Wednesday, May 30, 2007

Called the oncologist

Oh my gosh it's hot here. I'm swollen from the heat - ick. I had rested my elbow on my leg above the knee for 15 or 20 minutes, and there is STILL a depression where my elbow was, 1 1/2 hours later. Oh the joys of living in Southern Ontario.

So I called my oncologist's office today and talked to two of the nurses. Both were named Linda. Ok, that last bit isn't relevant, but it is funny :)

Anyways, they kept asking if I'd had radiation, which got me worried because I don't want to just have radiation - I want to know why my pain is increasing. It ended up that the oncologist decided that we would do bloodwork (which probably means checking my tumour markers), a bone scan, and a referral to a radiation oncologist.

Radiating my sternum is tricky because one of the lesions on my sternum (there are two; one on the left and one on the right - the pain is coming from both of them) is in the radiation field from when I had breast cancer the first time back in 2000. I hope that both lesions can be irradiated, though, because that would make the pain go away. Or at least reduce it.

I'm sure some of you are wondering what could be causing the pain to increase, and what we can tell from the tests. If you don't want to know, stop reading here :)

So. Here are the possibilities:

1. The cancer cells are dying and giving off a last gasp of pain - shown if the tumour markers went down or stayed the same and the bone scan both shows no new bone mets and that the bone mets in my sternum have shrunk.

2. I broke my sternum - like the above, but the bone scan might show extra activity in the sternum. An xray would be needed to confirm this. This is a very unlikely outcome.

3. My sternal mets have progressed (with or without other bone progression) - shows if the tumour markers go up and the bone scan shows bigger/new spots. If there is other bone progression, my current treatment (Femara) has failed and I will probably start a new hormonal.

4. Sternal mets have progressed a little bit or not at all and there is organ involvement - shows if the tumour markers have gone up quite a bit but the bone scan doesn't show much in the way of spots. Additional scans would be needed to confirm this. This is not a likely outcome, either. If this does happen, Femara has failed and I will most likely start chemo.

Realistically, we're probably looking at either the cancer is dying and giving me pain (which means that radiation will do the trick), or the Femara isn't working to control my sternal mets. I don't know what would happen if there were no other bone mets or organ involvement; I'm not sure whether they would start me on a new treatment or not. Apparently people get an average of 9 months on Femara, and I've been on it 7 months now so it wouldn't be surprising if it no longer worked. We call this scenario "treatment failure".

I'm not going to think about what it means for a treatment to stop working.... it's a little scary, really. I know that I will need to get used to this (or at least learn to accept it), because treatment failures are the way things will go. Right now, I have lots and lots of treatments they could do next. Treatment failure is a lot harder to think about when there are no treatments left.

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