My Journey Through Cancer (Part 3)

By Nancy McBride

Life is full of twists and turns, and this is my story of how cancer has ultimately blessed my life. I was diagnosed with uterine cancer at the young age of 38. During this time, I kept a journal of my doctor visits, thoughts, symptoms, and struggles so that I could tell others how to pray for me and my husband Shane. After a successful hysterectomy, we learned that the cancer was present in my lymph nodes, and I would need to start chemotherapy and radiation. All of a sudden, everything became so much more chaotic. I had appointments to schedule, new doctors to meet, questions to ask, and decisions to make. It seemed overwhelming at times, but God was so gracious to give us clarity and peace in the storm. I invite you to read snippets of my journal entries to see how God worked through the chaos.

We just got back from our consultation visit with the chemotherapy doctor, and here are some highlights of the visit. Based on the PORTEC 3 study, chemotherapy and radiation are used together for stage 3 uterine cancer to minimize risk of recurrence. Both should start on the same day. During the first phase of treatment, chemo is about 5 hours once a week, every week for 5 weeks. Radiation is 5 days a week, every week for 5.5 weeks. Chemo will consist of a drug called cisplatin for the first 5 weekly treatments. Cisplatin works with radiation to kill the cancer cells. The primary side effect of cisplatin is nausea, but there will be several anti-nausea medications that I will take to help with that. After the 5 weekly treatments, there will be a 2-3 week break for recovery. Then they will switch to two different chemotherapy drugs, carboplatin and paclitaxel, for the second phase of treatment. Both drugs will be administered once every 3 weeks for 12 weeks. During this phase, hair loss will likely occur about 2 weeks after the first treatment. After treatment, my hair should grow back like normal.

I just want to say how blessed I am to have such an amazing husband. He knows exactly how to calm my nerves down when I'm stressed (which is not always easy to do), and take some of the burden off my shoulders,... and he does it in such a loving and gentle way. I had a mini meltdown yesterday because I was literally receiving and making multiple phone calls with five different doctor offices, and trying to coordinate the start date for my treatment. I was trying to set things up according to when I thought things needed to happen. The reality is, (and Shane gently reminded me of this yesterday) we are running a marathon, not a sprint. A few days difference in beginning treatment is not going to have a negative effect on me.

It's sometimes easy to forget, especially in the middle of the cancer storm, but God's got this. He will keep fighting my battles (and He does it so much better than I ever could), and His timing is perfect. I have to keep reminding myself of that. Not only that, but I am so grateful to have a husband who loves and cares for me so much that he reminds me of these truths, not only through gentle, encouraging words, but with his actions. I couldn't have asked for a better partner to walk with me through this journey.

We met with my radiation doctor today, and learned a bit more about the PORTEC 3 study. He explained that for those uterine cancer patients with high risk of recurrence, doing the combined chemo and radiation treatment increased their 5 year survival rate from 70% to 80%. Again, he said that each individual case is different, and given that my situation is considered early stage 3 cancer, he would expect my number to be higher than 80%. But there's no way to tell how high that percentage is.

Radiation will be external radiation, 5 days a week for 5.5 weeks. Every treatment session will require positioning to make sure I am getting the radiation where it needs to go, and make sure the damage to surrounding organs is minimized. The actual length of radiation during each appointment is only a few minutes, and I shouldn’t feel anything. The side effects of radiation don’t occur until about 3 weeks into treatment. They include increased frequency of urination and defecation, possible diarrhea, and possible fatigue. Basically when the bladder, rectum and small intestine become irritated and inflamed from radiation, they have a tendency to move body fluids through faster, and have less tolerance for holding stuff in. These side effects will likely improve after treatment ends. The ovaries will atrophy with treatment, but it’s unknown when menopausal symptoms will hit.

After all this, I had a CT scan done of my pelvic area with and without contrast. They had to make 3 small tattoo markings in that area to make sure the radiation placement was exact every time I came in. They do all this to simulate on a computer where all my organs are located in my pelvis and how they will apply the radiation and minimize exposure to unnecessary areas. I believe the target start date for chemo and radiation is set for May 13th (5 weeks out from surgery), but that will depend on whether or not they can complete the simulation before the end of next week.

We went to see another gynecologic oncologist for a second opinion on treatment. She came highly recommended by my oncologist when we asked him for a few names. I would have liked to see her before I had my surgery, or even soon after, so we could have more time to consider our options if there were differing opinions, but the timing just didn't work out. Still, we figured that it would be worth seeing her now, even though I'm a few days away from beginning chemo and radiation.

In regards to treatment, this oncologist had a similar approach: she also recommended chemotherapy and radiation. However, she recommended 6 cycles of carboplatin and paclitaxel (which are the same chemo drugs I will be given during my second phase of treatment), and targeted radiation (vaginal brachytherapy) at the site where the cancer is most likely to come back - which in this case is the inner vaginal lining. We talked extensively about why she would choose a more conservative approach, and wouldn't recommend more generalized pelvic radiation. Her opinion is that some studies don't show any added benefit to doing pelvic radiation. Based on this information, she would rather do a more targeted approach to spare my bone marrow. Her estimate is that I could lose up to 20% of my functional bone marrow with pelvic radiation, and that could mean more difficulty in treating the cancer if it comes back within 5 years. Once an area of the body is radiated, you can't radiate the same area and expect therapeutic results. In addition, with the loss of functional bone marrow, it would make any future chemotherapy more likely to cause irreversible anemia, immunodeficiency, and clotting disorders. She believes that it is only necessary to target the area where the cancer is most likely to return with radiation, and let the chemo do the job of killing any cancer cells in the lymph system.

I will be honest - I left the visit more confused than when I came in. Thankfully Shane was there to help me narrow down the main question: do we go with vaginal brachytherapy, or stick with pelvic radiation? No matter which route we go with, I have to be comfortable with that decision, and it has to feel right to me. We decided that it would be best to have my oncologist weigh in on her opinion, so I called him and spoke with him in the late afternoon. Again, we talked extensively on the topic, and my main takeaway is that he would prefer to be more aggressive in treating the cancer now so that it never comes back. He is not interested in going with a more conservative route to "save some bone marrow for later" in case the cancer comes back. He wants to get rid of it for good. He did reiterate that there is no consensus on when to add radiation and when not to add it in my situation. He even said that if I felt strongly about vaginal brachytherapy, we could do it. But, if it were a family member asking him this question, he would recommend pelvic radiation to have more efficacy in treating the pelvic lymph nodes. If the cancer did come back, it would be harder to treat regardless of what type of radiation I chose now. He also added that if I really wanted vaginal brachytherapy, my ovaries would have to come out now because targeted radiation won't affect my ovaries, and the chemo alone won't shut them down as effectively as pelvic radiation.

After talking with my oncologist, I felt a huge sense of peace about his recommendation for treatment. I truly believe that the Holy Spirit has guided us to where we are at. Yes, there will be more temporary and permanent side effects with pelvic radiation compared to vaginal brachytherapy. But I absolutely do not want to go through something like this again, especially knowing that it may be harder to treat cancer the second time around. (To be continued…)

I knew after that phone call with my oncologist that God's hand was guiding us all along. The overwhelming peace and clarity I felt with our treatment decision was undeniably His Spirit, telling me, “This is the way. Walk in it. I will take care of you. Trust Me.” Next month, I will share my experience with chemotherapy and radiation, and how God strengthened and protected me throughout my treatment.