4/25

两位25女。。。

5、10年

这阵子，脑海里时常浮着“5年”、“10年”这两个名词。是有一点担忧、忐忑。

如果在以前，你问我5年后我会怎样，我会回答你说，“应该还是一样”。
但是，现在的我，已经没有以前那么乐观了。
我一直认为这次的病发，都是上天给我一个重新认识自己、爱惜自己的机会。自己还能走多远，就是得看那5年、10年了。

5年、10年，都是医学界对于癌症病发以致死亡或者癌症复发，通用的一个期限。

Diarrhea

Finish 1 roll toilet paper for each day...
Lose 2kg in 3 days...

Luckily only diarrhea but no stomach pain...

Has been at border for weeks, now finally < 70kg oredi...

Decided therapies

I have been quiet for weeks, because I need time to think about what therapies to go for.

After weighing the pros / cons and my cancer stage, I have decided not to undergo any western therapies that are recommended by doctor. I do understand the good intention of the therapies, and I should not undertreat my disease.

In fact, I will take alternate therapies, a combination of below:
- Consume healthier food, reduce meat and chicken intake
- Chinese medication
- Consume fresh vegetable and fruit juice few times a day

Am going to write emails to update some of the doctors, and am sure they will persuade + advice me further. Will see la...

Side effects after surgery & CT Scan?

Have discovered serious hair drop and dandruff problem these few days.

Are these the side effects after
- the radioactive contrast material that was injected for CT Scan, and
- the electronic wave from the CT Scan machine, and
- the anaesthesia used for the surgery
???

3rd Oncologist Advice

Went to meet Dr Manivanan from Wijaya International Medical Centre, located at PJ.

He first examine my report and body.

Some simple practical rules from him
- mastectomy, no need radiotherapy
- ER/PR -ve, must do chemotherapy
- ER/PR +ve, do hormone therapy

About radiotherapy, IMRT is only suitable for organ or area that is in inner body, like kidney, stomach etc. 3D  CRT is the most common and suitable used for breast cancer, as it is considers located at outside of the body, with minimized radiowave into other body organs. About 1% of lung will get damage, the wave will kill the lung cell; 1cm depth start from the edge that is close enough to the breast. He suggests to do 4 weeks shooting on whole breast and another 5 days for boost. Side effects are similar to what other doctors said, darker skin (temporary), nausea, cough, vomit etc. Dr Azrif from Prince Court told me there will be 3 tattoo dots on my body, but Dr Manivanan says there will be only removable marks but not tattoo. Somemore is invisible marks. Cost is about RM15k to RM20k, Dr Mani give me an estimated figure only.

There are 2 types of drug being used in hormone therapy, i.e. Tamoxifen and something called Armidex (not sure about the spelling, assuming this is correct now). Tamoxifen is a very old medication, which is being used for almost 30 yrs. It is very effective and less expensive. Armidex is being used for 5-6 yrs (most is 10 yrs only), better than Tamoxifen in a way, it reduces the side effects. But is about 5-7times more expensive than Tamoxifen. Less assume Tamoxifen is about RM100 / month, this Armidex will cost RM500 or RM700 per month then. According to Dr Mani, Armidex can cause osteoporosis. These medication will actually stop cancer cell from attaching to ER, but not to stop ER production. This is something I misunderstand about this medication previously.

If cancer come back again on the same breast, definitely it will at higher stage and chemotherapy is a must by then.
I dont have the option to do only radiotherapy but not hormone. If decided to go for therapies, must do both.
It is useless to only start the therapies at 6 months later. He mentioned something like, the therapy must start as soon as possible after surgery, otherwise is not much helpful for the cure. He used one very technical term when trying to explain to me, but, I couldnt catch.

4th Oncologist Advice

Made an appointment with Dr Ho Gwo Fuang from UMSC at 5.30PM, but only able to go into his room at around 7PM.

Before I meet him, one of my fren told me that she did meet Dr Ho at UMMC for her father's disease. My fren says he is a very soft spoken doctor (till my fren hardly to catch his words each time) that makes her dont have much confidence in him. I also feel hesitate to see him after I heard my friend's comment about Dr Ho. But luckily, I met him, and I got some useful information from him. He is a nice doctor and willing to spare me information.

He is scrupulous and smart. He gives me a very good impression for the start!
I passed him the pathology report, he read through. While he is reading, I start brief him about my journey, how I detected the lump and end up surgery in Prince Court. He noticed from the report that I have another lump in right ovary! This is what other doctor didnt noticed, may be except Dr Azrif, since he is Prince Court and can access my CT Scan report easily.

Dr Ho requested the scan report from me if I have. I passed him the CD (soft copy) of the CT Scan, I myself also never open it. I thought it is definitely something I will only get ??????? in my brain when I open it. It is an interesting CD . It contains a software which can open a series of images saved in the CD. These images are the images took by the machine during the scan. I can see all my body organs, lumps etc clearly! Dr Ho also shows me where my ovary and breast lump is.

I only discussed radiotherapy and hormone therapy with him, as I told him that whether will or will not he recommend chemo to me, I will insist NO to chemo.

He started with me discussing the ovary lump, which is something not in his scope . By using the images in the CD, he shows me that my lump is "light" color inside. He says this tumor is undecidable on the type as it is not something "dark" color like the edge of the tumor which can classified as a cyst. He recommended me to see Dr BK Lim from UMSC. He says he is a nice doctor.

