Fancy Cancer Drug
After a very long month I can finally announce that the surgery part of my cancer treatment is complete. Pathology results from the second surgery were good. There was no residual cancer in the breast tissue at all. My surgeon removed 31 more lymph nodes (wow!) and there were cancer cells in only 4 of them. These results are what we might have expected after the first surgery. I think I would have been annoyed if they didn't find any other cancer in the lymph nodes; it would have left me wondering whether the more invasive procedure was necessary at all.
My recovery from surgery continues to go well. My surgeon removed the steri-strips yesterday and all of the incisions are healing well. My armpit incision isn't as pretty as it was after the first surgery; since more tissue has been removed the incision looks more prominent than before. All of my incisions are still a little tender and very sensitive. I am finding that by the end of the day even the softest and most comfortable bra becomes irritating and I have to change out of it to get comfortable.
I continue to do my prescribed stretches and my 'snow angels' are getting a little better every day. I will be seeing a physiotherapist soon to help me with mobility and my potential lymphedema. I haven't noticed any issues with swelling in my arm. My upper arm is really tingly, particularly the elbow and the area extending up from there. If I set my elbow down on the arm of a chair or a table it hurts in a weird way. The closest thing I can compare it to painful pins and needles. There is an area on my torso behind my armpit that is completely numb and that is really weird. I was very happy to learn yesterday that I do not have any restrictions on my activity; I can do anything I like as long as it doesn't cause me pain. It's not like I'm planning to start marathon training, but it's good to know that it's up to me to find my limits.
Yesterday we also discussed the timeline for surgery on my other breast to even things out. This won't be happening for a while, but we can start planning for it six months after radiation when I have my first follow-up mammogram. I'm feeling good about this because it will give things time to heal and leave me with more time to think. Even though things are pretty uneven right now it's not glaringly obvious when I've got a bra on, so I'm confident I will be able to live this way happily for quite a while. When I don't have a bra on the asymmetry is comical and after some thought I figured it would be fun to share this picture I took when I was waiting for the doctor this week. My right breast has been transported back to my teen years. ;)
The main consequence of finding residual cancer in my lymph nodes after chemotherapy is that I am at a greater risk of recurrence. This makes me eligible for a change in my immunotherapy, so I started on a different drug at my infusion yesterday. I will be on this new drug for a whole year starting now. My other immunotherapy would have been finished in April, so I'm a little bummed that a few months have been added to my treatment. The new drug is amazing, so I am grateful to have access to it. I'm just processing the fact that I'm going to feel like a patient for longer than I had hoped.
As an aside, I arrived at my regular immunotherapy appointment yesterday expecting it would be about an hour long but it was actually THREE hours long. They had to give me the new drug slowly (90 minute infusion instead of 30) then keep me under observation for an hour to make sure I didn't have a reaction. This kept me there through lunchtime, so I was treated to a chemo suite feast of saltless saltines, a slice of cheese, 2 digestive cookies, and a small apple juice. Lucky me!
The immunotherapy I was originally prescribed is called trastuzumab (brand name is Herceptin). It's what is called an antibody and is able to bind (stick to) and block the HER2 receptors that are on the outside of my cancer cells. In the picture below, the drug would be the 'Y-shaped' red thing. When it sticks to the cancer cell it slows down its growth and its ability to reproduce. My new drug is similar to that one with an added extra feature. The drug is called trastuzumab emtansine. The 'emtansine' is an extra molecule that is attached to the the antibody. The extra molecule is a chemotherapy drug. It prevents the cell from reproducing and kills it. So, my fancy new drug is basically chemotherapy that is being delivered directly to my cancer cells. Pretty awesome. There are other cells in the body that have HER2 receptors so some healthy cells will also be damaged by this drug, but the side effects are very minimal compared to other chemotherapy. My blood will be tested before every treatment to make sure my levels are all normal. There is a chance of having lower white blood cell counts so I am back in the position where I need to go to the hospital if I ever get a fever. My liver function will also be watched closely while I'm on this drug as it sometimes causes liver problems. This means I need to take good care of my liver. I guess I'll be avoiding some alcohol calories for the next year!
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