Sunday, November 28, 2010

Neoadjuvant chemotherapy

The usual order of treatment in the cancerland triathlon  is Slash!Poison!Burn!. However, if the tumor is especially large or if distal mets have already occurred, they might do chemo first. This has two advantages: it may shrink the tumor to the point that a lumpectomy could be performed instead of a mastectomy and the sensitivity to a particular regime can be identified. If a particular chemo completely wipes out a tumor, they call it a CPR (complete pathological response) and this bodes well for the patient. If it killed the primary, it probably killed the mets.

This is assuming the mets are the same as the primary tumor. In blogsphere, Kim (of I'm just a little Batty) found herself at the ripe age of 25 at Stage 4. Could you imagine? The tumor was large. They treated her with neoadjuvant chemo and her liver mets shrunk to nothing. Her breast tumor was still there. The primary was Her2- and the mets Her2+. Fortunately for her, the situation was not reversed. She is now about to turn 32 and became pregnant while undergoing treatment. There is not a huge number of babies conceived while the mom   was being treated with Herceptin. Fortunately the baby was fine and is now 13 months.

My gut feeling was get rid of this tumor NOW! before it spreads any further.Since my tumor initially appeared small, neoadjuvant chemo was not even on the table. But then in those 3 weeks, the tumor apparently doubled. I wish they had measured it right before the surgery and maybe I would not have needed a second surgery. According to the Merck Manual, even a 1 cm tumor sheds around a million cells a day into the lymphatic and blood systems. Most of these cells die but all you need is for one to take hold somewhere. But in Susan Love's book, she brings up another scary cancer factoid. It turns out that there seems to a signalling system between the the primary and the distal mets. The primary apparently signals for the mets not to grow so much. But if the primary is removed, these signals stop and the mets blossom. Ugh!

Cold but sunny today. Shanna and the babies came this morning before her and Ramy's trip to Toronto for the medical procedure tomorrow morning. Two nights without babies! A luxury for Shanna.
Later Sunny, Josh and I went for a long walk. Lots of squirrels for Sunny to pursue but not catch. Josh and  Julia had gone to their 10th high school reunion last night. He filled me in on what the kids I knew were up to . Fun.

Turkey matzoh ball soup is on the menu tonight. That will be the last of Turkeyfest.

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