Finally, my results are back from the USA, and at an appointment at Bart’s hospital this morning, the oncologist set out my treatment plan.
The good news is that I don’t need chemotherapy. Although I quite liked the idea of all my hair falling out, the idea of months of feeling rubbish and running to the loo to puke several times a day did not fill me with excitement. So, no yodelling down the great white canyon for me. Hurrah.
Here’s how the test works. It’s a newish thing, called an Oncotype DX test, which is carried out when other factors which influence whether chemo will be effective or not are inconclusive. It checks out the activity of various genes in your cancer cells, which determines how responsive you will be to chemo. It is used to assess invasive ductal breast cancer (that’s the sort that is in the milk ducts – as against the nodules – and have the potential to spread), which is oestrogen-receptor positive and HER-receptor negative. That’s the type of cancer I have, as revealed by the biopsy taken at the start of this journey.
It is provided by a company called Genomic Health, based in the USA – hence the transatlantic trip for my cancer tissue. Grateful though I am that such a test exists, having been quite recently developed, it seems to me that rather than private owners keeping it to themselves and making their worldwide customers send the samples to them for testing, a rational and humane society would share medical knowledge like this, allowing tests to be conducted locally to the patients, with quicker results. It would also be far more efficient (a word so beloved of private-sector advocates) if the NHS could run this test itself rather than pay no-doubt-handsome fees to a private company.
The test results fall into three bands: high (chemo will have significant benefit in preventing the cancer returning), intermediate (some benefit) and low (negligible benefit). My result was low. High would have meant having chemotherapy, and intermediate would have been even more difficult – having to make a decision!
I will now have two treatments to help prevent the cancer returning:
- Tamoxifen tablets – one a day for ten years, although this will be reviewed, and perhaps changed, after five years (the prescription charge exemption will certainly come in handy). This is a small, tasteless, 20mg pill which can be taken with or without food, at the same time every day. I’m going to take it when I get up in the morning, although if I have side effects, I may switch this to the evening. I popped my first one at the bus stop on the way home from hospital.
- Radiotherapy – three weeks visiting Bart’s hopsital every weekday to have the area where my tumour was blasted with radiation. This will almost certainly start in January, but I will have an appointment with the oncological radiologist first.
Both of these treatments have a fairly long and slightly scary list of possible side effects (including causing cancer!), but I’ll cross those bridges if and when I come to them.
Before leaving the hospital, I had blood tests taken, mainly to establish whether I have been through the menopause or not. Strange question, you may think, but as I have an intra-uterine device, I don’t have periods so I don’t know. And as I have forgotten exactly what sort of IUD I have, I need to find the paperwork that came with it or ring the clinic that fitted it. Where I am with the menopause makes a difference to the effect that the treatments will have on me, and whether the tamoxifen shoudl at some point be switched to a different hormone treatment.
So – not out of the woods yet, but the cancer has gone and an arsenal of pills and microwaves is going to stop it coming back. And even if that knocks me over for a while, all in all it’s going to be a happy new year.
