Progression is not a good thing in cancer treatment.  Progression means the cancer has made progress, not we have made progress against the cancer.

That’s the news my wife, Loren, got from her last scans.  The scans show progression, which means the cancer has flared up again in spots.  Not much progression, but enough for the doctors to change tactics.

Loren’s infusion, once ever three weeks, now includes a targeted chemo drug attached to an immunotherapy drug.  The targeted chemo drug is stronger, with more side effects than the immunotherapy drugs, but, hopefully, it will prove to be effective for a while.

I say a while because metastatic cancer is like a fire we can’t put out.  We can knock it down, but there will always be embers — until we find a cure — waiting for a breeze to flare up again.

Copyright 2017.  All rights reserved.
#cancer #breastcancer #chemotherapy

Good News


The good news came in response to a non-urgent medical question.

“Good news,” Loren’s oncologist wrote. “I looked at your PET scan results. Everything looks a lot better. Some of the lung nodules have completely resolved, and there is no sign of abnormal radioactivity in the mediastinal and hilar lymph nodes, adrenal gland, and bones.”

In other words, there’s still cancer in Loren’s body, but all the tumors are shrinking. All the indicators are heading in the right direction.

“I’m very happy for you!” the oncologist added.

We’re very happy, too.

Six rounds of chemotherapy did the trick – they attacked all the fast-growing cells in Loren’s body and knocked her cancer down. Six rounds of chemotherapy also knocked Loren down. She lost all of her hair and most of her taste buds. And she slowed down considerably, with barely enough energy to make it through some days.

But if life with cancer were a boxing match, the judges just gave this round to Loren. Most of the large tumors have shrunk by more than half, the oncologist explained on the phone, later that day, and many of the small tumors have disappeared altogether. The tumors will shrink even more, she said, as immunotherapy targets her disease.

There is no cure for cancer, at least not yet. So we all know how this fight will end. The question is: How many rounds will we get, and how hard will cancer punch later in the fight?

Loren’s oncologist tells us that before immunotherapy, Loren might have lived a year, maybe two. But now, she has patients who live on Herceptin and Perjeta for years, ever since this combination of drugs became the standard of care for Loren’s type of cancer back in 2012.

“Nobody knows,” she said.

We certainly don’t.

And we are doing our best not to care. Because our life with cancer is like every other life – sometimes better, sometimes worse – and, at least for now, it’s good. It’s life. With cancer.

And we hope it stays that way for a long time to come.

Copyright 2017. All rights reserved.
#cancer #breastcancer #chemotherapy #immunotherapy

Chemotherapy, One, Two, Three

There’s a rhythm to chemotherapy, a simple one, two, three. Week one is bad, week two is better, and week three is good, almost normal, almost like life before cancer and chemotherapy. One treatment every three weeks.

Week one doesn’t start bad, but then it slowly, inevitably, gets worse. My wife, Loren, has chemotherapy on Tuesdays at 9:00 AM. Her first stop is the lab to draw blood, then a short wait and a quick chat with an oncology nurse about her what they see. Loren is running a bit anemic, but everything else looks fine, so they call down to the pharmacy and give them the go-ahead.

Loren’s chemo is administered slowly over four or five hours in a surprisingly cheerful infusion center at the Stanford Cancer Center South Bay in Los Gatos. Each station is a semi-private space, equipped with a TV and comfortable reclining chair, like a more spacious first class pod on an overseas flight, but without the on-demand minibar.

The cocktails are mixed in the lab and specially delivered in three separate IV bags. The first bag contains Herceptin, and it goes down easy — they all go down easy — because Loren has a Mediport in her upper chest, a rubber valve implanted just under the skin that provides a direct line into her superior vena cava. The first IV drains in about half an hour and is followed by Perjeta and then Taxotere, which comes with the most side effects.

Loren can walk around during her infusion, eat lunch, read a book, watch TV, or chat with friends (there’s a chair for visitors tucked into one corner of the pod). When she’s done she’s free to go, and she walks out to the car a little more slowly than when she arrived.

That’s because the first, almost immediate side effect is fatigue. We keep track of Loren’s symptoms in a small notebook: how she’s feeling listed on the left side of the page, medications and other countermeasures on the right. Chemotherapy day is marked with a capital “C,” and each day after that earns a “+1.” Fatigue is noted on Chemo day, and C+1 is more of the same. C+2 adds heartburn and a little bit of intestinal distress, which increases, but not by much, on C+3.

Loren is fortunate that she has almost no nausea, but she has significant bone pain. She receives a shot of Neulasta on C+1, which hyper-stimulates the production of white blood cells in the bones. All this extra effort makes her bones ache, beginning on C+3 in her hands and feet, then moving inward to larger joints on C+4 and finally settling into a deep, constant pelvic ache on C+5.

C+5 and 6 are the worst, and Loren spends those days as best she can, in and out of bed for regular naps. The doctors want her to manage the pain with Tylenol, which she does okay, but those days she’s tired and in minor, but constant, pain.

C+7 is the last day we track in this precise, abbreviated way, and by week two Loren is feeling better. Her pain disappears and her energy returns, though she remains immunocompromised through C+10. We avoid large crowds, but we get out and play, and by week three our life seems almost normal, like life before chemotherapy, and we schedule in as much as possible before the cycle begins again.

A couple years back, when we lived in small-town Maryland, I saw a piece on the local news about a woman whose baby was born with severe birth defects. Doctors said her daughter didn’t have long to live — maybe a week, maybe two.

Instead of keeping her baby in the hospital, the mother brought her home, so she could love her and care for her and hold her constantly in her arms. The baby died three weeks later, and when a reporter asked why she decided to bring her home, the woman smiled.

“Because that’s the life we’ve been given,” she said. “I want to make it the best I can.”

Every day, Loren and I try to do the same.

Copyright 2017. All rights reserved.