and now?

Had a little break from blogging, and from everything, I've been really tired and in fact working quite hard marking what feels like hundreds of papers but now I feel ready to blog again and move on.

So, what now?

In a word - Tamoxifen - an anti-hormone man-made drug which must be taken for a period of 5 years, daily.  This drug, and other related drugs which inhibit the hormone oestregen which, as my tumor was tested and found to be hormone-receptive (the oestrogen receptor test), could be one of the culprits in making an favourable environment for the tumor to develop and grow.  So, as far as I can see, Tamoxifen sort of takes away the 'food' to help further cancers develop in my breasts.  My tumor was both oestrogen and progesterone receptive and Tamoxifen is reccomended for both.  The pill must be taken every day at around the same time (you choose the time) and if you miss one, you don't take a double dose as Tamoxifen is not easily eliminated from the system so there will be still some sticking around even if you miss a pill.

This kind of treatment is called hormone-therapy and is an adjuvant treatment.  It is not really a form of chemotherapy.  In breast tissue Tamoxifen acts as an anti-hormone.  Tamoxifen has been used for 30 years now.

Tamoxifen is generally considered one of the very best anti-cancer medicines because

a) it is effective in reducing the risk of recurence and death in women who have had breast cancer.  It is also effective in reducing the risk of getting a second breast cancer.

b) there are tests which identify women like myself who are most likely to benefit from taking it.

c) for most women the side-effects of taking it are very mild, although some women may have severe effects and some women even die as a result of taking it (it has to be said).

The benefits are - reduced risk of a a metastatic disease, reduced risk of developing a local recurrence, reduced risk of a second cancer in the other breast and reduced risk of osteoporosis bone fractures.

The side effects of taking this drug can be
- increase in hot flushes
- weight gain (this may be due to the menapause, or not)
- depression (this is not entirely proven apparently)
- increase in vaginal dryness
- increased risk of endometrial cancer and endometrial changes (4 x the usual risk)
- increased risk of blood clots in legs, lungs or brain (1%)
- increased risk of cataracts (about 2% increase)

I spoke to the female oncologist (who in fact I prefer, I feel I get a much straighter answer from her) during my end of radiotherapy appointment when she prescribed the drug.  I had done a hormone blood test beforehand and for her, I was nowhere near the menapause so Tamoxifen was the drug of choice because it's mainly for pre-menapausal women.  Her opinion was the the endometrial cancer was rare but needed keeping an eye on, to avoid blood clots I had to walk a lot and cataracts are rare.  The other stuff, well yes.

A few days later I had a meeting with Dr Pink who did a scan of my uterus to use as a 'control' example so that any changes could be noted.  He noted that the lining was thin (which is a 'good thing' apparently).  He also did a smear test cos when you've got your knickers off and your legs apart in front of a guy with a speculum in his hand, why not?

So, I pervaricated for a few days and looked at the tablets and googled 'I don't want to take Tamoxifen' and found all sorts of horror stories.  But then I took it and have been taking it for over a week now.

I expect the effects will come over time although I have already had two nights when I got very hot (not drenched sheets or anything, but covered in perspiration) which meant I kicked off the covers then got really cold and put them back again and it comes around like this again and again, so those two nights were difficult as I didn't sleep well.  I also have a constantly nasty after taste in my mouth since I started the drug, which is unpleasant.

The blood test also showed that I was low in Vitamin D so I have to take 3 doses over 9 months together with a twice daily calcium tablet (I only take one as they make my tummy bad) as calcium can help you absorb vitamin D.  I still prefer that trip to Australia though.....