YOUR TREATMENT

Once the planning of Operation Kill Cancer has been finalised, you’ll soon be onto the hard work of forcibly removing, poisoning and blasting those cancer cells into oblivion.

Treatment for breast cancer almost always includes some surgery – ranging anywhere from a lumpectomy to a bilateral mastectomy and maybe even an axillary clearance. In addition to this, radiotherapy, chemotherapy and hormone or Herceptin treatment are tailored to most effectively target your particular cells.

The combinations of treatment are as unique as the individual and will involve some or all of the following…

Chemotherapy | Surgery | Radiotherapy | Hormone Therapy &/or Herceptin

CHEMOTHERAPY

…or Chemo to it’s friends

If you have invasive breast cancer and there is any chance it may have spread into your lymphatic system, you’ll most likely end up having to have chemotherapy for about 6 months. Being the bright young thing that you are, they need to hit the cancer hard as its usually more aggressive and you also have the rest of your life to spend keeping this bugger at bay.

For most of us the mention of chemo instantly conjours up pictures of bald, extremely sick, emaciated patients and that was indeed often true of treatment in the past – but the chemo of today is a different thing altogether. Yes you’ll probably end up bald most places, get funny nails and sometimes a sore mouth or vagina as the chemo kills rapidly dividing cells (hair, fingernails, mucosal membranes and most importantly…cancer). But modern anti-nausea and cytotoxic (cell killing) drugs mean that the chemo out-patient suite is usually full of pretty perky, bright and smiling people considering their circumstances.

Treatment regimes vary depending upon your Oncologist and location but the current ‘young things cocktail’ is usually a period of treatment with Adramyacin/Cyclophosphamide 2 or 3 weekly for 3 or 4 sessions and then treatment with a taxane like Paclitaxel (Taxol) weekly or 3 weekly for anything up to 16 weeks in total.

For your treatment you’ll probably visit a day ward or outpatient chemo ‘suite’ where you’ll be escorted to a chair or, fingers crossed, a lazy boy and warmed up ready to be hooked up to an intravenous (IV) line for the drugs and saline to enter.

For the needle-phobic chemo can be a nightmare experience and even for those less bothered, the constant round of blood tests, chemo needles and even more blood tests can leaving you feeling less than ecstatic to see anyone wielding yet another sharp instrument in your general direction. In extreme cases or when veins are particularly hard to locate or even see – ‘a porta-cath’ (portable catheter) can be inserted into a vein under general anaesthetic to provide direct access to your bloodstream.

Once in the chair and all hooked up, that’s exactly where you’ll remain for about the next 3 hours (apart from wheeling your bag of drugs to the loo if you need to go). The drugs will either be syringed, gravity fed or pumped into your IV, along with any steroids (warning – these can give you a prickling sensation in the nether regions) and saline. Don’t be alarmed if your first wee takes on the colour of the red drugs (namely Doxyrubicin) and your brain turns to mush as soon as the chemicals hit your bloodstream – its all par for the course.

Drink as much water as possible and take all the saline they’re offering as the more hydrated you are the quicker the residual drugs and toxins will get flushed out of your body and the better you’ll feel. Treatment can leave you feeling woozy afterwards so if this is the case its best to get someone to drive you home or come pick you up.

Chemo is usually given after surgery and before radiation but when the tumour is too large to operate or there is swelling as in the rare cases of Inflammatory Breast Cancer (IBC) it may come before surgery and radiation in order to shrink the cancer.

CHEMOTHEAPY

– THE UPS AND DOWNS

In praise of chemo….

It really works at killing cancer cells and therefore has a major hand in postponing your dirt nap

You get to try out that pixie crop and then Sinead O’Connor/Sigourney Weaver/Demi Moore bald head you’ve always wondered what you’d look like sporting

You get to sit down for uninterrupted 3 hour Scrabble/trashy mag/snooze marathons while being brought hot chocolate and stuffing your face with treats

You don’t have to shave your legs for months and get a (relatively) pain-free Brazillian to try out for size (okay that last one is a bit of a stretch but its all about making the best of a situation you’d rather not be in)

On the flip side…

You’ll more than likely lose most of your hair (starting 10-14 days after your first treatment) and your fingernails/toenails can follow suit

You’ll feel hideously nauseous/hyped up from steroids/red in the face and generally rather tired and unwell (to put it mildly) after each treatment and for a good few days after.

