11. Treatment Plan Explanation

DOCETAXEL

This is a chemotherapy drug used for a number of cancers, including, breast, prostate, stomach and neck. It is given as an infusion via a cannula which is a short, thin tube put in a vein. The cannula can only be put in your hand or in the lower half of your forearm. If lymph nodes have been removed in one arm then you only have the other arm to play with. Sometimes veins can be difficult to locate, and if this proves troublesome each time you attend, you may have a fine tube inserted under the skin of your chest and into a vein close by - this is called a Central Line. Alternatively, a fine tube can be inserted into a vein in your upper arm and then into a vein in your chest - this is called a PICC Line. I do have quite difficult veins - they don’t always cooperate, especially with so many blood tests in addition to the chemo. Luckily, despite 2 or 3 attempts each time, I have managed to avoid having a PICC or Central Line.

Docetaxel is given in cycles of 21 days with the dose given on the first day of each cycle. There is the possibility of an allergic reaction, so you are closely monitored with your first dose. The signs of an allergic reaction are pretty similar to any other allergic reaction, namely:

Feeling hot

Shivering

Itching

Skin rash

Feeling dizzy

Swelling of mouth or face

Feeling breathless.

If you survive without this happening, you then have the joys of a variety of side effects once you get home. This can include:

Neutropenia (Low white blood cell count)

Bruising and bleeding

Anaemia (Low red blood cell count)

Nausea

Lethargy

Loss of appetite

Sore mouth and throat

Diarrhoea

Constipation

Hair Loss

Skin changes - skin may be very sore and dry

Nail changes - they may become brittle, or become loose and fall out

Conjunctivitis

Muscle or joint pain

Peripheral Neuropathy (numb or tingling hands and feet)

Metallic taste in mouth

Sore and red palms of hands and soles of feet - skin may peel off

As I said before you may have some or all of the above to a greater or lesser degree.

TRASTUZUMAB

This is a targeted therapy drug used to treat HER2 positive breast cancer as well as some stomach and oesophageal cancers.

It is a bit of a wonder drug,which has revolutionised HER2 positive cancer treatment. Twenty years ago it wasn’t approved for use and I would not have survived this type of breast cancer as it spreads so quickly but now I have every chance. It is given as an infusion via a cannula or by subcutaneous injection in your thigh. It travels through the body hunting out abnormal looking cells and killing them off before they have a chance to mutate. This should also help to reduce the risk of me getting any other type of cancer in the future - a true wonder drug!

Again it is given on the first day of a 21 day cycle and as I am in the early stages of breast cancer I will need to take it for a year. If the cancer is advanced or has spread you would take it for as long as it controls the cancer.

As with the Docetaxel, it is possible to have an allergic reaction and the signs of this are the same for both drugs. Trastuzumab also has very similar side effects to Docetaxel with the lovely addition of:

Heart problems

Abdominal pain and indigestion

Headaches

Blocked or runny nose

Difficulty sleeping

Lung problems

If you are on chemotherapy and Trastuzumab at the same time then side effects are more likely - hopefully once the chemotherapy stops my side effects will also reduce.

RADIOTHERAPY

Radiotherapy uses high energy x-rays to destroy cancer cells. It’s given to destroy any cancer cells that may have been left in the breast and surrounding tissue after surgery.

In order to ensure the x-ray beam is directed to the correct area a CT scan is performed and a tattoo of 3 tiny dots is done to ensure all radiotherapy sessions are applied to the same area. Now I have been contemplating a tattoo for some time - Sophie and I would like matching baby elephants, with beautiful butterflies coming out of their trunks - 3 tiny dots on my breast does not seem such a great alternative and isn’t one I’m likely to show off!

Radiotherapy Is given for 5 consecutive days and takes about 10 minutes each time. I think some hospitals may do every other day for 2 or 3 weeks but my one gives a higher dose over a shorter timescale - my Consultant said that this has shown to be slightly more effective and reduces so many trips back and forth!

The side effects of Radiotherapy can be temporary or permanent and some may appear months or years after treatment finishes. Obviously, as with all treatment, everybody differs but the more common side effects are:

Skin reactions - 10-14 days post treatment - redness, tender, peeling, blisters

Swelling of the breast

Pain in breast and chest area

Hair Loss in the armpit (result!)

Fatigue - which can be ongoing for some time

Lymphoedema

Tenderness over the ribs

LETROZOLE

Letrozole is a hormonal therapy drug for women who have been through the menopause. It is used after other treatments to reduce the risk of the cancer returning.

ER2 positive breast cancer relies on the hormone oestrogen to grow. Letrozole reduces the amount of oestrogen in the body by blocking an enzyme that help produce oestrogen in the fatty tissues of the body.

It is given in the form of a daily tablet over a number of years and comes with it’s own little set of possible side effects as follows:

Hot flushes and sweats

Muscle or joint pain

Fatigue

Nausea

Indigestion or abdominal pain

Raised cholesterol

Change in appetite

Hair thinning (which is cruel if you are trying to grow some back!)

Skin changes - rash or itching

Mood changes

Headaches

Dizziness

Weight gain

Vaginal bleeding

Diarrhoea or constipation

Osteoporosis

Raised blood pressure

Swollen feet and ankles

ZOLEDRONIC ACID

Zoledronic acid is one of a group of drugs called Bisphosphonates and is used to help protect the bones from the side effects of breast cancer treatments and to reduce the risk of early breast cancer coming back.

One of the cells inside bones are called Osteoclasts and these break down and remove old bone. Zoledronic acid reduces the activity of the osteoclasts helping to reduce pain and strengthen the bone. It also reduces the amount of calcium that is lost from the bone.

It is given via an infusion through a cannula in the vein and will be given every 6 months for 3 years. You may have guessed that this treatment also comes with its own set of possible side effects as follows:

Numbness or tingling - mouth, fingers or toes

Kidney problems

Red or sore eyes

Anaemia

Headaches

Nausea

Hip pain

Initially I was only worried about the chemotherapy but, as you can see from the above, all my treatments carry some risk. If I think about it too much it is overwhelming and scary. I just have to remind myself of the anticipated outcome and that I don’t really have any other options - I need to get well and I need to give myself the best chance of a cancer free future. It is daunting but I just have to keep moving forward, facing each new challenge as it arises and just taking one day at a time.