Today was our first follow up with Dr. Oncologist.  I am a candidate for Tomaxifen because of the type of cancer and that I can metabolize this particular drug.  I am also a candidate because I am not prone to blood clots, I don’t smoke, I don’t take birth control.  In addition to blood clots some other side effects include endometiral cancer (prevents one cancer and can cause another).  Weight gain is also a side effect which thrills me to no end.  Tomaxifen should start within 30 days of radiation ending.  Some choose to regain some strength, others start right away.  Tomaxifen is recommended for me because I’m considered premenopausal even though chemo put me into a menopause-like state.  It will keep my ovaries in check.  It could happen that once the 5 years is up, I might return to having periods again and go through ‘natural’ menopause at some other time.   We were told today that if I only did surgery that there would be a 50% chance that I would remain disease free.  Since we did chemo – surgery – chemo – radiation, there is an 80% chance that I will remain disease free.  Well, actually she said a 20 % chance that it would reoccur.  B and I both like to look at the 80% better than the 20%.    She said people who are active do better in all regards most of the time. 

The plan is

• Start the Tomaxifen this week and take for 5 years.
• Meet with Dr. Oncologist in one month (or sooner if I feel lousy).  We can stop the med and wait a couple weeks if needed.  We can also stop it all together and choose another drug if needed. Lab work at this visit to monitor liver functions and other things.
• Meet with Dr. Radiation Oncologist in a month.
• Have yearly paps to monitor for abnormal endometrial tissue.
• Have a mamogram every 6 months.
• Have a breast and chest wall exam every 6 months.
• The first scan will be at 6 months to check on my liver, since there was initial observation of something there which was not thought to be cancer.  She said that a lot of people at this stage ask why they are not getting more scans to see if there is any cancer.  Here was her response:  “We are not going to go looking for this.  We do not want to expose you to any more radiation than you’ve had if there is nothing telling us that there is a reason to look for something. ”  It has been said to us by Dr. Oncologist and Dr. Surgeon that the cancer was gone after surgery. 

When I think of that last statement, my mind wanders.  A part of me wants to say “how do you know?”  I’m not much of a skeptic, and yet of course I want proof there is no evidence of cancer in my body.  This is something no one can say.  I don’t know.  There was activity in some of the lymph nodes.  This puts me in a different catagory than someone with no lymph involvement.  The nodes are supposed to drain the system and yet they can also be the gateway into the rest of the body.  It is my understanding that we don’t know if the cells that were found in the nodes were being drained out after chemo, or on their way to greener pastures.  We do know that the pathology report said that at least some of the cells found were ‘chemo affected’ which seems to indicate that they were on their way out.

Meeting with Dr. O was a mixed blessing for me.  It marked the end of aggressive treatments.  It was yet another meeting where I’m in the petri dish with others and am part of the stats which mark the survival of the human with invasive breast cancer.  I’ll keep you posted on the Tomaxifen effect.