Last week, Kathy's oncologists made the decision to stop Taxol chemotherapy permanently because Kathy has lost so much function in her hands and feet. Yesterday Kathy had a diagnostic mammogram and breast MRI to evaluate the impact of her treatment on the tumor. We'll now move to the next phase of treatment decision making. Will she benefit from any additional chemotherapy or can we move on to surgery, either lumpectomy or mastectomy?
It's been three weeks since Kathy last received Taxol and sensation is beginning to return to her 4th and 5th fingers. Her thumbs, 2nd and 3rd fingers, and palms are still too numb to feel a pin prick. Taxol affects each patient differently. The degree of numbness, the recovery between treatments, and the amount of permanent disability are highly variable. Kathy's clinicians believe she is among the most sensitive patients to Taxol.
Chemotherapy is not a precise science. There is no controlled trial that suggests 5 cycles of Taxol are insufficient and 9 cycles are perfect. For Kathy, the 5 cycles she received may have given her the best balance of benefit and risk.
Given that chemotherapy was stopped, an objective analysis of the tumor is important. Does she have residual cells or has all 5 centimeters of the tumor disappeared?
Here's her mammography report:
Left breast with two clips, no visible mass, left axilla scar, skin thickening
Impression - resolution of tumor mass since 12/2011
The radiologist reading the study called the result "miraculous"
We'll have an interpretation of her MRI tomorrow.
Our next step is to confer with her care team and decide if there is any benefit to additional chemotherapy, such as a final cycle of Adriamycin/Cytoxan. Kathy's hair is beginning to grow back (described by her as gray/white peach fuzz) and her body is starting to recover from weeks of intravenous poisons. Her liver enzymes were elevated modestly last week, likely due to the Taxol, providing further evidence that chemotherapy drugs are not benign. She'd prefer to close the chemotherapy chapter and move on to surgery as soon as possible. During this entire process, it was not the loss of a breast that was her greatest concern, but the cumulative effect of chemotherapy on her mind, body, and spirit. It would be good to declare the chemotherapy process finished.
In the upcoming days, we'll finalize a go forward plan. It may be that lumpectomy in May followed by radiation this Summer will be our final steps on this journey. More to come!
Thursday, April 26, 2012
Our Cancer Journey Week 19
Posted by John Halamka at 3:00 AM
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Wishing you both strength.
We know it's critical not to jump the gun prematurely, but we sincerely hope your and Kathy's journey down this path comes to a successful end this summer! All the best!
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