2 years of poison....starting, NOW.

 

Next stop on the Cancerland Railroad...abemaciclib! 

Tomorrow I will start 2 years of this incredibly expensive, less-toxic-than-regular-chemo drug called a CDK4/6 inhibitor (cyclin-dependent kinase 4 and 6, for those that speak cell biology). Some recent trials have demonstrated a significant disease-free survival interval for early hormone + breast cancer patients taking this along with antiestrogen therapy. 

Disease free. 

No evidence of Disease. 

The absolute best and happiest state you can hope for as an early cancer patient. 1 in 8 women in the US will develop breast cancer. Of those that do, 20-30% will progress to metastatic cancer - with chemo, surgery, radiation, ten years of meds. With doing all the things they told you would 'kill' your cancer. Your cancer will still kill you. 

Who is in that 20-30%? How can you prevent yourself from being there? Well unfortunately we don't know, and you can't. You can live your best life, increase your chances of survival with things like meds and exercise and not drinking, but at the end of the day, biology is a random bitch and I might end up there. 

Enter abemaciclib. 

The idea is that this might prevent a recurrence by blocking cell replication in any lurking cancer cells. So that they don't turn into metastatic cancer. So I don't die of breast cancer. This is a newer class of drug, and a more targeted therapy than traditional chemo, and I appreciate the trials and researchers that brought it to patients. 

Exciting side effects to anticipate: nausea. diarrhea. profound fatigue. low white blood cell counts and easier infections. hair loss. anemia. Horror stories of needing adult diapers and imodium to prevent diarrhea explosions in public. This should be interesting in 3 weeks when I'm supposed to race a half-ironman...

But I know this increases the chances if me staying in the 70-80% of women who outlive breast cancer, so it's a worthy sacrifice now for longer life later. I appreciate the hell I've put my body through to survive, and I hope it can manage this next phase without too much more collateral damage. 

2 years starting now....

If you knew death was coming...would you live differently?

Time is certainly a thing not to be taken for granted. Somehow most of us go about our lives working, saving for, planning for later. What we'll do when we are old enough but still young enough, when we have enough time, enough money, enough of whatever we think is the key to getting where we want to go. Somewhere inside we know that we shouldn't be sacrificing our time now for the promise of time later, but we justify it in a lot of ways.  

When you have cancer, you definitely do not take time for granted. The frustrating thing is that time is both shortened, and lengthened. Joy and appreciation for little moments abound, but it becomes overwhelming to plan for a future that might not exist. If you could know with 80-90% certainty that your cancer was going to come back, not a matter of if but when...

Would you want to know? 

In a few weeks, I will know. 

Finally FDA approved and sent by my oncologist, my tumor sample and a blood sample were sent off to create a profile of my cancer DNA, and to look for it circulating around. 

If it's NOT there, that is a huge sigh of relief and it means we haven't found any rogue tumor cells or missed any tumors lurking about...for now. Since they have my tumor DNA, we can retest for it in the future to know if things have changed. 

If it IS there, now or later, it's an early warning. But it means there's an 80-90% chance I will develop "clinically relevant" metastatic breast cancer within the next 9-12 months. 

It means I'll be in this weird state where we know the cancer is coming back, but we don't yet know where. It will mean a ridiculous amount of scans to look for spread. It will mean that I will die of metastatic breast cancer someday. 

Not today. Not tomorrow. But someday in the not-too-distant future. Short of the freak accident, car wreck, lightning strike etc, it will be breast cancer that kills me. 

And it will mean an even bigger change in life plans than the recent past has already given me. If I knew my death was coming, I sure would live differently today. 

Part of me regrets having the test, because there is bliss is not knowing. I'm a planner at heart, and I couldn't resist the idea of having a 9-12 month lead time on f'ing cancer, to do some epic life shit while I still can. But now that the test is pending, and the gravity of a positive result has settled in, I'm absolutely terrified. Maybe I won't look at the result - I wish I had that kind of self control. But right now cancer is in control, and whatever the outcome here, I can at least take some control back for now.