No Radiation!

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Today we met with Dr. Susan McCloskey, a radiation oncologist at UCLA to whom Dr. Hurvitz referred me. Both Drs. Funk and Hurvitz said that they thought it was unlikely that I would need radiation therapy, but they both said that they don't ever make the final call - it's up to the radiation oncologist (and me, of course) to decide.

Radiation therapy is treatment with high-energy rays or particles that destroy cancer cells. Radiation to the breast is almost always given after breast-conserving surgery (lumpectomy) to help lower the chance that the cancer will come back in the breast or nearby lymph nodes. Radiation may also be recommended after mastectomy in patients either with a pre-treatment cancer larger than 5 cm, or when cancer is found in the lymph nodes.

Radiation is widely considered to be easier than chemotherapy - I've even heard a doctor refer to it as "a walk in the park". But the truth is, in cancer treatment, everything has its cost. A number of women in my support group are currently in radiation, and to a one they have experienced pretty horrific skin burns at their radiation sites. Other, non-skin-related side effects are also quite common; the most prevalent seems to be fatigue. Beyond the immediate effects of treatment, there can also be long-term impacts, including heart damage, which concerned me particularly because my cancer was on the left side, right in front of my heart. Radiation also affects the muscles, turning them into "cardboard" as one doctor I saw put it, which can complicate breast reconstruction. All in all, nothing about radiation sounded good to me, and I was very much hoping that Dr. McCloskey would tell me I didn't need it.

And she did. She walked us through her analysis of my case in great detail, which I found very satisfying. She touched on a lot of different points, but her main concern for me was nodal involvement (evidence of cancer in the lymph nodes). My original ultrasound had shown some thickening of the edges of my lymph nodes, and the first biopsy was non-diagnostic, or inconclusive, because they missed the lymph nodes. Because my additional imaging was performed at Cedars-Sinai, my UCLA file didn't contain the test results - so based on the information she had, she didn't feel confident that we could say definitely that there was no nodal involvement when I first presented. However, when I told her about the second biopsy and the PET scan, both negative, she was visibly relieved and said that radiation wouldn't be likely to benefit me. She's going to review the imaging and test results from Cedars just to make sure, but it seems that I'm in the clear.

On to tamoxifen!

Information from cancer.org.

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