One step at a time: that's been my philosophy for getting
through my cancer treatment. My doctors
have wisely taken the same approach, giving me just enough information to get
through each stage without overloading me with information.
But now that the mastectomy and chemo are over, it is
finally time to turn my attention to radiotherapy. I have been prescribed 25 sessions, so that
means going to hospital every week day for five weeks plus an initial week with
two preparatory appointment. That's when
they will decide how I will be positioned and mark me with small tattoos so
that they can recreate that position exactly for each session.
Last week I met my radiologist and I had various questions
for him, starting with - why do I need radiotherapy
at all? After all, the operation
removed my entire breast and the infected lymph nodes, then the chemo
supposedly killed off any cancer cells that had escaped in my body. Hormone therapy should hopefully prevent any
new cancers, so what is the point of radiotherapy?
First, he explained the
criteria for prescribing radiotherapy.
If my tumour had been small and contained in the breast, then the
mastectomy would have been enough. But
if the cancer is also in the lymph nodes (yup) or there is more than one tumour
(yup) or there is one tumour larger than 5cm (my two tumours had joined to
create one 5cm monster so I guess that's another yes) - then radiotherapy is
prescribed.
That's because surgery cannot reach all the problem
areas. A mastectomy cannot remove absolutely
all breast tissue and there are lymph nodes in places that would be too
invasive to reach with a knife. And in theory chemo should take care of
anything left behind by surgery but in practice it isn't 100% effective, particularly
around the breast area, possibly because the surgery removes the routes the
chemicals need to travel.
So, where will I need
radiotherapy? They will blast areas
where localised cancer cells might still be lurking i.e. the chest wall and the
lymph nodes hidden behind the sternum and the clavicle. And finally they will blast the armpit where first-level
nodes have already been removed but, unlike surgery, the radiotherapy will be
able to reach the second or third level.
If I wasn't yet convinced, the statistics helped me see that it is worth making the trip to
hospital every day for six weeks.
Without radiotherapy, there's a 15% chance of localised recurrence. Radiotherapy reduces that to only 2% after a
lumpectomy. For me, post mastectomy,
radiotherapy will reduce my chance to 1%.
Those are odds I like.
And how does
radiotherapy work? They will blast me with high energy x-rays in small doses
that will break down the DNA in all cells.
Healthy cells have a repair mechanism so will have repaired themselves
before the next session. But abnormal cells
and cancer cells don't have this ability, so will be unable to reproduce and
will die by the end of the 25 sessions.
That sounded like a good result but not much fun for my
healthy cells. So my next question was -
Won't it hurt? My radiologist promised that I will feel no
pain during the sessions and, in fact, will have no side effects at all until
the last couple of weeks. By then I may
get some dryness and redness on the skin but no burning (large breasted women can
burn where the skin folds but, as I have had a mastectomy, I should be fine). There might also be some fatigue towards the
end...but not as bad as chemo-exhaustion.
Well okay, but shouldn't
I buy some protective creams? He
almost rolled his eyes at this one, clearly he despairs of the advice people
receive. Ignore what everyone says, he
pleaded, don't use cream or oils, soap or deodorant. Just wash with water. To keep yourself comfortable, avoid wearing
your bra or prosthesis if possible and wear white cotton T shirts next to the
skin. I have, of course, been advised to
buy a 'wonder cream' that a friend (who survived radiotherapy unscathed) swears
by. I'm hesitating...but I think I'll
stick with my radiologist's advice for now.
Finally he explained that I should have four weeks recovery
time between the end of chemo and the start of radiotherapy. But my last question was, can I wait a couple
of weeks longer? You see, I told him,
the kids have a week's holiday and I really don't want to come to hospital
every day when they are not at school...
He agreed, though the gap couldn't be any longer. So now we can go on a family holiday during
the break and get a week's rest and relaxation before the next phase starts.
One step at a time.