Loose Strife

Some folks are wondering why this chemotherapy decision is so important. Since most of us associate chemo as the standard cancer treatment, isn’t this expected? Well, the answer is mostly simple, but slightly complicated.
Here’s a little cancer school. When cancer spreads to other organs, the cancer cells that have invaded are still of the type where the cancer originated, i.e. the breast. So even though the cancer is in, for example, her bones, it’s still breast cancer. Now most breast, prostate, and ovarian cancers are dependent on hormones (estrogen or testosterone) for survival. This has led to successful treatments that involve various ways of blocking hormones.
It’s very ironic, but the primary treatment for early stage breast cancer is typically harsher than for metastatic disease. Early stage treatment usually involves surgery to remove the tumor and possibly the breast, radiation to the tumor site, chemotherapy, and finally hormone therapy. All this is done to try to cure cancer by physically removing as much of the cancer as possible and beating down the few remaining cancerous cells to minimize the chance of recurrence. However, treating advanced cancer (“mets”) is different. The aim is to keep symptoms under control, keep the cancer from spreading (but it can’t be completely eliminated), and keep Laura as happy and healthy for as long as possible. As a result, it’s actually common to use hormone therapy as the primary treatment. It has minimal side effects and it’s effective in most women. If it doesn’t work then that means that treatment options and future successes are more difficult. So the success or failure of hormone therapy for people with mets is a big deal.
Beyond that, this is just a big deal from an emotional perspective. Statistically speaking, most mets to bone and “soft tissue” (like pleura) are slow growing. And cancer like Laura’s that was tested as being so-called ER+ (referring to estrogen receptors) are responsive to hormone therapy. We were also told that hormone therapy is slower acting, so we assumed that a poor scan after just 6 weeks of treatment would not alter her treatment. Another point is that there isn’t just one hormone treatment: there are many — so we also figured that one failure would mean that she would try another. In short we were expecting a relatively slow pace for treatment with time for deliberate experimentation of multiple hormone therapies if there were difficulties. Since that didn’t come to pass, it’s been a shock.
Lastly, chemotherapy is just plain frightening. Chemo is a type of poison that attacks rapidly multiplying cells in the body — mostly indiscriminately (although there are some emerging “targeted” drugs). This means that all such cells — like white blood cells and hair — along with cancer cells are killed. Administration of chemo involves sitting in a soft chair for several hours as the drugs slowly drip into an IV. Chemo is a nasty SOB. And Laura is pretty freaked out over it. Optimistically, there are augmenting drugs to minimize the side effects and the treatment doesn’t last forever, but that doesn’t make it more desirable.