FEC Chemotherapy for Breast Cancer

When I was diagnosed with breast cancer, apart from being completely taken aback that something like this could happen to me, I got detailed advice from the oncologist about the type of treatment I would need.

fecI was told that after surgery to remove the tumours, the oncologist told me that I would receive chemotherapy and then  radiotherapy. The chemotherapy I received was called FEC. This is a combination of three chemotherapy drugs 5 fluorouracil, epirubican and cyclophosphamide. FEC takes its name from the initial of these three drugs.It is normally used to treat people with primary breast cancer that has not spread to other parts of the body. Chemotherapy destroys cancer cells by interfering with their ability to divide and grow.

All cells in our bodies continually divide and grow. This enables growth and repair of body tissue. Cancer cells are different because they grow by dividing in a disorderly and uncontrolled way. Different chemotherapy drugs work in different ways and attack the cancer cells at different stages of their growth. This is why a combination of drugs is often more effective than just one drug.

I was given my FEC intravenously. I had a Hickman line fitted because the veins in my hands did not allow easy acces for the cancer nurses.  All my medication was given through my Hickman line. I did not like having it, but it was useful. I was given the FEC as an out patient, every three weeks for 18 weeks. This meant I could go home on the same day after treatment, that was nice, but the days were long and tiring. The time involved is not just that required to give the drugs, but also waiting time, blood tests and time for the drugs to be prepared.fec tired

I suffered side effects with FEC. The common side effects include bone marrow suppression.Bone marrow suppression or myelotoxicity is the decrease in production of cells responsible for providing immunity, carrying oxygen and those responsible for normal blood clotting. Bone marrow suppression is a serious side effect of chemotherapy. The decrease in blood cell counts does not occur right at the start of chemotherapy because the drugs do not destroy the cells already in the bloodstream. However, the drugs affect new blood cells that are being made by the bone marrow. The suppression of bone marrow activity causes a deficiency of blood cells. This condition can rapidly lead to life-threatening infection, as the body cannot respond to invading bacteria and viruses.It can also leading to anaemia due to a lack of red blood cells and spontaneous severe bleeding due to deficiency of platelets. This resulted in me suffering from severe tiredness and exhaustion. It is difficult to describe the depth of the feelings of exhaustion. I also had several spontaneous nose bleeds.

Other side effects include nausea and vomiting. The hospital supplied medication to minimise this. I was instructed to take the medication at specified times after my treatment. However, the most visual side effect of chemotherapy is hair loss. I did try an ice-cap to reduce that, but to no avail. It did not work.

fec baldWhen people think of hair loss, they, and women in particular think of the loss of hair on their head. Certainly that does go. The result is a cold head in winter! However, all of the hair on my body was lost. This included the hair on my limbs and inside my nose. The good news was that I did not need to shave my legs for a year, the bad news is that it meant there were no hairs to stop my nose from running. Always carry a handkerchief!

I was not going to bother buying a wig. However, my cancer nurse advised that I should. This was partly because it might make the sight of me during my illness less difficult for my children and my elderly mother. She also pointed out that it would keep my head warmer, especially in winter. She was right on both counts.

Cancer affects not just the person who is diagnosed, but all the people who love them: their friends and family. I hope you never suffer such a diagnosis, but if you do, bear in mind the agony of those around you.

Valerie Penny

 

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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

Making the Effort: Taking the Time

I love getting letters. I was appalled when the cost of stamps went up by such a large percentage earlier this year because I am sure it will result in fewer and fewer letters and cards being sent. Who can blame anybody for using e-mail or social networking sites to keep in touch rather than more traditional methods when the costs are so great?

It is certainly lovely to have been receiving so many pretty cards from friends and relatives, despite the cost of postage!  Not only that but the flowers and visits continued to arrive. Friends further afield would skype, phone and write.  Suddenly time was more important than anything else and the fact people were willing to spend their time with me was very humbling.

Around this time it also became clear to me that I should make the effort to spend my time wisely.  

There are some things I do not have the energy to do. Although I am registered with the local library to assist people who need help to use a computer, I do not feel able to undertake this duty just now. I am just too tired. Exhaustion is one of the most debilitating side effects of my treatment for me. However, I did feel able to attend the meeting of the poetry group the meets on the library.  I was thrilled t be able to do that. It allowed me to thank the poetry group for the lovely bouquet of flowers they sent me.

It was a special pleasure to join the group that day as renowned local poet, Gerry McGrath was reading some of his verse.  His website is gerrymcgrath.co.uk. One of his books A to B is reviewed at: https://bookreviewstoday.wordpress.com/2013/04/05/from-a-to-b-by-gerry-mcgrath/

Although I got tired easily and felt a bit tender after the surgery, it was important to me to meet with the group and join in usual social intercourse that did not revolve around me being sick.  I do not like being ill. I am sure most people would prefer to avoid ill health, if they could.

While I was at the library, I was able to pick up the book the library book group was reading that month.   It was Gardens of Water by Alan Drew.

I was equally thrilled when I felt well enough to go to the singing class that runs in the Community Centre. It was another way for me to meet and mingle with the people that I share this interest with too.  members of the group had taken the time to visit me and bring me flowers, so I was able to thank them for the lovely bouquet of flowers.  There is no doubt that making the effort to spend time with people and taking the time to share my interests with them made me feel better.

Valerie Penny

Friends and Flowers

I have never believed anybody who claims to have hundreds of friends. Friends are a treasure to be valued high above rubies and true, loyal friends are a very rare commodity. It is when times get tough that you really realise who your friends are. After the operation, word of my breast cancer spread amongst those I know quickly. I was truly overcome by the kindness, love, affection and support shown to me. The cards, flowers and chocolates given to me were lovely. Even more overwhelming were the phone calls, texts and visits.

When all of a sudden frailty struck and I had to accept the possibility of my own mortality, it was rather nice to know that there are those who care.

I received many lovely cards too. The living room of the house was so finely decorated by all these lovely things that the flowers given to me by friends at my book group and the local poetry group were displayed in the bedroom window.

There was only one problem. My disease had been found early in a scan. I had not had any symptoms. I had never felt ill, indeed, I was not aware I was ill. So I felt completely unworthy of all the good wishes I was receiving. I felt like a complete fraud. .

My sister and brother-in-law even came drove across the country to have lunch with my husband and me. Both their cars were out of action so they had to hire a car to spend time with us. What dedication to duty! How generous and kind!  We met for lunch at The Rowan Tree Restaurant, Ardrossan, Scotland. Have a look st a review of that restaurant: https://hotelandrestaurantreviews.wordpress.com/2013/04/13/the-rowan-tree…ossan-scotland/It was a lovely lunch.

The Rowan Tree offers an excellent choice of food at very reasonable prices. My sister and brother-in-law joined my husband and me for Sunday Lunch. We had a choice of the Roast of Pork as well as the regular menu. Service was unobtrusive, the meal was freshly cooked and tasty and the coffee very smooth. I always enjoy a visit to The Rowan Tree Restaurant. This visit was no exception. 

So much kindness: it all seemed too much. I was amazed how even just going to lunch made me so bone achingly tired. Exhaustion makes me miserable, but the love of friends and family is wonderful.

Valerie Penny

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