Poison or no poison?

When Wednesday hit I was sick to my stomach. I had a bad feeling that wouldn't stop eating away at my mind. What would come of all this? Chemo or no chemo? Or should I say, poison or no poison? I would have to wait yet another day to find out.

Thursday morning soon arrived and I made my way to the hospital with the same crew as last time-- Mom and Mike. As soon as I arrived, I was asked to go to the bloodwork room for some bloodwork. Bloodwork? No one told me I needed bloodwork. I wonder why? I went into the room and sat patiently while someone drew 3 viles of blood from my arm. When this was finished, I went into the waiting room to meet Mom and Mike. I was surprised to see the room FULL of people-- at least a dozen or more people, all cancer patients and their loved ones. Wow, so many people have this disease. I looked around and tried to read their expressions. I finally knew what it was like to be in their shoes. But still ... I was the youngest person (by far) sitting in that room.

After another hour's wait, I was finally called to wait in an examining room for Dr. MacCormick. And, after yet another 30 minute wait, he finally arrived. As one of the least patient people I know, I never thought I could handle this much waiting.

Down to business: That is where I'd like to get and thats where the doctor got as soon as he entered the room: "Well Melanie, let's take a look at what I've got here after endless work this week." He then informed me that Dr. Pritchard hadn't yet got ahold of him with the results from the research panel, but he HAD spoke with more pathologists and cancer specialists in Halifax about my case. The third pathologist, who is specialized in breast cancer, agreed with the second report I got-- this cancer is grade 2. Not an overly agressive cancer, but with the ability to spread. This ability to spread was shown in its movement to the lymphatic space in the breast tissue. I'll explain:

The body is full of lymph channels or vessels that carry fluid to the lymph nodes and then beyond. The lymph vessels in the breast carry lymph fluid to the lymph nodes in the breast and under the arm. My cancer had begun to invade the lymph vessels, but hadn't yet made it to the lymph nodes under the arm. Click here for a diagram. Luckly, the breast was removed, and with it so were those lymph vessels. This then posed a concern not about the cancer spreading, but about the behaviour of the cancer. It told them that the cancer had the ability to spread beyond the breast.

Dr. MacCormick then went on to write on one of his little cards: "There are 2 things that concern me here, Melanie. The first thing is your age. The second thing is this lymphatic space invasion." He went on to explain that my prognosis was still good, but the grade 2 diagnosis with the lymphatic space invasion gave him a little added uneasiness. He said that he, the pathologists, and another specialist in Halifax came to the consensus that chemotherapy should be recommended. He stressed that I was in the 'grey area' here and that these were difficult decisions to make, but he thought it best to err on the side of caution.

This is exactly what I did not want. I did not want someone poisoning my body and ruining my otherwise perfect health just to be cautious. I wanted chemo only if it was necessary ... remember? This is when my questions began. And I came prepared ... surprised? Here are justa few of the questions I asked and the replies I got:

What chemotherapy drug is being recommended and what would the long and short term effects be? The 2 drugs were called Adriamycin and Cytoxin. This is a common combination of chemotherapy drugs, often known as "AC." He said that the most common short term effects I would experience would be hair loss, nausea, fatigue, infection, and sore mouth. The longer term effects were what he and I both were most concerned with. The first and most concerning long-term effect is leukemia. He mentioned that there is a 1 in 1000 chance of developing leukemia from chemotherapy. The second longterm effect is infertility. However, the particular dosage he is interested in giving me would only change my chances of having children from 95%- 85%. The final concern with meis osteoperosis, which mainly concerns him due to my thin body structure. He assured me that the dose I would get would be small, so there would be less of a risk for these longer term side effects for me.

What are the exact numbers for risk of recurence for no therapy, hormonal therapy alone, or a combination of chemo and hormonal therapy? He called a specialist for this answer. The results were: 25% risk with no therapy, 17% risk with just hormonal therapy, and 11-12% risk with hormonal and chemotherapies. He said that if I took the chemo and tamoxifen for 5 years, there would be a 90% chance that I would live my life without ever seeing breast cancer again.

Where, when, and how long would the drug be administered? The drug would be administered for one hour through intravenus every 3 weeks for 4 cycles (so approx. 9 weeks). This would occur in the cancer centre at the hospital in the 'chemo room.' The chemo room is large open room with a number of hospital beds, where cancer patients sit and get chemo. 1 visitor is allowed with each patient. My first chemo would begin next week if I would agree.

I told Dr. MacCormick that I would like to think about this more and decide whether I thought that a 5-6% added benefit was worth all the extra side effects and health risks. He told me that it would be best to book my first chemo and then just cancel if I decided not to go through with it. I agreed to this and he sent me out to see his nurse and arrange the first chemotherapy session.