The Monday after Disneyland (March 2nd) started off with a bang. Lindsie had to be at the hospital at 6:15am to have a port surgically inserted under the skin near her left clavicle. The port allows a consistent access to a large vein without the need to poke a new vein each time she needs IV meds, chemo, a blood draw, etc. The port is completely covered by skin, so accessing it still requires a poke, but there is no fishing for a vein. The needle goes through the skin and straight into the port. Additionally, chemo drugs can burn and damage veins. Threading the port into a larger vein means the drugs are diluted more quickly by the blood therefore decreasing the risk of damage. Lindsie handled the procedure like a champ and was home within a few hours.
Post-Surgery
On Tuesday, March 3rd we met Lindsie's medical oncologist, Dr. Bridges, for the first time. This is the doctor that handles chemo.We were expecting Linds to start chemo pretty immediately and we thought this appointment would explain her chemo regimen. However, Dr. Bridges had a different idea.
Earlier that morning Dr. Bridges had presented Lindsie's case to the tumor board. A tumor board is a group of doctors and other specialists (medical oncologists, radiation oncologists, surgeons, pathologists, geneticists, and who knows who else) who determine together the best course of treatment for a particular patient. The oncologists present had unanimously agreed that the best course for Lindsie would not be chemo, at least not immediately, but instead a hormone blockade therapy.
The only catch was that it all depended on Lindsie's HER2 results (see glossary) which still hadn't come back. If the result was HER2 positive she would do chemo. HER2 negative meant the hormone block was the best option. A hormone block is essentially a chemical menopause. Because Lindsie's cancer is ER+ (glossary) it is fed by estrogen. Take away the estrogen and the cells begin to die. The tumors wouldn't be eradicated completely, but they would shrink. The ovaries are shut down by the drug Lupron and then estrogen receptors in the body are shut down by a drug like Tamoxifen or Arimidex. Lindsie would stay on these drugs indefinitely. At some point the body would stop responding to this treatment and chemo would be the next step, but that could be years.
Other points from our meeting with Dr. Bridges:
• Because this cancer is incurable the goals of treatment have shifted. Instead of eradicating the cancer completely the focus becomes shrinking existing tumors, prolonging life, and creating or maintaining a good quality of life.
• Radiation could be used in conjunction with the hormone block. It is used to target specific tumors that are causing pain and shrink them in order to relieve symptoms.
• As the tumors shrink there will be soft areas in the bones where the tumors were. The body will naturally calcify around these places, strengthening the bone and encasing the remaining tumor.
• A shot of Denosumab will be given once a month to promote bone growth.
• Regular PET scans are given to monitor changes.
• Mastectomy may come down the road, but for now the tumors in the breast are the best gauge as to how well the treatment is working so leaving them intact as long as possible is helpful.
Lindsie seemed comfortable with and excited about this possible course of treatment. No hair loss, no chemo sickness or other side effects. Essentially a normal life for as long as the treatment worked... except for all the fun that comes with menopause, but that was going to be a part of the original plan eventually, so this seemed like an easier option. Lindsie didn't want to get her hopes up that she could initially avoid chemo, but it was hard not to.
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