Your periods will almost certainly cease at some stage (temporarily or sometimes permanently depending upon your age) and with that comes your very own menopause and its side effects like sweating and hot flushes

You can suffer from evil constipation or diarrhoea (or both) that like you’ve never had in your life!

- MAKING IT EASIER

Things that can make chemo easier to handle…

Company

Some people like to have others with them and some don’t – if company is your thing then don’t for goodness sake try and brave it on your own. Ask someone to come with you and hang out – even if you both just read together it feels less lonely.

Distractions

Whatever’s your thing…take it along with you. Ipods, DVD players, trashy mags, good books, earplugs/eyemask/do not disturb signs or board games are all perfect ways to pass the time and distract you from the matter at hand. (Just a heads up on the board games, you’ll be great all the while its saline going through the IV but when the drugs head in, you’re brain will become mush and any winning streak you were on will be lost for the day). Make sure you have plenty of the same at home too cause you’re gonna need more distracting for a while yet.

You’ll also find that you start to get to know other ‘regulars’ being treated the same day as you, so you can catch up with them, play ‘spot the newbie’ or just eavesdrop in on their conversations (‘people watching’ as those in denial call it!).

Food – whatever you fancy!

Now here’s the funny thing – while chemo itself makes you feel nauseous to the point of not being able to even look at food, the steroids like Dexamethasone that they give you alongside to help with nausea make you starving hungry! Just eat whatever you fancy in those first few days and you’ll find after a bite or two you may even be able to finish a whole serving. Don’t be surprised if KFC features largely in your post-chemo session diet – for some reason it’s the one food that universally transcends all nausea and is most fancied late at night (good old Colonel Sanders).

Water

You really can’t drink enough of the old H20 during your treatment – it ill help get the drugs through your system, go some way to preventing and helping with constipation and flush out all those toxins released by dead and dying cells. It also helps to wash down all that KFC you’re scoffing!

Wigs, Hats & Scarves

To have the ability to blend into the crowd (more than say… a shiny pink head) you need to find yourself a trusty syrup in a colour and style that you feel comfortable with. Yes they’re itchy, yes they’re different to your regular hair but by golly do they buy you some time off from being seen as a ‘cancer patient’ and that’s more valuable than you can imagine.

Similar to wigs in that they provide a handy cover up – headscarves are a bit more conspicuous but come in a far better range of colours than wigs! You’ll end up with more than you need but hey it’s a time for treats – what more can we say? If you’re having chemo during the winter – get some warm hats (especially for sleeping) and if its summer get one with a wide brim as you’re not supposed to be out in the sun with some chemo drugs and the last thing you want to do is burn your balding head.

RADIATION

Seeing as most people picture giant mushroom clouds or disasters at the mere mention of the word, it seems a very strange concept that radiation can be used as a life giving treatment for cancer.

However, the cell nuking capability of radiation treatment makes it an effective treatment for destroying rogue cells in a targeted way. There’s lot of planning and science that goes into radiation treatment – quite necessary seeing as they’re nuking all cells, good and bad, in the area where the cancer has been hanging out.

You’ll probably meet your Radiation Oncologist quite a while before your treatment starts so firstly, they can explain all the risks and benefits associated with treatment and secondly agree on your treatment plan and answer any questions you may have.

A radiation planning appointment will then follow where you have yet another scan – this time a CT scan (without the IV dye) to measure you up precisely. You’ll also have the privilege of getting three new tattoos to help them line you up correctly during treatment. Not to worry they never seem to offer sailors anchors or the LOVE/HATE combo, instead opting for the regulation little black dots like freckles that the nurses will do themselves (no need for hairy biker tattooists on standby).

You’ll also now be advised of your first appointment date which will probably be a week or two after the measurements are taken. This enables the team to work out all the complicated maths so that they only nuke the area requiring treatment with the necessary amount or radiation to be effective. Treatments are usually given only on weekdays and in 3 or 5 week blocks but it all depends upon your particular case.

TREATMENT

On your first treatment session you’ll meet the team, change into your gown and spend a bit longer than most other days while they take some x-rays and double-check all your measurements to make sure they’re blasting the right parts (take as long as you like with that thanks!). Then the giant robot-looking radiation machine rotates around you making high pitched noises while you have to stay perfectly still. The radiation treatment itself only lasts about 5 mins – the longest part of each session is getting changed, the lining up of the tattooed dots and the weekly x-rays.

