Here I am on my husband's birthday, sitting in the lab for 3+ hours for my dreaded 3-hour GTT (which luckily for me I've done numerous times due to PCOS and insulin resistance). At the same time, I was scheduled for a full CBC panel so thought, why not? Five vials of blood so far, 1.5 hours down, baby is kicking like crazy, and I could really go for a hamburger.
We met with hematology/oncology on Thursday afternoon, and so much has changed in a matter of days. My Oncotype DX (https://www.oncotypeiq.com/en-US) recurrence score came back on my tumor, and to my surprise and dismay, it indicated a high risk of recurrence. While my surgeon and I both thought and hoped I could be spared chemotherapy and move straight to radiation after delivery, that is no longer the case. With the new information, the statistics show that with both a combination of chemo and endocrine therapy, the risk of recurrence in my individual case will decrease by half. In my oncologist's words, he said I would benefit from chemotherapy and the treatment would be like "an insurance policy."
Even though I don't always feel it, I know I'm young to be diagnosed with breast cancer. At my age, I wouldn't have been scheduled for my first mammogram for a couple years yet and my oncologist said it was good that I had found the lump on my own. It's because of my age that I understand the recommendation for chemotherapy, as difficult as it was to hear and process. My logical mind could understand those facts, but the mother in me immediately thought of the child I'm carrying and what it would mean for the both of us moving forward.
We discussed timing. I had a few options. The standard is to treat pregnant patients like non-pregnant ones. A few adjustments would be made, yes, but overall chemotherapy is "safe" when it is administered in the second and third trimesters since all the baby's organs are fully formed. Does that just blow your mind or what? I had been told this by my nurse navigator the same day I was diagnosed, but hadn't been ready to process it then since I was hoping for a miracle. So option #1 is to start treatments right away. I would go through 2 phases, the first being 4 cycles of Adriamycin/Cyclophosphamide every 3 weeks since I wouldn't get the booster shot being pregnant and it would take that long for my blood counts to recover. The second phase would be Taxol every week for 12 weeks, which means when all is said and done, that is roughly 6 months of chemo. So timing is crucial. My oncologist felt I shouldn't delay, otherwise I would not see the benefit in the long run. We talked at length about chemo during pregnancy. Since I'm currently 28 weeks, he recommended that I start as soon as possible so that we could undergo 2 cycles prior to stopping at 35 weeks, before resuming treatment a week after delivery. Since my pregnancy is being followed by MFM, we agreed consultation was necessary with all providers involved to give their blessing.
I had an appointment with my OB that same evening where we discussed the risks and benefits, and she promised to reach out to MFM before my appointment the next morning. MFM consulted with my husband and me on Friday morning, covering the research on chemotherapy drugs during pregnancy and any reported incidents of issues affecting babies. We talked about coordinating therapy with a delivery date, as inducted at 35 weeks was no longer necessary but at 36-37 weeks a distinct possibility. We agreed to a referral to the NICU to prepare for a pre-term baby and what to expect. Meanwhile, baby, at 28w2d is measuring at 30 weeks, already 3 lbs 3 oz, and as my OB says, happy and snug and pretty much oblivious to everything going on outside of the womb.
By Friday afternoon, I was already scheduled for my bloodwork, 2D echo, nurse education, port placement, first 2 cycles of chemo, and follow-up nadir visits. My first chemo will be in less than 2 weeks.
Besides our families and a few select friends, we haven't updated anyone else on this new development. My initial feeling? A bit of fear. Baby and I have made it this far, through surgery and recovery, and I'm scared of going through anything else that could put him at risk. It's a bit hard to align my head with my heart, so I've been relying on my logic to move forward. My parents are currently overseas and can sense them freaking out a bit. Obviously, this wouldn't have been my choice. Who wants to go through chemotherapy? Especially while pregnant? But my oncologist assured me he's seen it done with successful outcomes and I think my MFM provider said it best when he said I need to get healthy to be around for my kids' weddings. So here I go... investing in our future.
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