Last time I told you that although my recurrence had been completely removed, the deep margin was positive. This means there may be cancer cells left on my chest wall. There was no more tissue for my surgeon to remove, which means that the chance of me getting another local recurrence in the same area is high. And that could mean serious surgery, such as removing part of my rib cage – not high on my list of priorities, let me tell you.
In an ideal world, I’d just have a three-week course of radiotherapy.
However, it’s me, and the recurrence was in an area that had already been fully treated with radiotherapy. And this is where it gets difficult. You can give radiotherapy to the same area twice, but it’s rarely done, and the side effects can be much worse second time around. For me, that could mean:
Worsening of the chronic pain on my chest wall
Thickening and scarring of the skin and muscle below my armpit, further reducing my shoulder movement and causing pain
Lymphoedema (especially as I have already had 3 ops in my armpit)
Break down of the scar in my armpit needing a skin graft or a muscle flap
Brachial plexopathy (where the nerves that run from your spine to your arm, at the very top of your armpit, are damaged, leading to permanent paralysis of your arm)
Sounds delightful, doesn’t it!
And I could go through radiotherapy, and get all of the above side effects, and the cancer could still come back, since it grew in an area that had been previously treated and was probably resistant to radiotherapy.
It was my call to make – my oncologist couldn’t tell me what to do.
What do you do?
Do you do everything you can to avoid another local recurrence, knowing there’s a high chance the side effects might worsen your quality of life? I’m a triathlete. I quite like having a left arm that works. I’ve already got pain and shoulder stiffness. How could I cope if I ended up with a paralysed arm? When does quality of life mean more than quantity? On the other hand, if I don’t have more radiotherapy and it does come back, could I ever forgive myself? Could my Dermot ever forgive me for not having it?
In the end, I went to see another oncologist for a second opinion because I simply couldn’t decide what to do. I was almost too close to the decision to be logical. She told me that I should have more radiotherapy because the deep margin was positive, and the cancer couldn’t be completely excised. It was the sensible thing to do. And I hoped that I’d get a double dose of super powers (like Spiderman) as this was my second dose!
And that was that. Decision made. I had to mentally prepare myself for another 15 sessions of treatment. To try and reduce the side effects, they were going to use electrons, which only penetrate down to 2cm depth, to target a 7x7cm area where the recurrence was. A large gantry called a collimator is used to target the beam. I felt like I was in a spaceship with all the lasers and lights.
The treatment itself is over in less than a minute, and like last time, is painless. The tiring part is the 3-hour round trip to get there and back. Every day. Luckily Dermot has been able to take me to a couple of sessions. I’m keeping active and am starting to run again – with a jog/walk interval programme every other day. It would be all too easy for me to spend my days on the sofa bingeing on the West Wing whilst knitting for my step-grandchild, but I know how important exercise is to help with the awful fatigue I’m feeling. I also want to keep my strength up for my oophorectomy next month.
At the moment I’m just over half-way through. My skin is starting to darken but I don’t have any blisters yet. The skin is starting to stick to my chest wall, so I’m massaging it every day and doing my shoulder exercises. I’m sore and I’m tired, but I’m getting there.