You’ll be monitored weekly by nurses and your Radiation Oncologist to see how you’re feeling and how your skin is holding up under the regular exposure to burn inducing radiation. Other than that its all plain sailing – that hardest part of treatment is being at the hospital every day (constant reminder) being at your appointment on time come rain, snow, earthquake, children’s illnesses etc. and the after-effects of treatment that can be experienced.

Getting adorned with ink is the more pleasant mark that radiation can leave on your life. If your skin breaks down it usually happens towards the end of treatment and gets worse (or ‘peaks’) about a week afterwards before getting better. Your armpit and chest may resemble a weeping, BBQ’d version of their former selves and gauze-free dressings, strong painkillers and soft clothes turned inside-out to minimise seam damage will be the mainstay of the next fortnight or so. Keep an eye on the wound for signs of infection and follow any instructions you’ve been given by the hospital regarding dressings. The good news is that when it heals up it happens rather quickly and you’ll then be the proud owner of a one-sided red/pink/brown square(ish) (ex) boob tan and the possibility of a brighter future.

About two weeks after the end of treatment (around about when any burns have healed) don’t be surprised if you start to feel like you’ve been hit by a train in the fatigue department. Its quite normal after being nuked for your body to have its very own nuclear fallout. You’ll be working overtime getting rid of dead cells, beavering away making new ones and trying to detoxify all the rubbish waste products that radiation has left in the area. Try to get as much rest as possible and know that this too will pass in a few weeks and before you know it it’ll be gone.

Radiation treatment isn’t a totally bleak picture (the nurses are lovely, you might get to listen to the radio every morning and hey its helping to save your life) but its really important to recognise that its often the last stretch of treatment after any chemo and surgery and so easy to discount quite what it demands of you physically.

RADUATION

– THE UPS AND DOWNS

In praise of radiation….

It nukes the life out of any pesky cancer cells in the breast and/or armpit

You get to listen to groovy music during your treatment
Treatment sessions only take about 15 mins

You get inked – not just one but 3 new tatts courtesy of the health service

It’s the one treatment that won’t give you evil constipation 🙂

On the flip side…

Treatment is every weekday usually for 3 weeks (15 sessions) or 5 weeks (25 sessions) depending upon intensity of treatment and cancer

Your square boob tan can rapidly turn into a weeping, BBQ fest that’ll have you swearing like a sailor

Approximately 2 weeks after your last treatment you may physically feel like you’ve been hit by a train – when they say mild fatigue they mean bloody exhausted!

- MAKING IT EASIER

Things that can make radio easier to handle…

Cream

Aqueous Cream to be precise. Do yourself a favour and do as you’re told! – put this and only this on every day, several times a day. Use nothing else in the treated area – soap, deodorant, razors or anything else crazy.

Saltwater Bathing

As your personal armpit BBQ heats up it also had the undesirable effect of getting rather itchy. A cup of cooled, boiled water with a teaspoon of ordinary salt dissolved in it and applied with cotton wool makes you less likely to scratch the hell out of it. Make a fresh cup very day and keep it where it won’t be mistaken for a tasty beverage.

Kind Clothes

It’ll probably be suggested that you choose to wear a ‘loose fitting camisole’ (if you even know what that is!). Never fear, it doesn’t mean you have to add 1980s satin slips to your attire – it just means wear loose fitting clothes that don’t rub and try turning your singlets inside out so that the seams don’t take off your top layer of skin

Water

Drinking plenty of this will help to flush out all those nuked dead cells from your system. The tiredness you feel is apparently caused by your body working extra hard to process all the waste from your radiation treatment – if this goes any way towards relieving that it’s a good idea to get glugging.

HORMONES & HERCEPTIN

When you receive your pathology results from your biopsy and/or your surgery, you’ll find out whether the cancer has sneakily been using your very own biochemistry to fuel its growth. If this is the case, it ‘luckily’ provides you with another treatment tool to show the cancer the door. Results that come back as negative for all receptors (oestrogen, progesterone and HER2) are known in the business as triple-negative cancer (i.e. ER-/PR-/HER2-) and hormone or herceptin treatment would not be effective.

Herception and HER2+ cancer

A positive result for the HER2 testing means that the over-expression of HER2 proteins in cell membranes cause the cells to multiply even more rapidly and uncontrollably than normal. HER2 positive cancer is usually more aggressive in nature but can also be treated using a drug called Herceptin (Trastuzumab) that binds to HER2 proteins in breast cells stopping them from wreaking so much havoc. Herceptin is given via infusions (into the vein) either alongside chemotherapy or as a stand-alone treatment.

