Now that surgery is behind me (whew!) it's time to turn our attention to the next step in my treatment - radiation.
A couple weeks ago I added yet another doctor to my repertoire when I met my radiation oncologist - Dr. Evans - for the first time.
After doing a physical exam, Dr. Evans sat down to talk to my parents and me. He said he was already very familiar with my case, as he was present at the "tumor board" meeting where Dr. Sara had presented my situation after the two spots on my spine were discovered. He told me that in the meeting Dr. Sara said that I was young, strong and motivated, and that he felt very strongly that these two spots to the spine should receive treatment, despite the fact that typically, a case like mine would not call for treatment to the bone.
The thing is, even though my bone scan came back negative, meaning it did not show evidence of active cancer cells, these tests are not foolproof and it doesn't mean that there are not still microscopic cells remaining even after the chemo. Just as my PET scan before surgery did not detect any active cancer in my liver, but the pathology report following surgery did find microscopic cells, the same could very well be true with these two spots on my spine. So we are not taking any chances and are going to blast those suckers with radiation to try to kill any cells that may possibly have survived chemo.
Of course, I will also need radiation to the breast, for the same reason. I have always known I would need radiation, because radiation treatment is indicated in cases where the tumor is larger than 5 cm, which mine was. And especially since my post-surgery pathology report found a fair amount of cancer still remaining along with positive lymph nodes, well it is all the more reason to blast the area with radiation too in order to kill any pesky cells that may have remained.
However, Dr. Evans said that the priority is to treat the spine first. Unlike the breast radiation, in which I will have to go for treatment for about a half hour every day for 6-7 weeks, the radiation to the spine will take place in a total of 2-5 sessions, each of which will be about an hour or so in length.
The first spot will likely be treated in just one session, since it is not located near the spinal cord and therefore is safe to blast all at once. However, the second spot is located much closer to the spinal cord, and so to be safe, treatment of this spot will probably take place in 2-4 sessions.
As far as side effects are concerned, Dr. Evans said that I will not feel anything during treatment - it is like getting an x-ray. However, I may feel some fatigue as treatment goes on, and I may notice some scratchiness in my throat or lungs for a day or two after treatment. Since one of the spots is located close to my spinal cord, there is also a very low risk (Dr. Evan said less than 1%) of paralysis. But I am not really worried about this because the risk is so low.
I asked Dr. Evans what the "measurement of success" will be, i.e. how will we know if the radiation worked. He said that I will have a PET scan following treatment, but because of the radiation itself can skew test results, we have to wait at least 3 months after treatment is complete before we can get an accurate reading. Since my last PET scan did not show "active" cells, but rather two areas that appeared to have already been treated, between you and me I think we will know if the treatment worked when the cancer either doesn't come back or it does.
The first step in the treatment is to have a "treatment planning CT scan," which was scheduled for the day after my appointment with Dr. Evans.