Medical Update No. 6

We had a meeting with Jen's oncologist today (Tuesday April 21st) to decide on further treatment, building on a meeting last week with the radiation oncologist. In short, the decision is have radiotherapy targeting the primary tumour and the lymph nodes. This will hopefully start next week, and go on five times a week for six weeks. Jen will then have more scans towards the end of June.

The reasoning behind this decision starts with the results of the three scans Jen had in the weeks before Easter (one PET/CT scan and two MRIs). The good news is that there's no tumour activity detected in Jen's liver. This doesn't mean that the cancer has gone from there -- there are almost certainly tumour cells still in the liver, but for the moment they're dormant. It's still likely that at some stage the cancer will again grow there. The primary tumour in Jen's left breast is smaller, and "multifocal" (i.e. not one homogeneous lump) - the scans show necrosis in the middle, but tumour activity around the edges. There are two lymph nodes which show tumour activity, both around 10mm in length - smaller than in the previous scans. All in all, it's a good response to chemotherapy.

I should repeat what I said in a previous message, that all the treatments at this point are "palliative" rather than "curative" - meaning that nothing is going to cure Jen, and the aim is to buy some time by slowing the cancer growth, and to minimize pain and discomfort.

Jen's case was discussed in a "multidiscplinary meeting" before the clinic (without us present), and our impressions are based on the report of Jen's oncologist. The three basic treatment options are surgery, radiotherapy or nothing. The two breast surgeons were "uncomfortable" with the idea of operating, because on the basis of experience they felt it would be very difficult to remove the cancerous tissue around the lymph nodes without affecting nerves etc.

The "do nothing" option would mean waiting and watching until there's an external problem (like the pain in Jen's arm that she had at first) and then treating. It's certainly favoured by some specialists. This approach has the advantage that it avoids unnecessary treatment. However it seems quite likely, given the previous problems, and the size of the primary tumour, that Jen is going to have future problems in that area. The disadvantage of "do nothing" is that the problem is likely to be harder to fix later on - for example, having to fit radiotherapy into a chemotherapy cycle. Also, it's emotionally hard to stop treatment (though of course this has to happen). At this stage we'd rather do everything we can right now.

As the survival of women with metastatic cancer has improved over the last few decades, there is a move to treat it more like a chronic illness, and use more aggressive treatment in the hope of improving quality of life and (in some cases) overall survival. Radiotherapy done now will kill off more of the cancer cells in the primary tumour and the lymph nodes, and reduce the likelihood of Jen having problems in that area later on. The side effects are mainly fatigue and local skin problems, with a lesser chance of swelling in the arms due to fluid in the lymphatic system (lymphadema). The disadvantage is that radiotherapy can't be repeated in this area if there are more problems later on.

The main reassurance from today's meeting was that our oncologist thinks the radiotherapy option is a good idea, and we both want to be as proactive as possible. So now we enter a new phase of treatment, and get to know another specialist. (You know you have cancer when you see more of your specialists than you do of your friends).