Why Chemo?

I'm doing another FAQ post, like the one I did when I was first diagnosed. Next week, I'll start chemotherapy. "Hey wait," you might say, "Didn't you just tell us that your scans are clean? Isn't the cancer gone?"

That crossed my mind, too. So throughout this process, I keep asking questions that can help us understand the reasons behind my treatment.

During my initial meeting with Dr. Cooper (surgeon-extraordinaire), I told him that before feeling this lump and having a mammogram, ultrasound, and biopsy, I was the happiest person around. I asked, "What would happen if I ignored this whole string of events and went on living my normal life?" Now, I won't repeat exactly what he described, but that 2.5 centimeter tumor of cancer cells in my right breast would have made my life miserable pretty quickly. (The charts always say 5-year survival rate, and I'd certainly have been on the wrong end of that one.)

Then I went ahead and had him cut the offending boobie and it's left friend off. He also found some cancer in the right lymph nodes, and they're gone as well. So of course, I had to ask again. "Dr. Cooper. What's my do-nothing prognosis now?" This one wasn't as certain. "Well," he said, "You'd probably pass that 5-year point. And we don't know for sure that the cancer would ever come back. But it probably would. So that's why we're being aggressive with your treatment and sending you to an oncologist."

At that point, we didn't know that the CT scan and bone scan would be clear of cancer. In fact, there could have been another tumor in my body, but there wasn't. We cut out all of the tumors. Yay! Right? So why should I put myself through this chemotherapy poison thing?

The fact is that my body doesn't have any visible tumors, but the odds are that some of the cells from that original tumor escaped into my blood stream and are still there. There's really no way to find out if they're there and where they are. There are these teeny-tiny cancer cells floating around in me. They could do that for a long time. Or my body could fight them on its own (something called apoptosis that my new friend Katie told me about). Or one of them could start dividing and cause a tumor somewhere else (that metastatic thing I mentioned the other day). We have no idea what will happen and when.

But I think you'd all vote with me that we might as well do something about those floating cancer cells. And my choice is to do lots of things. Whatever is out there, I'll do.

Now again, after the clear scans, I posed the, "What's my do-nothing prognosis?" question to the chemo team. Dr. Kirshner printed me my actual survival rate percentages from a site called adjuvantonline.com. (Unfortunately, I'm not a doctor, so I can't get on.) This one talks about the chance of a relapse within ten years. Now, I've got a 31.4% chance that I could do nothing and be cancer free for Maggie's Bat Mitzvah (um...yeah...I don't think she's having one, but that's besides the point). With chemo and hormone therapy (another drug regimen I'll take for five more years after chemo ends), it's up to 70.6% chance of no relapse. And I'm going to throw in some radiation, too, which wasn't on his little printout. Maybe I'll be up in the "chances of being killed by a terrorist" range after that.

During my chemo-teach, I asked Maggie the same question. Though she didn't have the adjuvantonline calculator, she said that she'd track me down at home and drag me in for chemo if I was planning on stopping right now. I wasn't, but just like the reassurance that I'm doing the right thing.

So, what the chemo drugs will do is target the fast-growing cells in my body. These include hair, nails, the lining of the stomach, and the insides of the mouth. Oh yeah, and cancer cells. It's been done for years, and the most effective drugs for my type of breast cancer starts with a combination of adriamycin and cytoxan and is followed by taxol. They're new words to me, too, but I'll know them well soon enough.

Is there a chance that all of this is for nothing? Yes. I could be in that completely cancer-free minority right now. Or I could relapse anyhow. But a bunch nausea and fatigue over the next few months is totally worth the extra percentage points I get from taking my poison.

Let's go, chemo!