St Croix River Road Ramblings

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Monday, March 18, 2013

30% -- Margo and Radiation

Monday--March 18th  Update on Margo's breast cancer
Got back through the blowing drifting snow from Margo's post mastectomy surgical checkup.  One of the two drains was removed, and the healing is coming along fine.  She is still quite sore, but improving.  She got a refill prescription for another 30 oxycodone pain killers, so should be set for another week!

  After that check, we went to visit the Radiation doctor.  Initially Margo was told that chemo, surgery and radiation were all necessary parts of her cancer treatment.  We had some hopes that since chemo had gotten rid of all of the known cancer except for a 1mm spot in a single lymph node, and that her swollen lymphedema/scleroderma left arm and hand were likely to get worse with radiation, that she could skip it. 

   The radiation oncologist said:  With triple negative cancer where even a small amount was found after chemo and surgery, the chances of cancer returning within 5 years is about 30%.  With radiation, this drops to about 5%.   She also estimated that radiation has about a 30% chance of permanently scarring and further damaging the arm in Margo's case where there are already problems. This would leave her arm with less strength, possibly more swollen, and with difficulty raising it above shoulder length without daily exercises the rest of her life.  

   We hedged a little on the decision for radiation.  We asked to have the lymphedema and scleroderma doctors weigh in on the arm problems.  If the arm truly has scleroderma, an auto immune disease, then it can be treated by prednisone or any of the drugs that treat MG.  If not, they wouldn't help, and something else is wrong.  

   Radiation treatment for her was set at 5 weeks of 5 days per week and would begin about mid April.  Although it is likely Margo will go ahead with it, we haven't scheduled it yet.   The radiation oncologist said she asked two of her colleagues and one counseled no, and the other yes, and that the final decision would have to be Margo's.  So the question becomes one of balancing risks of cancer returning with the potential loss of use of her left arm (she is left handed).  

   "If Margo skips radiation and the cancer comes back in a few years, can't it be treated then?" I asked.   
    "Yes," replied the doctor, "but there would be about a 30% chance it wouldn't be successful then--an ounce of prevention is worth a pound of cure."   
     "How about taking only part of the radiation treatments--maybe 30% of them?" I asked.  
     "No, all of the treatments are necessary to get rid of any remaining cancer in the breast and lymph nodes in the armpit area."
  So right now we are about 30% likely to skip radiation and 70% likely to do it. 
    Margo has been without the use of her left arm and hand since September--she has had the arm and hand wrapped with a cushioning sleeve and elastic wrapped around that along with individual finger sleeves.  She takes them off for an hour each morning.  Without them, the arm and hand swell up tightly and could break the skin.  With them the arm and hand are not usable, but don't get worse.  It appears that somehow the chemotherapy along with an MRI injection that missed the vein caused the problems, and 6 months later, nothing has solved it yet.