One of the long term constants with cancer survivorship is that there are no constants. Changes in medications, chemotherapy, and otherwise what one would hope would be a stable way of life are the constants. Yeaaah. Riiiight.. With Tracy's specific makeup, original cancer diagnosis, and long term prognosis, anything which increases or at least prevents a reduction of estrogen is somewhat problematic. So - how do oncologists deal with this? While there may be more than the two therapies I mention below (I'm not an oncologist, although I could play one with my experience), the ones we are familiar with are based on "Aromatase Inhibitors" (Arimidex in Tracy's case), and - a mouthful - a "Selective Estrogen Receptor Modulator" - aka Tamoxifen.
One factoid I didn't know, by the way, is that Estrogen is made in the fatty tissues of our bodies, not just in the female reproductive organs. Go figure. Well - back to the parts thing.. Since Tracy's cancer was of the type sensitive to estrogen (ER+), anything to reduce estrogen production is a Good Thing - except - that the side effects of these Good Things are generally Bad Things.
Let's Make a Deal!
Usually behind Door #1 for an oncologist trying to reduce residual estrogen production is the above mentioned aromatase inhibitor. Its claim to fame is that it -well - inhibits things. Those things Aromatase ability to do its thing. What is Aromatase you ask? It is an enzyme that synthesizes - TA DA - estrogen. Hence - aromatase is persona non grata in a post-surgery/post-chemo regimen. It is one of the "go to" treatments, but..... It has a dark side. In Tracy's case, it was her initially prescribed treatment, and it became evident pretty quickly that this was not going to end well. It left her crippled from joint pain, combined with an in ability to not be hunched over almost all the time. As her doctor put it (paraphrasing) "Wow - you seem to have an extreme reaction...". Known side effects - osteoporosis, liver damage, kidney failure, adrenal damage, and more. So - crippling, bone destroying, organ damaging side effects, or increased estrogen production.. Neither, thank you.
If you choose (or have chosen for you) Door #2, it usually is Tamoxifen or an equivalent. Its purpose in life is as the antagonist of Estrogen Receptors in breast tissue, with a usual course of five years. Another thing I did not know is that "agonist" is a real word, the opposite of - yes - antagonist. Really. Remember this. Where as Door #1 inhibits the production of estrogen, Door #2 gets greedy with the receptors and prevents estrogen from actually binding to them. End result? Less estrogen laying around to feed any ER+ cancer. Downsides: Potentially significant. Remember the agonist thing? Well... Tamoxifen is a known carcinogen (Srsly - true) and - is known to increase (not insignificantly) endometrial cancer - i.e. uterus. Here's the rub - the five year thing is because of the increased risk of endometrial cancer - but - BUT - research is now showing that there are significant benefits of staying on tamoxifen for 10 years - maybe more.
Ok - a 1000 words - you should be screaming "WHAT IS YOUR POINT????????"
It comes down to Crippling Organ & Bone Destroying Door #1, or Cancer-for-some-other-part-of-you Door #2. There really isn't much to be done with Door 1. However - with Door 2 you have "options". These options are what Tracy has elected to invoke tomorrow.
So - up at 4:00 AM tomorrow, and "we" report to the surgical unit at Exeter Hospital tomorrow morning at 6:00 AM EST. Yes - Six AM where Tracy will be prepped for a Total Hysterectomy and Bilateral Salpingo-Ooporectomy, aka "BSO" - and as part of a surgical two-fer - the removal of a keloidal scar (left over from the last several reconstructions) from the left breast. Think of a keloid as a really strong band-aid which is permanently attached to a sensitive part of your body, which when flexed (basically any time you move) really, really hurts.
More tomorrow.
Bill
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