Disclaimer: everything in this post is accurate to the best of my understanding. We've gotten a lot of information thrown at us in the last week, and I am not an expert in this field. I may not have all the details quite right at this point, but hopefully close enough. I am also writing under the assumption that will I tolerate the medications well and that the treatment will be effective. So here we go!
I have Diffuse Large B-Cell Lymphoma (DLBCL), which is the most common type of non-Hodgkin lymphoma. Although it typically presents in much older people, there is a sub-type that presents in young women in their chest. It is very treatable, but it is also aggressive.
When my tumor was first measured, it was 8.5 x 9.5 x 7 cm - for all you sports fans out there, that is bigger than a baseball. It is large enough that it is causing me pain, but vicoprofen is helping with that.
The best news that we've received so far is that my PET scan was clear (except for the mass in my chest, obviously). We are waiting on the results of a bone marrow biopsy just to make certain, but that is expected to come back clean as well.
We had all of my scans and reports sent out for a second opinion, although we don't expect anything to change. Apparently, I am pretty much a textbook case, but it never hurts to have someone else look.
I am scheduled to start chemotherapy on March 31st following the R-CHOP protocol (rituxan, cytoxan, adriamycin, vincristine, prednisone). We are looking at 6 cycles of 1 dose every 3 weeks, so 18 weeks total. After each treatment, I will need to get a Neulasta shot to keep my white blood cell counts up and lower my risk of infection. If my red blood cell counts drop too low, I may have to get a transfusion. I will lose my hair, and there are lots of possible side effects, but they should only be short term issues. My oncologist doesn't think that radiation will be necessary, so we will be done mid-July.
Things that have to happen before then:
- Port insertion: I will need frequent blood draws and IVs over the next few months, and all that wear is hard on the veins. More importantly, some of these drugs can cause serious tissue damage if it is not injected into the vein properly. A port addresses both of those issues, so I'm getting one put in next week.
- Muga scan: adriamycin can be hard on the heart. They need to check my heart function before hand to make sure there isn't anything extra they need to monitor.
- Fertility counseling: in general, there is a risk of loss of fertility with chemo. My oncologist does not think we will have an issue, but we are meeting with a fertility specialist to discuss our options.
- Teach with my nurse: we have an appointment to go over all of this information again and more with my nurse. We'll get more information about things to watch for and things to avoid, and get another chance to ask any questions we've come up with by then.
One more thing that we discussed, which doesn't need to happen before starting chemo, is that we should see a genetic counselor. When you combine the fact that I am 28 and have already had two malignancies with the cancer history in my family, you have a very strong case for seeing a genetic counselor and doing some further investigation. My oncologist recommended it, though if he hadn't, I would have brought it up. We still have to get this scheduled.
If that wasn't enough information for you, there is a good lymphoma resource available from the American Cancer Society (http://www.cancer.org/cancer/non-hodgkinlymphoma/). And for anyone who wants to read more about the drugs in my treatment plan, you can look them up at http://chemocare.com/chemotherapy/drug-info.
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