on what is to be expected and perhaps some insight into what has been successful for others.  My partner is 42, premenopausal and adopted.  Her path report is as follows:  1.5 cm tumor upper right quad R breast.  6/9 Nottingham;  tubule formation3/3,  nuclear grade2/3,  mitotic1/3  ER + 90%, PR + 75%.  Her2/Nue-.  As I said, sentinal node + 3mm, one additional node +, no extra capsillar extension.  Lumpectomy revealed Nottingham rade 2/3.  Tubule score = 2 ( approx 50% tubule formation)  pleaomorphism score = 2 (moderate)  mitotic figures = 2 (7 mitotic figures per 10 high power fields)  total score 6/9  PATHOLOGICAL STAGE T1, N1, Mx

Hopefully this will be sufficient for what we can be expecting to hear and even more so, any helpful suggestions that may be out there.

Thank you for your continued support

[darcytwin]

Im done with 3 out of 6 rounds...during my first chemo, my head felt weird..not tingley, just weird...i also had some shortness of breath (mild coughing) and the shortness of breath continues...and basically and out of touch sensation...

first few day are fine, you just feel really really tired...slightly nauseated...day 6-10 are the worst for me...stomach cramps, aches and diarreah...those are due to the neulasta shot...(i know this for sure because i forgot to get my shot this go-round and feel pretty darn good....but now i also caught a cold...not sure if its because i didnt get my neulasta, but next time im not forgetting....i need to stay on schedule....who wants to drag this **** out.....

the worst part is day 4-12 i have THE WORST taste in my mouth.  I dont taste metalic, but it is so bad that i have woken myself up in the middle of the night..my tongue is slightly numb during this time and the only things that i can stomach to eat are things that are salty, sour or spicey hot....anything sweet makes me gag...best foods are plain potatoes (any kind with salt), plain noodles with butter and salt, mexican food (i know, its weird), and spicey asian food....oh and veggies are actually okay tasting too...

i sure hope this helps..i know its better to be prepared...

oh one more thing...she must get her water intake in, and water, at least to me tastes like pond scum...so i add some crystal light raspberry lemonaide or lemon hydration to the water....it is the only way during that bad taste time to get my water intake.....

good luck, xo

[Irishgal2]

Oh that sounds like a nice trip and I am sure one that is well deserved.  She will be delighted.

The bottom line with Chemo is that all the drugs are toxic and very strong and because of this there are a huge number of possible side effects with the drug and even the combination used.  The anti nausea steriod I was put on had limited side effects, none remotely has severe as the chemo drugs.  As you said yourself, the reality is that your partner is going to have chemo.  The internet gives you a good idea of the chemo regimes out there specifically for breast cancer, the drugs used and the possible side effects of each drug.  Gather as much of this information before the appointment and read up on it and then see what the Oncologist says.  This is what I did and his face dropped when he saw the bundle of pages in my hand but fair play to him, he did explain himself well and answered all my questions.  I just wanted to be sure that he was giving me the right treatment.  I also asked the Oncologist at this meeting what anti nausea meds he would be giving me also.  I really got the best available to me in Ireland at the time.  To be honest my Oncologist did not go into the side effects with me, it was left to the Oncology Liaison Nurse and she was very informative for my husband and myself, but again I had done my research.  You can research the main side effects for each drug but to be honest there are a host of other side effects associated with chemo that are not even mentioned.  It is only as they happen and you mention to your Oncology Nurse that you are advised it can be a side effect.  Let me give you some examples:

- tingling in your scalp
- sensitive on your scalp and hair folicles when hair starts falling out
- metallic taste in your mouth
- tingling on your tongue
- sensitive on your tongue

None of them are severe side effects, but little things like the above happen during the chemo regimes.  I always mentioned everything to my Oncology Nurse and she was very good at giving advise how to aleviate or counteract a lot of the side effects.  

Best of luck with the appointment tomorrow and let us know how your partner gets on.

[BhumikaMD]

Hi,

Well the 'what' is very difficult to answer. Several drugs are available and used in patients of breast cancer.

The choice of drugs, whether one drug or multiple drugs and the number of cycles o chemotherapy can only be decided by your oncologist based on your clinical presentation, investigations, the type of cancer and so many other factors.

You would be told the side effects of the medicines being started and when you would need to follow up. You would also be told when to be alarmed of the side effects.

You are normally given antireflux and antinausea medications to counter the nausea and vomiting associated with chemotherapy.

Do let us know what your doctor advises you.
Good luck.

[paranoidpartner]

Thank you all for your return comments.  I guess I should have made myself a little more clear about the chemo.  It is not a question of yes or no, but what.  We already know that chemo is going to take place,  I was just wanting to get some back ground on the number of cycles that should be expected as well as the drugs so I would be able to research the possible effects.  I am now a bit concerned about the steroids used for tha nausia as they too can be harmful.  I will Monday the 7th as that is when we meet with the onc.

Thank you again for your constant support.

PP

P.S .
Irishgal2   We have not yet gone on the Bday trip but have planned one to a mountain resort getaway spot.  All rooms are equiped with fireplaces and various other wonderful ammenities.  We will be going the long holiday weekend - Jan 18-21.  Thanks for remembering, I will be sure to let you know just how wonderful everything goes

[often]

With the postitive node, her age and being pre-menopausal, I would guess that chemo will be advised.  Certainly it is something that should be discussed.  I would want to know what type, how many, known side effects, stats of survival (absolute percentages) with and without.  Side effects vary depending on type of chemo and, of course, the individual's tolerance levels.  I found it to be tolerable, worked through it (but with the understanding of great employers and was able to basically come and go as I needed).  The effects are cumulative and with each session I became more nauseous and more brain fogged. It sucks, the long term side effects of both chemo and rads are not fun, but I don't have regrets.

