I had an appointment to see my oncologist on Tuesday to discuss hormone treatment. Because my cancer was oestrogen receptive (basically oestrogen made the bugger grow) they can give me medication to try and prevent a recurrence. I use the word try as there are no guarantees that it will work, but fingers crossed hey?
My surgeon put me on Tamoxifen when I went to get the results of my surgery three weeks ago. Tamoxifen is an anti oestrogen drug which tends to be the standard drug of choice for oestrogen receptive breast cancers. Tamoxifen is a mystical drug - it works in a way that’s quite complicated and not
yet even yet fully understood by medical bods.
Oestrogen positive breast cancer cells have proteins called receptors. When oestrogen comes into contact with the receptors, it
fits into them and stimulates the cancer cells to divide so that the
tumour grows. Tamoxifen fits into the oestrogen receptor and blocks
oestrogen from reaching the cancer cells. This means the cancer either
grows more slowly or stops growing altogether. Theoretically.
However, I don't want any oestrogen floating round my body - as little as possible anyway. So i asked to see my oncologist abut ovarian suppression or the 'shutting down' of my ovaries. Little bastards...
To cut a (relatively) long story short, my hormone treatment has been changed to one that is deemed to be stronger than tamoxifen. Studies have shown it to be more effective in preventing recurrence and because I am classed as 'high risk' for recurrence (I really wish oncologists would learn to temper their language sometimes!) it would be of greater benefit to me. Such is my disordered brain at the moment, even though I made the appointment to see the oncologist and I left with the drug combination I wanted, I then panic about the fact that they gave it me and think I need it. Sigh.
The treatment involves a monthly injection of a hormone implant called Zoladex and a daily tablet called Exemestane. Zoladex works by stopping the production of luteinising hormone by the pituitary gland, which in turn leads to a reduction in oestrogen produced by the ovaries. I've essentially been put in to a chemically induced menopause which comes with side effects such as hot flushes, mood changes and weight gain. I'm also now at risk of osteoporosis and can lose up to 12% of my bone density per year.
Exemestane is a member of the drug family called aromatase inhibitors. In women who have gone through the menopause the main source of
oestrogen is through the conversion of androgens (sex hormones produced
by the adrenal glands) into oestrogens. This is carried out by an enzyme
called aromatase. The conversion process is known as aromatisation, and
it happens mainly in fat. Exemestane blocks the aromatisation process and reduces the amount of oestrogen in the body.
It isn't given on its own to pre-menopausal women (like me) but because I have now been put in to a menopausal state it is the most effective drug to use.
Zolodex is given by injection in to the stomach. This is the needle they use:
I shit you not.
I was brave. No numbing cream. It hurt. Really hurt.
I'll probably be on this combination for about five years (lets hope I live that long). If I have one every month that is 60 of those beauties in my stomach. But to be honest, if it helps to keep the cancer at bay I'd gladly stick it my eye, never mind my stomach.
So here comes the menopause - I'm already having hot flushes that are such that I want to rip my wig off in public places and stick my head in a freezer. I'll be moaning about how things were not the same as when I was a lass and having a blue rinse next. If I had any hair that is.......