Hormone sensitive cancers and hormone therapy

Hormone sensitive cancer can be partial to either oestrogen (ER+) or progesterone (PR+) or both (ER+/PR+). It is most common for breast cancer to be oestrogen receptor positive and blocking the production or uptake of this is how hormone treatment works. Tamoxifen or Armidex are usually given to us young folk and are taken daily in tablet form usually for a period of 5 years or more. They work by blocking the oestrogen receptor sites on breast tissue cells (like a plug in a hole) so that only very limited amounts of oestrogen can bind to cells, and the fuel supply is cut off.

All being well, if you intend to try for a family before 5 years after your diagnosis, you may instead be prescribed Zoladex (goserelin acetate). This is a lutenising-hormone releasing agonist (in plain English that means it tricks your body into temporarily stopping the production of oestrogen). Its given by a rather painful, but thankfully rather quick, monthly injection into the flab of your abdomen. It can be stopped easily and the effect is usually quickly reversed so you see your periods return within a few months. In some cases you may be on Tamoxifen or Armidex and Zoladex at the same time – it all depends upon your unique treatment regime and circumstances.

Side effects

While this all gives you a further device to rain right on cancer’s parade, it doesn’t come without its fair share of side-effects. Your periods will stop and with that comes your very own temporary menopause and its side effects. Night sweating, insomnia, joint-pain, mood swings, loss of libido and hot flushes will probably all show up at some point during hormone treatment. Its not pleasant but the treatment really works – what more is there to say?

HORMONES & HERCEPTIN

– THE UPS AND DOWNS

In praise of hormone treatment….

If the cancer is hormone receptor positive (i.e. uses estrogen or progesterone or both) to fuel its growth, blocking the production of said fuel or inhibiting its uptake can slow or stop cancer cell development.

You don’t have to visit the ‘womens’ aisle of the supermarket for a while and get to wear your nicest undies every day of the month

No more period pain or PMT for a while yet – but before you jump for joy get ready for the flip side…

On the flip side…

Hormone treatment kick starts a menopause that’s quite unique and intense as your body’s gone from ‘go’ to ‘no’ in the hormone department

Menopausal side effects include, no periods (yay!) hot flushes (bah!) night sweats (boo!) joint pain (argh!) mood swings (grr!) insomnia (noooh!) loss of libido (wah!) and increased risk of osteoporosis (ohhh!)

You have to get injected (Zoladex) every 4 weeks to the day or take a tablet (Tamoxifen & Armidex) every day, or both.

- MAKING IT EASIER

Things that can make hormone treatment easier to handle…

Strategies for sleeping

You’ll probably find that you have trouble getting to sleep at the best of times during all this cancer lark (unless it’s the 2 weeks after radiation treatment fallout!) let alone waking up drenched or spending the night thrashing around trying to get the temperature right. Wearing light cotton PJs and throwing the covers on and off several times a night seems to be the way through. Also having a cool flannel near the bed in summer can help you to mop up the sweat and cool down at the same time.

Natural fabrics and layers

Sweating like a pig in public is not pleasant especially when it comes randomly out of the blue several times a day. Try to wear light layers of natural fabrics, that way you can breathe, strip off a bit if/when need be and not have big sweaty ‘magic spots’ under your arms/on your back.

Talking with your loved ones

Think PMT without the PM – menopause can cause you to put the T in Tension! Feeling up one minute and down the next, or having feelings of anxiety, depression or agitation (just like PMT) can all be down to this lack of raging hormones believe it or not. Make sure that everyone around you knows your not just being a super-bitch for the sake of it (unless of course you are!) and try to be aware of what is going on for you – mindfulness is really the key to mastering this.

Dealing with ‘headaches’

An absence of sex hormones (oestrogen/progesterone) can unsurprisingly lead to an absence of sexual desire. If you’re feeling less than interested in frisky business it can cause problems down the track, especially if you’re in a relationship. If you can find a way to talk about it to someone (best of all your partner in crime, but a trusted friend if not) you’re on the road to stopping it becoming a bigger mental drain for you than it may be already. This is a really hard one, so go easy on yourself and try not to add guilt to your already rather large emotional load.

SURGERY

Depending upon your personal treatment plan, surgery will probably be one of the first things that you encounter. The result of all that scanning, poking and prodding to date means that your specialist will have a good idea of the extent of the tumour and what type of breast surgery you’ll be expecting.

Lumpectomy

Used for the early stages of cancer and where the tumour is small and confined, a lumpectomy removes just the tumour and surrounding tissue until a clear margin (a clear margin of tissue where the cells are normal again) is reached.

