August 5, 2020 - Everything Changes - Even Cancer Cells
Pathology Results Offer Surprises
As I reflect on the last year, I realized that I didn’t write much about cancer types. Last June 24th, 2019, I mentioned in my journal that we knew that my breast cancer tumor was ER+/PR+ and HER2-. Those markers determined my treatment plan and chemo drugs for last fall. BUT, what do all those letters mean?
To put it simply:
Breast tumors are tested to see if they are estrogen receptor (ER) and/or progesterone receptor (PR) positive or negative. In general, tumors that are ER+ and/or PR+ are slightly slower growing and have a slightly better prognosis than tumors that aren’t. If your tumor is ER+ and/or PR+, then your cancer can be treated with a hormone therapy.
Hormone therapies slow or stop cancer growth. For early stage cancer, these treatments can include a class of drugs called aromatase inhibitors or AIs. After radiation, I was taking the AI Anastrozole (Arimidex). I began that drug in April and started feeling increasing side effects. My headache was a big one, but little did I know that it was not the AI, but a pesky brain tumor.
This is where it gets interesting.
HER2 stands for human epidermal growth factor receptor 2. HER2 proteins are found on the surface of breast cells. They’re involved in normal cell growth but can become “overexpressed.” This means that levels of the protein are higher than normal.
HER2-positive breast cancers have abnormally high levels of HER2 proteins. This can cause the cells to multiply more quickly. Excessive reproduction can result in a fast-growing breast cancer that’s more likely to spread. Originally, my breast cancer was HER2 NEGATIVE. However, cancer markers can change. (Click for article) .With my new biopsy results of the brain tumor, my Brain Mets (breast cancer in the brain) is now HER2 Positive. This is a lot of mumbo jumbo of why the cancer spreads and can spread as quickly as it did. So, in 2019 I was ER+/PR+ HER-, but in 2020 I am ER+/PR+ HER+. I always knew I erred on the positive side of life. My glass is always half full!
On the bright side, there are many new drugs that target HER2 Positive cancer. It is only a matter of finding the right drug for me. I know it’s out there!
When I spoke to my oncologist yesterday, she confirmed the new pathology. She also confirmed that the tumor was indeed 3CM (greater than an inch). She said that it was in my Cerebellum, but the concern was it was starting to shift downward. As I said before, I am one lucky duck! I am blessed beyond measure that they found it and found it when they did.
So next up for me is staple removal, another COVID test, another brain MRI and then the Gamma Knife Radiation Procedure. This is all scheduled to occur August 13th, 17th, and 18th. After all that glorious fun, I will meet with my Oncologist to find out my new drugs of choice to keep these cancer cells at bay, or better yet, eradicate them.
What is Gamma Knife Surgery?
Gamma Knife Surgery, source Mayo Clinic
Gamma Knife radiosurgery is a type of radiation therapy used to treat tumors, vascular malformations and other abnormalities in the brain.
Gamma Knife radiosurgery, like other forms of stereotactic radiosurgery (SRS), is not surgery in the traditional sense because there is no incision. (Yay, me!) Instead, Gamma Knife radiosurgery uses specialized equipment to focus about 200 tiny beams of radiation on a tumor or other target with submillimeter accuracy. (It better be!). Although each beam has very little effect on the brain tissue it passes through, a strong dose of radiation is delivered to the place where all the beams meet. You have got to love science.
The precision of brain stereotactic radiosurgery results in minimal radiation delivery to healthy tissues surrounding the target. Gamma Knife radiosurgery is usually a one-time therapy completed in a single day. I think my lucky stars! I couldn’t imagine multiple treatments.
This is a great explanation; however, it is missing the scariest part. They will “attach” 4 screws to my head (2 in the forehead and 2 in the back). They will then attach the halo contraption to the screws in my head. This is to ensure that my head will NOT move during this procedure. Seriously, I just want to pass out! I included pictures for your enjoyment!
My first question was around sedation. Who in their right mind would want to be lucid for this procedure? I assure you, not I. I was very relieved when they said I would be sedated, very much like a colonoscopy sedation. I am totally down with that. I want music jamming in my ears and me slumbering away as they radiate my brain.
The doctor said the actual radiation could last 1-3 hours. It will all depend on how the tumor (or absence of tumor) looks today. The intent is the Gamma Ray Radiation will remove any rogue cancer cells that didn’t get the hint last week. I am also told it is relatively painless. I will report back on that one.
How are we doing?
All in all, I do think we are hanging in there. Jamie and I have made peace our new normal. Mason is as tough as he can be. He assures me he is fine and not worried, but I know deep down he is scared. I can only assure him that Mommy is fine and how lucky we are that the doctors found it. I’ve told him that Mommy is on the mend.
My pain has finally subsided. I have successfully replaced narcotics with Tylenol for headache pain. The headaches are not that bad. They are residual headaches from having 21 staples in my head! This too will pass.
Jamie and I were really hoping that cancer would leave us alone for a while. I was counting on that 5-year mark of no cancer spread, but alas, that was not the case.
There is a purpose, there is a plan. We have taken a right turn and are on a new path. We know it will not be easy, but nothing worth having in life is ever easy.