Radiation Oncology

Today was my follow-up appointment with the general surgeon (Dr. Lal) and the first dedicated appointment with the radiation oncologist (Dr. Schulz).

Dr. Lal is also pleased with the way I'm healing and how even I appear, which apparently isn't common with the spacers (?).  She also took off the steristrip over the lymph node removal scar and said I could leave it uncovered.  Basically, she said I'll be seeing lots of other doctors in the next 6 months to a year and they'll be monitoring my "breasts" for lumps or other signs of recurrence, but after that time, she will be the one I see for follow-up and clinical breast exams.  I'm okay with that, because she's awesome.  :)

Then I met with Dr. Schulz and he went into somewhat greater detail about radiation.  The start date will be 3-6 weeks after my final Taxol infusion.  If all else goes according to schedule, that should be about June 24th.  I will still be having Herceptin via the port, but it does not interact with radiation like the A, C and T do, so I can have it alongside the radiation.  Radiation will be 5 days a week (M-F) for 5 1/2 weeks.  Unlike chemo, the side effects of radiation develop in a cumulative manner.  Supposedly the first few weeks aren't a big deal (and each appointment is only 15-20 minutes), but then the two most common side effects start to build.  Skin irritation (ranging from slight pink to peeling blisters) and fatigue are the likely side effects, both lasting for up to a month after radiation is done.

I asked Dr. Schulz why chemo is done before radiation, as I had an inkling but wanted to know for sure.  I know that chemo is sometimes done after surgery and sometimes before surgery (if a tumor is very large and/or seems to have reached into lymphatics and/or surrounding muscle, the goal is for chemo to shrink it first), but always seems to be before radiation.  He explained that research has shown (and even told me which research--the group, the n size, etc.) that likelihood of recurrence is lesser, and survival is greater, when chemo goes first.  The reason is the chemo is systemic, so if there are any escaped cancer cells in the body, you want to get them first before they can settle in and set up house in another location.  Radiation is localized, and since there was lymph node involvement and the tumor was near the chest wall, recurrence there is more likely, so you want to hit it with more than just chemo--thus the radiation.  But metastasis is worse than the local recurrence, so chemo first.