Partial Mastectomy

Bigger than a lumpectomy and smaller than a mastectomy – also know as a breast conserving surgery. For larger tumours and more invasive cancer this is where a portion or segment of the breast is removed and the rest is spared as much as possible.

Modified Radical Mastectomy

Large, invasive tumours or cancer such as inflammatory breast cancer require removal of the whole breast tissue but the underlying chest muscles remain intact.

Radical Mastectomy

Total removal of the breast and underlying chest muscles – rarely performed today.

Sentinel Node Biopsy

The first lymph node draining from the breast (sentinel node) is injected with a special dye to see if it contains any cancer and this aids the decision as to whether an axillary clearance and chemo are required.

Axillary Clearance

Any evidence or suspicion that they might contain cancer will require removal of the lymph nodes from the armpit – this is usually completed at the same time as the mastectomy and often leaves no additional scarring.

One bump or two?

A mastectomy can be either one breast (unilateral) or both breasts (bilateral) aka mono boobs and nono boobs. This decision is made along with your surgeon and depends upon many factors such as genetic disposition to breast cancer, disease in the other breast and personal wishes.

You may also have the option to have an immediate reconstruction or a reduction on your remaining breast – this will be dependent upon your treatment plan and will need to be discussed with your surgeon.

SURGERY

– THE UPS AND DOWNS

In praise of surgery….

It removes as much of the diseased tissue as possible with the aim to reach a clear margin around the tumour, giving your body the best chance to fight anything that’s left

You may be able to have a Sentinal Node Biopsy performed where the spread of cancer can be assessed and you may not have to have lymph nodes removed or undergo chemotherapy.

You’ll find out from the pathology report exactly what you’re dealing with (size, grade, hormone receptor status, Herceptin receptivity and lymph node involvement)

Despite the perception, the surgery is not as painful as you might imagine.

You psychologically feel better knowing that unwelcome tumour is no longer with you

On the flip side…

Your boobs will never be the same again – lumpectomy and partial mastectomy change the appearance of your boob(s) whereas a modified radical mastectomy removes the boob altogether

You are left with emotional as well as physical scars – sometimes neat, sometimes jagged but 1,000 times more manageable than unchecked cancer.

Your arm range of motion can be restricted for some time and in some cases permanently

You have to carry your very own handbag of horrors around for a week.

You can suffer from evil constipation from the painkillers like you’ve never had in your life!

- MAKING IT EASIER

Things that can make surgery easier to handle…

Company

Getting ready for your operation and waiting to be wheeled off the theatre is nerve-wracking and a pretty gruelling experience. Add to that waking up and knowing that your girls have had some serious work isn’t the most pleasant feeling in the world (although the drugs do take the edge off). …Cue No.1 support person/posse – its their job to make sure their smiling faces are the last you see as you head in towards surgery and the first you see when you leave the recovery area. You probably won’t make much sense after your op due to the heavy duty pain meds, but just knowing they’re there as you talk nonsense and nod in and out of sleep is a comfort like no other.

Distractions

Life is undoubtedly better for hospitals and the wonderful treatment they provide, but they are also very ‘beige’ in décor and atmosphere at times. Here’s where your trusty entertainment package of Ipods, DVD players, trashy mags, good books, earplugs/eyemask/do not disturb signs or board games from home come into their own.

Food

It’s a big cliché but its also no secret that hospital food is mass produced by big catering outfits on a limited budget. While its edible and the jelly and ice cream transport you back in time to tea at your Grandparents house, its not really the ‘food as medicine’ approach to speeding up your recovery. Loved ones and visitors that bring fresh fruit, juices, salads and (of course) treats are the best tonic for your tired bod.

Water

This’ll help you get the anaesthetic drugs through your system, make sure you stay hydrated in the sauna like hospital environment and may go some way to helping with the dreaded painkiller (mainly codeine) constipation! The last thing you want right now is a sore bum.

Comfy clothes

There’s nothing like your own slippers and robe to make you feel less like a patient and right now (when that’s most definitely what you are) that’s a real plus. There’s something about getting up, showered and dressed (even if it takes you all day) that helps your mind feel more in control of this situation. Make sure you pack some loose tops as you’ll have dressings and the handbag of horrors to accommodate.

Movement

Now, you’ll think they’re stark raving mad when you have a physio talk the day after your operation, but you need to do what they say and get yourself moving – if you don’t you’ll have real problems down the track and it easier to prevent than treat.