Our Chosen Path - To Radiate or Not to Radiate

Yesterday I met with my radiation oncologist, Dr. Kang, along with my regular oncologist Dr. O'Brien. As promised, Dr. Kang contacted other colleagues and professionals in his field getting their input on if I was indeed a good candidate for radiation therapy. We had a good talk yesterday about how confident I felt about the cancer being fully removed during surgery due to the chemotherapy giving an opportunity for such clear margins, as well as the pros and cons of using radiation as a therapy for me. Leading up to most appointments, I have always had a clear vision of what I am hoping for or what direction I would like things to go. This was honestly the first time I can remember that I didn't really know what to hope for. Given the conversation from last week, it was clear to me that either path -to radiate or not to radiate- had its own set of risks. Either direction required a leap of faith on my part. While I am a devote Christian, I must admit that doing those leaps of faith is a struggle for me. I am a bit of a control freak , and like to plan to the best of my ability the best path for the future I want. I know that God will always prevail, but there is just something about me that requires an active role in the decision process. In this scenario however, there was no clear "winner" in my mind of how this should play out.

Dr. Kang said that his colleagues, as well as himself, could make a case for going either direction. It was really a 50/50 decision. While a good part of me knows that statistics are just that...only statistics and not a guarantee, it was mind-boggling to feel like I was playing a bit of a "roll of the dice game" with my life. One side *could* bring a higher risk of cancer recurrence, the other side *could* bring on a risk of cancer just by trying to prevent recurrence. This may seem extreme, but whenever he was presenting facts about what statisically can happen in 20 years with either scenario, part of my brain was occupied with flash forwards of all the life I wanted to live. I have a husband I want to grow old with, kids I want to watch take the next important steps in life, and I want to be healthy enough to play with my grandkids in 20 years. How could I know which path I should choose when there was no crystal ball to look in to learn the outcome? He asked how I felt about the facts that were presented, and I really didn't know what direction to go. I decided to turn it back to him and said, "If this was one of your loved ones you were treating, how would you proceed?" He said that given the risks of radiation effects and my age, and based on how confident they were with the margins they got during surgery, he would opt for no radiation. I looked at Dr. O'Brien, who has been just the right amount of cautious and aggressive along the way during my treatments, and she concurred. They both agreed that I would be closely monitored with MRIs and check ups, as well as starting with 5 year hormone treatment, Tamoxifen, to block the estrogen that fed my cancer. And with that, the decision had been made.

There are very real benefits to this option. I get to be done with treatments a lot sooner than expected. After just a couple more tissue expansions, I can go in for reconstructive surgery and be on my way to the "new normal". I am excited about that, but just needed some time to wrap my mind around the change in the path I had been planning to take since diagnosis. I feel good about it as of today. I would be lying if I said there wasn't a little voice of anxiety in there wondering if this was the "right" choice. But honestly, that would be there regardless of which way we decided to proceed. It's the voice of the unknown. But for now, I have taken the leap of faith and it's in God's hands. Knowing He holds the key to the future is a good place to be.

"Do not be anxious about anything, but in everything, by prayer and petition, with Thanksgiving present your requests to God." Phillipians 4:6

Gray is not a color I want to be...

I am approaching the end of my tissue expansion process in the next week or two. Last week's expansion brought the first bout of pain that I had to endure since the process started. I found I had to carefully manuever my left arm so that I guarded my muscle as much as possible. When I moved just the right way it would send a sharp pain from my breast all the way around to my back area. I took ibuprofen for a couple of days, and by early Friday I was doing much better. Dr. Burgess said this is to be expected as when the expanders get fuller and fuller, they will obviously put more pressure on my pectoral muscle, which is already in a weakened state from the tumor being there. She only had to put 50cc's in each breast this week vs. the 100 we had been doing, since I am getting close to the end of the weekly "fill ups".

The original plan was be done with that part, and then move directly into radiation. However, we met with my radiation oncologist yesterday (Dr. Kang) and he is not certain he wants to proceed with radiation. It turns out that I am in sort of gray area. Usually radiation is required when the tumor is over 5cm, mine was 4. And then the additional factor is if it went into the lymph nodes, which mine did not. Radiation carries certain risks with it, and can cause cancer on its own. Statitics show that usually by 20 years post-radiation that cancer is a real risk. In patients that are 60 or 70, this isn't as much of a factor in deciding whether they should proceed with radiation given that supposedly at that age, a person would usually live to their life expectancy by the time radiation risks would kick in anyway. However, since I am only 40, the radiation risks are, as he puts it, "very real". So, he said he is left in sort of a gray area of what to do with me. Since my cancer was in the muscle, the preference would be to radiate to really make ultra sure not even a single cancer cell remains. Being in the muscle, it is much harder for them to do tests to rule out any suspicious cells. If radiation carried no risks of its own, then he said there would be no reason not to "throw the kitchen sink" at me and give me every treatment possible. At this point it is 50/50 on the benefits outweighing the risks, so he wants to talk to some of his colleagues from various facilities and universities to get their take on how they would proceed with a case like mine. His words to us were, "They will have to convince me that radiating is the way to go for you." So...he is going to work on contacting them and will get back to me early next week about how they have decided to proceed. I am not sure how to feel about this, as I am usually one of those that embraces doing whatever it takes to make sure the cancer doesn't return. But, on the flip side knowing what all the possible risks are, there is no way to say that 20 years down the line I won't really regret pushing for radiation. This is where I need to trust that God will give them the guidance and insight they need to make the best decision they can and I will put my trust in that.

While there yesterday, the sweet nurse, Ko is her name, gave us a packet of info regarding what to expect during the radiation process. She was concerned about overloading me with too much information, but I am definitely a person who feels like "knowledge is power" so bring on the informational websites, brochures, testimonials, etc. One website she shared with me was called "An Introduction to External Beam Radiation Therapy". Because I am often asked what various procedures are like by supportive friends and family, and because so many newly diagnosed are referring to my blog, I have included a link to the video site. It is a wonderful video that answers so many basic questions about radiation, and gives a glimpse of what to expect.

http://www.rtanswers.org/treatmentinformation/whattoexpect/index.aspx


Thank you for your continued prayers and please continue to pray that the doctors will find clarity in the best way to handle my treatment.