On Friday, I had my monthly visit to Nebraska Medicine for my Lupron shot. When people ask me if I am still on treatment, it’s a tricky question. I don’t do “treatment” anymore, but there is some “maintenance” done to shut down cancer from multiplying in my cells. And Lupron is something that I get on a monthly basis to shut down my ovaries.
“But Ashli?! Why on earth would you want your ovaries shut down? You’re 35!” I know, right? But guess what? Shutting down the oves may just be saving my life.
You might recall that my breast cancer was identified as Triple Positive. What the heck does that mean? Well, breast cancer cells can be “fed” in the human body by three different hormones: Estrogen, Progesterone, and something called Her2neu. These cancers are called “hormone-receptor positive.” Adversely, it can also be found to be fed by no hormones. If a cancer is found to be hormone negative, they would call it “triple negative.” Someone can be positive in no hormones, one hormone, two hormones OR all three. If you are identified to have all three hormones feeding your tumor then it is called “triple positive.” That’s me! (Perhaps that explains my happiness level).
Sooooo… my chemo regimen was determined from those characteristics, as well as the size, of my tumor. That is how it was determined that I would have Taxotere, Carboplatin, Perjeta, and a year of Herceptin. Then, those same characteristics are used to determine your post-chemo “treatment” or “maintenance” or “prevention.”
If one is triple negative, they generally (from what I understand) don’t take a daily pill post-treatment because shutting down hormones would not prevent a non-hormone fueled tumor grower from growing more cancer. Does that make sense?
But… if your cancer was early stage and hormone-receptor positive, then there are a few options for drugs that will help your body destroy the way cancer cells would multiply or mutate within the body.
I think of Cancer as Pac-Man. It goes around the body looking for other cancer cells and in my case, hormones like estrogen, progesterone, and her2neu, to eat up and then it grows and grows and grows. So, there are drugs to shut Pac-Man and his cancer-feeding friends, down. Brilliant, right?!
One of these drugs is called Tamoxifen. This drug is taken once daily for, usually, ten years post cure date. It is used to combat the growth of tumors. This drug is used in premenopausal women. Some people have crappy side effects… some don’t. It just depends how each person’s body reacts, like any drug. Tamoxifen, is to my knowledge, the only current option for cancer prevention for women who are not yet in menopause {pre-menopausal}.
Another option is a type of drug called an aromatase inhibitor. An AI is a drug that works by blocking the enzyme aromatase, which turns the hormone androgen into small amounts of estrogen in the body. This means that less estrogen is available to stimulate the growth of hormone-receptor-positive breast cancer cells {according to Breastcancer.org}.
There are currently three commonly used AIs. And they show GREAT efficacy in stopping Pac-Man BUT are only effective when the ovaries are closed for business. So, they can only be used when a woman has gone through menopause either naturally, or chemically. And because I still have my ovaries, those girls had to be either yanked out or chemically shut down.
Because I was only 34 when we started discussing my options, my doc and I discussed either just tamoxifen or an option of a) shutting down my ovaries monthly with a Lupron shot and taking Aromasin every day or b)having my ovaries removed and taking aromasin daily.
Based on the current research (2016) the most effective preventative treatment appears to be the AI Aromasin coupled with no ovary production of estrogen. That has shown to be just as, if not more, effective in a five year period as compared to taking Tamoxifen for 10 years. Also, for me, a huge consideration was the fact that Tamoxifen has greater long term issues with heart problems. Having a high familial risk, I try to steer clear of anything that adds to my long term risk.
Soooooo… all that babble is to tell you that after conferring with my doctor, I decided to chemically shut down my ovaries and take Aromasin. I did this knowing that there was a huge chance that should the side effects be too great to handle {common issues/complaints are: lack of period {obvs}, major joint pain, bone loss, mood swings, hot flashes, rapid weight gain, failure to lose weight, sleep disruption, vaginal dryness, depression… really anything that comes with menopause}, I could always try two other AIs or Tamoxifen before running out of options. This option works for me because our family is complete {the hubs has been snipped}, and the side effects have been manageable.
Things that seem to help minimize any side effects I do notice are daily exercise {help with joint pain, weight gain, and sleeping}, high water intake {joint pain and hot flashes}, and a healthy diet. I notice more issues on days when I am more sedentary or eat too much sugar {more hot flashes}.
When I get my monthly Lupron shots, I also have my Estradiol level checked to make sure my Estrogen production has been suppressed to less than 20. Less than 20 is what estrogen levels are when a woman is considered to be in menopause.
Every morning, I will continue to take Aromasin. As of right now, I will repeat this regimen until I’m 39. And then, I will go back to being a normal pre-menopausal woman {ha! Like there’s a normal…}, or perhaps I will end up having a hysterectomy… only time will tell. I also have to work to keep my weight in a healthy range and eat a healthy diet. Estrogen looooooooves body fat, too.
Mostly, I am just so grateful for something to say, “oh hey there, cancer cell dudes, you don’t get to be all Kum Ba Yah in my bod. Bust up the party, fools.” And to know that there are advances happening constantly that will only make it easier to fight the disease as time moves forward.
And for now, I will just continue with the monthly visits, the daily pills, and the talks with the Big Guy and count each day that I get to be cancer-free as a gift upon gifts.
*note: I’m not a doctor. I have never been to medical school. I am just a very info-hungry patient who tries to make sense of stuff for people going through breast cancer or those who might be trying to understand the process. Also, every doctor has different opinions and way of using research studies.
