Metastases

In the fall of 2001, my right arm began hurting. First, I thought it was from lifting too much weight exercising. Then I thought it was the result of our new Golden Retriever puppy jerking on his leash.

I saw my massage therapist, my primary-care doctor, and a joint specialist, looking for a soft-tissue injury such as a rotator-cuff tear or a tear in the biceps.

Nothing.

I had no idea at the time that breast cancer often metastasizes to bone. If I had, I'd have been more suspicious of this painful arm that was not improving.

"Nearly 25 percent of breast cancers metastasize first to the bone, and most others eventually show some bone involvement," writes Musa Mayer, in her book, Advanced Breast Cancer.

Finally, a CT scan ordered by the specialist turned up a tumor in my right arm. I got this news at 6 p.m. on a Friday night. The doctor who called said my arm was in danger of breaking at any moment, and I should be very careful.

But I couldn't think about a broken arm, all I could think was that cancer had returned and that I was going to die this time.

I paged Dr. Livingston in a panic, and he calmed me down and told me to come and see him first thing Monday morning, which was December 31, New Year's Eve.

A friend drove me to the cancer center early Monday, where I spent the entire morning being poked, prodded, scanned, and X-rayed. Before long, Dr. Livingston was there to give me the bad news: The cancer had metastasized to numerous spots in my bones and one in a lung. The right arm was already broken, as a result of a 5-centimeter tumor.

He said I would need surgery to repair the broken arm, radiation to shrink the tumor in my arm, Herceptin, an antibody that would attack my cancer because it was her2neu-positive, two other drugs, Femara and Zoladex, to suppress estrogen production because my cancer was estrogen-positive, and another drug to help my bones remain strong, Zometa.

Then later we'd do conventional chemo, he said. I actually got my first treatment that same day.

This is not necessarily the treatment another woman with metastatic breast cancer would receive. My medical oncologist said that all of my treatments were picked to target specific features of my disease. And yes, I do know what he meant. E-mail me if you'd like me to elaborate.

I don’t like surgery, so I decided to try a splint for my broken arm, rather than having surgery, which would have delayed the start of my other treatments.

The arm healed perfectly well within two months. Within that same two months I received daily radiation to my arm of 200 rads a day for 20 days, followed by a five-day "boost" on a smaller area focusing on the visible tumor, also 200 rads a day.

My radiation oncologist only zapped this one tumor because of its size. She said the systemic treatments would shrink the smaller tumors in my spine, ribs, and elsewhere.

I took a Femara tablet daily and received the other drugs every three weeks, either by IV or implant (for the Zoladex), and within two months of diagnosis, Dr. Livingston was telling me my cancer was in clinical remission.

This felt like a miracle to me. I gathered up a group of my closest friends and went out dancing.

Dr. Livingston said at the time that my case was unusual. "It is unusual for systemic treatment that does not involve the use of chemotherapy to produce a remission so quickly," he said.

Again and Again
Of course, I didn’t stay in remission, and in the years since then I have continued my cancer treatment with a number of different drugs, usually several at a time.

My doctors monitor my cancer by watching my tumor marker, a blood test that indicates cancer activity, and with various scans, including PET scans and MRIs. If the tumor marker gets too high, or a scan shows that a particular tumor is putting me at risk, then it’s time to change treatments.

I have taken Herceptin continuously for five years without problems. Herceptin can cause congestive heart failure, so I get a MUGA scan every few months to check that my heart is still working well, and so far so good.

The drugs I’ve had include Taxol, Navelbine, Avastin, and hormonal therapies.

Right now I am getting two targeted therapies, Herceptin and Avastin, by IV every three weeks, and Zometa, also by IV every six weeks. I also take oral Cytoxan, which is a conventional chemotherapy.

On December 26 I finished a series of 14 radiation therapy treatments to my spine, because one of the tumors there had broken out of the bone and was moving toward my spinal cord. (Yes, this did creep me out. I don’t like to think about it.)

This was the third time that I have had radiation therapy—first, in combination with Taxol, to treat the local recurrence I had in 1999; then to treat the tumor that broke my right arm when my cancer spread to the bones in late 2001; and now this radiation to my spine.

I’m pretty calm about getting radiation. It’s kind of a non-event. But this time, because of where the tumor was, at T-11, the radiation caused some nausea and also GI upsets. My red blood counts dropped too, making me tired.

The radiation is over, but I’m still living mostly on hot cereal and pudding. With the occasional Christmas cookie for variety.

@ Jeanne Sather 2006