It is a personal decision that needs to be made after all information is gathered and understood.  Once the decision is made, you can never look back with what if's...so be sure.

[Tricia3]

The decison is for the person who has to live through it and with it.This is early stage breast cancer, grade 2 (moderately aggressive). With a positive node chemo is a good idea. As for how any individual reacts, well... that's wait and see. Lots of precautions may be taken before hand to ensure she stays as healthy as possible. Eg;. neulasta injection 24 hrs after each cycle of chemo. Very clean home and avoid all crowds. Lots of help at home. Personally I quit chemo due to acute toxicity. However this is rare and the only reason I quit was due to extremely negligent care and having absolutely no help at all. All my post chemo labs and care for toxic shock and septic shock were done in another hospital in ER!! Thus I quit all my care at the world class cancer hospital. Had I had any help whatsoever plus MD's who listened and responded appropriately I may have continued.

[Irishgal2]

Happy new year and welcome back.  Did you ever get to go on the surprise birthday trip with your partner?

I live in Ireland and had chemo and radiation.  Below are the reasons why I got chemo.

- Grade 3 tumour
- I was 39 when diagnoised in March and pre-menopausal

I had a lumpectomy and full axilla clearance.  My tumour was 2cm and thankfully no node involvement.  I was ER and PR positive and Her2 negative.

The chemo I was put on was AC Regmine.  It included 4 cycles of two drugs at 21 day intervals.  If I had had any positive nodes, I would have been given TAC Chemo Regime i.e. AC x 4 cycles and then 4 additional cycles of Taxotere or Taxol.

As Liz says, chemo is tough, but doable.  It is hard on everyone concerned.  Like Liz I too took all the treatment options available to me.  I am on Tamoxifen now for 5 years.  I have completed 6 weeks of the drug and the only difference I have noticed is that my mood is a little bit off (mind you, my husband may say something else!).  What is key to chemo is preparing yourself as best you can regarding getting best anti nausea drugs available, a plan of action for when the hair starts to fall out and settling little milestones for herself.  There is no way to predict how your partner will cope with the chemo, it really is a lottery. I was very lucky in that my anti nausea meds worked very well for me, not everyone is so lucky.  I was given the drug EMEND (licenced by Merck Sharp Dohme).  I took the first tablet 1 hour before my chemo and then a tablet at breakfast for the next two days.  On the day of chemo the Oncology nurse gave me Zofron anti nausea injection and also Dextamedrone (anti nausea steriod injection) also before my chemo drugs were injected into me.  Then for the next 3 days I took 4 tablets of Dextamedrone steriods (not sure if I am spelling it right) with breakfast also.  I did have mild nausea for the first 5 days of every cycle but thankfully never got sick or could not eat.  I tended to treat it like a pregnancy morning sickness and ate little but often and this worked for me.

I do wish you and your partner the best of luck during the chemo and do remember that the website is always here for support.

[lizziecee]

Hi - we are fortunate now to have 3 doctors responding to some of the questions posted, and I hope at least one of them will reply to you with an opinion/advice from a physician's perspective.

However, it seems you are also requesting information on patients' experience, and for what it is worth, I would detail my own. My dx was almost similar to your partner's.

I was dx Jan 2003 with a 2 cm invasive ductal carcinoma with associated intermediate grade DCIS,both comedo and cribriform. The tumour was stage and grade 2, ER+ (PR not done) and only some 3 yrs later did I go privately for the HER2 test, which thankfully was negative, a good prognosis. My Nottingham score was 4/4 an there was no vascular invasion.  I was offered either a Wide Local Excision with rads or a mastectomy with no rads.  I opted for the WLE figuring I could always go back for a mastectomy if it was advised.  Chemo was not mentioned at all at that time. When they did the WLE they also did a sample of 8 nodes, as sentinel node biopsy was not available at that time in my hospital in England, although it is now. 3 of the 8 nodes were cancerous. I went back a month later for total axillary resection, and 1 more node was found positive. 18 nodes in total were removed.

This was when chemo was first mentioned and I queried the Oncologist as to why I needed both chemo and rads. His explanation was that rads is localised treatment to the breast to mop up any remaining cancerous cells, and the systemic chemo was to zap any microscopic cells that may have already spread through the lymph nodes to other organs. I had bone,chest and liver scans and all were clear.  The protocol at my breast care centre of excellence is that if the tumour is over 1 cm , with lymph spread, they strongly advise chemo. The FISH test was not done and I am not at all sure any Oncologist in England does this, as it is only a prognostic indicator.

I had 6 x FEC, every 3 weeks, and then 25 rads with 2 boosters. I was started on tamoxifen during radiotherapy but was changed early on to Arimidex as I am post menopausal, and Arimidex has a better chance of non recurrence.  I am lucky in that I don't seem to have any side effects from the Arimidex, although some people do.  The chemo is tough, but doable. I just wanted to think I had done everything possible to prevent a recurrence. Some ladies/men do not opt for chemo, or even rads, and this I respect.

My 5 yrly review, mammo and ultrasound is Jan 8th, and although I have some symptoms of changes in the breast (swelling, aureole white, striation lines etc.) I am hoping this is lymphodema of the breast and not a recurrence.

I hope this has helped. Your partner is indeed very fortunate to have such a caring guy who makes the time to do his research.

Take care both.
liz.