Seems like it’s taken FOREVER to get things moving on my wife’s recently-diagnosed Stage 4 breast cancer. We had the initial terrible news- that her cancer had returned, now designated Stage 4, meaning it had “escaped” and was no longer curable. You read the statistics about her particular type of Stage 4 breast cancer (triple negative metaplastic) and it’s like… time to get your ducks in a row ‘cuz you’re not likely to be around very long. How scary? Oh, not that bad, just stuff like 10 months average lifespan from time of diagnosis. Not even enough time for the “flash” of your life passing before your eyes.
That’s what motivated us to find the best specialist possible, Dr Telli at Stanford, and created drama when it appeared like we wouldn’t be able to see her, then we found someone who knew someone (thank goodness we take good care of our customers, because it was a customer with the connections!), and Dr Telli’s reading of the tea leaves was very encouraging. The cancer had not spread past this one spot in one lung, and she felt, and our Kaiser doctor concurred, that removing that lump made sense and would buy time. Normally, you don’t bother removing a tumor at Stage 4 because you’ve already got spots all over the body, lighting up the PET scan. But there’s a real chance that getting rid of this tumor would both buy time and we’d learn something about treating the cancer by studying the tumor. Turns out doctors LOVE to talk to tumors. Tumor whisperers, kind of like I am with some bike things. Unless it’s a noisy disc brake.
But geez, getting on the schedule to get it removed has seemed nightmarish. Delays, a strike at Kaiser, and feeling like nobody had a good handle on things. I get it; Kaiser has lots of patients, but my wife is the only one I know who was recently diagnosed Stage 4, told that removing the tumor would be a good idea, and has had to sit on that for a couple of months. Meanwhile thinking that tumor is only growing and up to no good.
Friday, a week from today, she goes in for the surgery. The recovery period isn’t supposed to be too long; it’s a pretty small tumor (at least it WAS, last time it was scanned) and the surgery isn’t terribly invasive. No flying for 30 days afterward, and that was a bit of an issue since we fly to Hong Kong on Dec 7th for a cruise. The far far far bigger issue would have been that any delay coming close to the 30 days prior to our trip would have meant living with that tumor inside her that much longer, knowing there was no way that could be a good thing.
And that’s the other strange thing. They give you these cancer diagnosis and act like you have time to deal with it. I don’t buy that. Logic tells you that something with a mind of its own, multiplying rapidly, up to no good, is eventually going to kill you. The sooner you take action, the better the odds that it won’t. Or at least you’ll be delaying when it does. So to my thinking, acting sooner will probably buy you additional time at the back end. At some point you delay long enough that it’s too late to expect a reasonable outcome. Who knows when that point occurs?
My logical side says, show me a study that demonstrates differences in outcome based on when a serious cancer was diagnosed and how long before treatment began. And now I’ve found evidence to support that here- Every month delayed in cancer treatment can raise risk of death by around 10% | LSHTM. Kind of wish I hadn’t! I can rationalize that, in Karen’s case, the need for immediate treatment was actually questionable as there really isn’t much to treat, and she did immediately undergo medication (an aromatase inhibitor, targeting the less-than-5%-prevalence of estrogen-sensitive cancer cells in her system).
As Picard said, the line must be drawn here, this far, no farther. Whatever needs to get done is going to get done, and if we need to move our travel plans around or cancel them altogether, for the best-possible outcome, then that’s what we’ll do.
I wonder if a chemotherapy could be used to arrest or limit progression until surgery.
That was the idea to the aromatase inhibitor. Unfortunately, with chemo, there are only so many shots you’ve got at it. Many of them can only be used once; a few of them simply have a total amount that’s allowed (the most infamous being doxorubicin aka “Red Devil” which damages the heart over time, so if you use too much of it, your heart will no longer take the strain of… just about anything else). So let’s say there are three temporarily-effective chemo treatments that could be helpful to Karen. None of them will cure her. And if we go through them too quickly, there is nothing left for later on. So you use them sparingly, hoping to see a lengthy remission, and don’t start another until there’s a compelling reason to do so.
Prior to Stage 4, you use chemo hoping it is actually a cure, with the cancer not coming back. So you throw everything you can at it, hoping to not have to face a Stage 4 situation down the road.
It’s not a fun thing to have to work through. And in general, the doctors don’t help you figure this out. They don’t want you to be thinking there’s only a certain number of magic bullets and when you run out… On the other hand, you hope to live long enough to find a better treatment that wasn’t available before.