Today Nick and I spent 8 hours going to, coming from and surviving doctors appointments. The first half of the day was a visit to the Fertility Preservation Clinic at UCSF. The second appointment was with my Oncologist.
The fertility appointment was a "dream" appointment (as much as anything can be a "dream" under these circumstances). We met with the doctor, he explained how fertility works, how the chemotherapy affects fertility, and what my options are. Then he took us into the exam room to check my ovaries for eggs. This is where the good news comes in. He "conservatively" estimated that I currently have 18 eggs in this cycle. This is an outstanding number and indicates that I am what we refer to as a fertile myrtle. =) This bodes well for my ability to get pregnant the old fashioned way post cancer. But since there is still a risk, Nick and I decided to move forward with the cryogenic freezing of embryos. This means I am now not only a cancer patient, but also an "infertility" patient. I begin my fertility drug regimen tomorrow night which involves me giving myself two shots every night. Then in approximately 10-12 days we will harvest the eggs and they will use intracytoplasmic sperm injection (ICSI) to turn my eggs into embryos. This process means they take one sperm and inject it directly into the egg to ensure fertilization (as opposed to just putting the eggs and sperm into a dish and letting them fertilize the semi old fashioned way). Based on the information we gathered today, the doctor thinks we could have as many as 15 embryos to freeze and ultimately transfer via IVF. That is a really great amount, especially since you really only need a couple for each transfer. We could create our own clan! =)
Then our second appointment was with my oncologist. I feel a little bit like we left with more questions than answers, but I'll tell you what I know. As I previously mentioned, we are starting with chemotherapy. I was under the impression that they wanted to send me to Stanford for a trial, but it is looking less likely that this will happen. I have a decision to make actually. The cancer center that I am working with is hopefully starting a trial of their own in the next 2-3 weeks that I could participate in. This would combine the standard of care for breast cancer along with the trial drug (I'll elaborate on this in a moment). If they do not get it started in time, I will not be able to participate because my doctor does not want to delay my treatment. In this case, we would have to decide between the standard of care on its own, or the Stanford trial, which uses different chemo drugs along with the trial drug.
The standard of care (according to my doctor) is called dose dense chemotherapy. This would involve me receiving two IV drugs once every two weeks for eight weeks (four cycles), and then one different drug once every two weeks for eight weeks (an additional four cycles). All in all this totals 16 weeks of chemotherapy treatment, which should mean I will be done by the end of June or beginning of July. If I participate in the trial the change would be the addition of a drug called a Parp-1 inhibitor, which is apparently extremely effective in cases of Triple Negative cancer (just not currently used and approved for the first line of defense, only for subsequent treatments). Also the second set of treatments would be every week at a lower dose. The Stanford trial uses a different set of drugs than the standard of care. I also am not sure if our health insurance would cover it (Stanford is out of network we believe, and it is "experimental" to boot). My oncologist doesn't seem to have a strong opinion outside of using standard of care (supported by statistics) and the parp-1 inhibitor (cutting edge drug for this type of cancer). So I have some decisions to make if I can't participate in the local trial (which I am really hoping I can at this point).
Once I complete my chemotherapy, I will still have surgery 4-8 weeks later. They are still advising a mastectomy because of the type of cancer that I have. Even if I have an amazing pathological response to the chemo and there is zero cancer left after, there is just too much data showing recurrence of this type of cancer if the tissue isn't removed. My doctor did acknowledge that the data is based on studies with chemo over the last 10-15 years. The drugs are much much better now, so it is possible that the data they are using isn't fully relevant today. I am leaning towards just going with the (single) mastectomy because it really isn't worth the risk. If I had no desire whatsoever to breastfeed even a little with future babies (you only need one breast!) I would probably let them cut them both out and get a nice new pair of tatas. =) But I am not really a believer in surgery for surgery's sake and at this point there is no indication for that.
So there you go! I still have an MRI (to best measure the tumor) and a PET scan (to verify no other cancerous activity anywhere in my body) before we call the diagnostics complete. Slowly but surely the fact finding is winding down and we are approaching action. Thank goodness. As totally exhausted as I was today from all of our appointments, I am grateful to have them out of the way. There will be plenty more to come (especially with the fertility treatments) but we will get there.
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