I’m back home from my drawn out appointment and I am still not sure what my overriding emotion is.
The good: My oncologist explained that my CT scan from Monday showed no progression of disease and the tumours in the bone were stable. What this means is that, the tumours haven’t increased in size or number although they haven’t reduced either. Stability is a good place to be in cases where NED (No evidence of disease) hasn’t been achieved. For that report, I am grateful.
The “Not so good”: The fluid in the lining of my lungs (pleural effusion) has increased significantly. The quantity and pressure from the fluid has shifted most of the organs on the left to the right and my left lung is partially collapsed. This is obviously not ideal and he recommended having more of the fluid drained. Remember the 1 litre that was drained two weeks ago? Some sample of the fluid was sent to the lab and it showed the fluid contained cancer cells which confirms that the pleural effusion is also malignant.
What does all this mean? Even though the bone mets are stable on the drug I’m on (Letrozole), the drug isn’t working as expected on the pleural fluid as a result, the oncologist thinks the best way forward is to switch meds. There’s a chance Letrozole was working at a point as my CT scans in August showed the bone mets and pleural effusion were both stable. Sadly, with metastatic cancer, the cancer often becomes resistant to treatment and when this happens, drug change/switch needs to happen. The reason why this terrible disease ends up in death is that there are only so many drug options available, there comes a day when every drug option has been explored and there’s nothing left to try. For today, that is not the case and I still have a few options available to me. Hopefully, more drugs continue to become available and the time before resistance to drug occurs continues to increase.
New Meds: The new meds I will be switching to are called EXEMESTANE (aromas) and EVEROLIMUS (afinitor). The exemestane is similar to Letrozole so side effects should be pretty similar; menopausal symptoms mainly. The everolimus on the other hand could potentially introduce some brand new symptoms. I included links to more information on both drugs above in case anyone is interested in some bedtime reading. The Oncologist explained that the combination of the two drugs has been shown to work in cases where Letrozole has stopped working. He advised that I take any side effects seriously as some of the ones from Everolimus could be very serious.
What do I make of all this? I am not excited about switching meds as the sad reality is, the Letrozole stopped working after just five months – I can’t afford to go through drugs that quickly! I’m praying the combo of the new meds work to stop the pleural effusion from re accumulating, help with the bone mets and hopefully help with attaining an NED status with minimal side effects. I’m praying the cancer doesn’t get resistant to the drugs after a few months especially if they prove to be effective. I pray cancer cells stay away from my soft organs (lungs, liver, brain) as I have a good chance as long as the disease remains in the bone or better still, goes into hibernation aka NED.
I don’t feel great because I’m forced to think again about what my options are and how one appointment could change everything. At the same time, I am grateful for little mercies like the stability of the bone mets and the overall health of my soft organs and tissues.
After my appointment with the oncologist, he referred me to the ultrasound unit to have more of the pleural fluid drained and they were able to drain another litre before I started feeling intense stomach cramps from the Thoracentesis. This time was a lot more painful than the first time and almost three hours later, I am still having very painful cramps in my tummy. I have an appointment at the dyspnea clinic next Wednesday and there’s a chance they will put a catheter in so the fluid can be drained more frequently potentially from home.
I have never given so much thought to the pleural effusion, in my mind it was less scary than actual tumours in the bone. However, after I learnt it was malignant, I did a bit more of reading (Bad idea? I know!) and I have to say I’ve managed to get myself all scared. Apparently, prognosis is pretty grim – less than one year in most cases. I have no idea why the statistics is that bad, I imagine a lot will depend on the type of advanced cancer resulting in the pleural effusion. Either way, I’m pretty freaked out.
I’m reading Psalm 61:2 at the moment “From the end of the earth will I cry unto thee, when my heart is overwhelmed: lead me to the rock that is higher than I”
I need a refill on my strength, hope and faith as I don’t seem to have a lot of those at the moment…