About radiotherapy
- 3D CRT
- Commonly 5 weeks shooting for whole breast, and 1 1/2 weeks for boost. But studies shows that 3 weeks whole breast shooting is also efficient enough for the cure. Therefore he recommended 3 weeks and follow by 1 1/2 weeks boost for me. This treatment will be conducted in SJMC.
- Lung damage, about 1cm depth, starts from the edge closest to breast. But this damage is not significant to us, but yes to a marathon runner.
- Without radiotherapy, it is about 25% to 30% local recurrent. With radiotherapy, it reduces to < 5%.
- Use marks but not tattoo. There is option for me to choose. Mark is fine and good enough for breast.
- Treated breast is firmer, tends to be long term. But degree is patient dependent.
- Treated breast will be swollen.
- Treatment course will take 4 weeks in SJMC, and will meet Dr Ho once a week or once every 2 weeks.
- Treatment must starts within 6 weeks after surgery. Therefore I must decide before end of February.
- Cost is a little bit cheaper than other hospital.

About hormone therapy
- When consuming Tamoxifen, cannot get pregnant as it is harmful to baby.
- < 50 yo women get more benefits from chemotherapy.
- >= 50 yo women get more benefits from hormone therapy.
- http://www.adjuvantonline.com, a website that shows me some statistics about the relapse and alive rate. This is the tool Dr Harjit is using that day!
- ovary ablation will stop ER production, but not Tamoxifen.
- Tamoxifen is to stop cancer from attaching to ER.
- AI, another name (?) of Armidex that was told by Dr Manivanan, is more effective for women in post menopause. AI can be prescribed following by ovary ablation. But the result is not significant for women > 30 yo. The result of Tamoxifen as compare to ovary ablation and follow by AI is the same.
- AI will cause osteoporosis.
- Something new to me, Tamoxifen will pause menses, uterus lining get thicker after some times, could then cause uterine cancer, especially to post menopause women. But reported case is only about 1%.

Before I leave his room, Dr Ho told me Dr Azrif is his best friend.

2nd Oncologist Advice

Went to Prince Court Medical Centre to meet Dr Azrif today.

Unexpectectly, he is a nice guy, and give me confidence to undergo my treatments with him.
He anwered all my doubts, like, some ppl says radiation will cause recurrent of cancer in another breast etc.
He also explained to me, about the radiation methods that I have learned online, 3D CRT, IMRT and IGRT.
IMRT - Low dose wave shoot into our body from every angle (front, side and back), and only high dose focus on the breast. Therefore, lung will also receive a lot low dose wave.
3D CRT - Low and high dose shoot front ftont and focus on the breast. Therefore, only the top layer of lung will receive the low dose and high dose wave.
IGRT - is type of technolgy that is also used in the above 2 methods.

According to him:
- Breast cancer can mainly categorized into 3 groups, i.e. ductal, lobular and misc. About 75% of breast cancer is ductal cancer, and 20% for lobular, and 5% for misc. Tubula, Mucinous, Papillar, Medullary are some of the rare type of breast cancer under misc category.
- My cancer type is rare type, and is not as dangerous as the ductal cancer, therefore he suggests me to undergo radiotherapy and hormone therapy only.
- Radiotherapy will last 4 weeks, 3 weeks for entire breast shooting and last week is boost shooting which focus on the lump area only.
- About 20% of young breast cancer patients that undergo radiotherapy will still have recurrent of cancer on the same breast, but it reduce to 10% only after boost shooting.
- He suggested 3D CRT for me, which he think this is best for me as it minimize the low dose wave to other organs in the body, especially the lung. Which indirectly to minimize the damage to the lung.
- Sample of side effects: Redness, peeling expecially underarm and breast, skin darker (temporary) and breast becomes firmer (permanent).
- Tamoxifen will cause irregular of menses cycles, or in worst case, will cause menopause.

1st Oncologist Advice

Today, I met Dr Christina Ng at Sunway Medical Centre, to discuss about the treatments that she will suggest to me if I decided to undergo the treatments under her supervision.

She made a call to Prince Court Medical Centre. After getting the detailed lab result of the tumor, that was not printed in the pathology report, she suggested the 3 most popular and common therapies to me, as expected. They are chemotherapy, radiation, and hormone therapy. Therapy will be carry one one after another. Chemotherapy will start first. Chemotherapy is suggested due to I am fall into young age category.

The discussion, somehow is a bit disappointed me, although this is the expected result. Some online articles and information gave me hopes that I might not need chemo and radiation base on my pathology report. But the result of discussion is in opposition.

Chemotherapy
6 cycles, 3 weeks once.
Will finish in about 4 months time.
The quality of drug that they are using will not cause much nausea, but hair lost is confirm.
Will cause < 1% heart damage.
In most cases, other organs will recover after chemotherapy.
Should start on 16 or 17 Feb 2011.
Total cost is about RM20K.

Radiation
25 sessions, finish in about 5 weeks, from Monday to Friday.
Using external beam.
The good radiation machine / chemical material will not cause damage to lung and other organs.
Focus on the whole breast.
Total cost is about RM12K.

Hormone Therapy
Tamoxifen will be used, which to stop the body from making estrogen.
Menses will be stopped.
Side effect similar to menopause.

Shortlisted oncologist

With frens' help and online information, I had shortlisted 3 oncologists and I am going to meet them to get consulation about the treatments. They are Dr Christina Ng from Sunway Medical Centre, Dr Ho Gwo Fuang from UMSC, and Dr Azrif from Prince Court.

Tomorrow is the first meet up with Dr Christina, and then Dr Azrif on Saturday, lastly Dr Ho on 7th February.