Hard Truths about Cancer

Over the next few days I had an appointment about my breast cancer with my consultant, Mr Osman. He explained to me that the  tumour he had removed was slightly bigger than anticipated. It was about 8mm long. He had expected it to be about 5mm. It still did not sound big to me, but I knew bigger, in this case, did not equate to better.

Mr Osman also explained to me in some detail that the tumour was HER2 positive and that I would benefit from treatment with the drug Herceptin. HER2 is a receptor found on the surface of certain cancer cells.  It is made by a specific gene called the HER2/neu gene. HER2 is a receptor for a particular growth factor called human epidermal growth factor, which occurs naturally in the body. When human epidermal growth factor attaches itself to HER2 receptors on breast cancer cells, it can stimulate the cells to divide and grow.

He told me that some breast cancer cells have a lot more HER2 receptors than others. In my case, the tumour is described as being HER2-positive and that it is thought that about 1 in 5 women with breast cancer will have HER2-positive tumours.  HER2 is a gene that sends control signals to the cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly.

This genetic problem is not inherited from your parents. The most likely cause of this problem is aging, and wear and tear on the body. It is not yet known if environmental factors (pollution, smoke, fumes) are part of the cause of this problem.  If your breast cancer is tested for HER2 status, the results will be graded as positive or negative. As my results were graded as HER2 positive that meant that my HER2 genes were over-producing the HER2 protein, and that those cells are growing rapidly and creating the cancer. Mr Osman thought that he had removed all the cancer from my body with the surgery but in order to be sure of this and to minimise the risk of return, he recommended that the oncologist discuss with me the benefit chemotherapy would offer me.  

The oncologist, Dr Lumsden, recommended that I should have three lots of three weekly cycles of chemotherapy. The first 3 would be Herceptin and then docetaxel in a liquid that I would get through a drip (infusion) into a vein (intravenously). Each infusion of herceptin takes about 90 minutes, the docetaxyl takes about an hour and I would have one treatent every 3 weeks for 9 weeks. He recommended that I would then have chemotherapy as a course of 3 cycles of FEC (fluorouracil, epirubicin and cyclophosphamide) for a further 9 weeks.

Docetaxel can cause an allergic reaction. To try to prevent this, Mr Lumsden explained I would be given steroid tablets to take, usually for 3 days, starting the day before each treatment. He went on to tell me that FEC treatment would be given to me as a day patient. Before I started treatment, I would need to have a blood test a day beforehand. He also told me that I would be seen by a doctor or specialist nurse. If the results of my blood test were normal, the pharmacy would prepare my chemotherapy drugs. All of this might take 2-3 hours.

A nurse would insert a thin, flexible tube (cannula) into a vein in my hand. Dr Lumsden told me also that some people need to have their chemotherapy given through a thin, plastic tube that is inserted under the skin and into a vein near the collarbone (hickman line). He did not know if this would be necessary for me. I was also to be given some anti-sickness drugs as tablets, or more usually by injection through the cannula, which is often connected to a drip.

The chemotherapy drugs are then given separately after this.

It was so much to take in. The disease had been found so early that I had had no symptoms that I was aware of. Looking back, the extreme tiredness and exhaustion caused by any degree of physical effort, so typical of cancer, had already started to show. I just did not know to consider it. Still, it sounded like the cure was going to be worse than the disease. All of a sudden it was emphasised to me that my condition was serious and needed to be fully eradicated.  I was forced to face some hard truths that, until then, I had preferred to try to ignore.

Valerie Penny

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