2013.05.16: 12 - Another Relapse

我与癌 (12-再次复发) 2011年3月，距上次化疗结束8个月，经PET-CT证实，癌又赖上我了。 这次复发，因部位较多，不是手术适应症。E 医生仍然语气温和而坚定地对我说，Do't worry, there are plenty chemo we can try. I'm sure there is one which will be effective on your cancer .  这也是我为何厚脸皮返回成为他的病人的重要原因之一。前次复发手术后，化疗期间，我曾想不再打扰E医生，因他是妇女肿瘤外科医生，工作以手术为主，一周只有半天门诊，多数我都与他的护士G打交道（护士G是我迄今为止所见到的最具责任心和 专业性又超棒的护士）。在护士G的推荐下，去看了S医生 （Hematology/oncologist)，化疗结束后，自己感觉S医生不太适合我。 E医生建议采用前次对我有效的Doxil+Avastin。没料到保险公司竟拒绝我用Avastin，E医生便主张我先上Doxil赌一回，如果有效，那我真是走大运了！同时继续与保险公司交涉。 对Doxil我可是情有独钟！也许就是因它的红色，一旦进入我的血液系统，就将自身的造血功能搅的天昏地暗。只能靠Neulasta 的帮助来保证我的白细胞达标，但也带来了烦人的背部结椎痛并发低烧，幸亏有Tylenol与以解救。另当别论的是它对心脏功能的损害，然我心依坚不可摧，无大碍。 做了三个疗程的Doxil后，效果不够乐观。Ca125反而从87升至242（很难判断是否有效，因它的副作用也能导致Ca125的上升）。让我难以忍受的是腋下皮肤的过敏反应，如擦伤。E医生给开的Cream使我的皮肤得以恢复得又快又好。赞一个！ 保险公司终究还算通情达理，给Avastin用于我的治疗开了绿灯。E医生经全面考虑，认为我应转用Topotecan+Avastin，预期会有效，且副作用轻。Topotecan 是作用于DNA复制的一个环节。Avastin 其实是一个抗血管形成的抗体。因癌生长周期较其它组织短，代谢快，供以营养的血管也相对丰富。如切断癌周围的血循环，癌细胞自然也会被饿死，从而达到抑制或消灭癌组织。多药组合化疗会增加药物有效的保险系数，但同时也会带来更多的副作用。 对于卵巢癌的治疗，第一，第二线的药物应用有规则可循，到了第三，第四线的药物就全凭医生的经验和患者的体力加上天的旨意行事了。医生和患者有良好的沟通就显得特别重要。这只是本人的拙见。 感谢弟媳在此期间对我无微不至的照顾。不仅自己要学习进修，还陪我做化疗，帮助料理家务。感谢朋友J从我得癌以来不间断的问候和随时对我的有求必应，并抽时间和我共进午餐，帮助解答我的疑问。 日子也就这样在磕磕绊绊，反反复复地与癌较量中流过。我面对治疗中的态度相信也影响着小闺女的成长。5月，迎来了她初中毕业，因三年的Car Pool和同学父母的友谊将成为美好的回忆。我感谢小闺女带给我的一切，她从小学就自己搞定早起，早餐和备午餐，中学开始负责全家Landry，成绩也越来越好。还总是乐呵呵，一幅与世无争的样子。 我接受一轮Topotecan+Avastin治疗后，2011年8月，Ca125降至77!  有效！

Me and Cancer (12 - Another Relapse) In March 2011, 8 months after I finished my last round of chemotherapy, it was confirmed through a PET-CT scan that I had cancer again. Since this relapse was in more places, it wasn’t really suitable for surgery. In a gentle but firm tone, Dr. E said to me, "Don't worry, there are plenty of chemo treatments we can try. I'm sure there is one which will be effective on your cancer." This is one of the most important reasons why I went back to become his patient again. After the surgery following my previous relapse, during chemo, I had decided not to see Dr. E anymore, because as a gynecologic surgical oncologist, he primarily performed surgeries and saw patients for half a day every week, so most of my interactions were with nurse G (nurse G is one of the most responsible, professional, and awesome nurses I have seen so far!). Through nurse G’s recommendation, I went to see Dr. S (hematology/oncology), but after my chemo was over, I felt that Dr. S was not right for me. Dr. E recommended I use Doxil and Avastin, which had worked for me before. But this time my insurance wouldn’t cover Avastin, so Dr. E recommended that I start on Doxil: if it worked by itself, then I could count myself lucky, and at the same time I would  continue to negotiate with the insurance company. I’m old buddies with Doxil now! Maybe it is because it has a red color, but once it enters my bloodstream, it completely destroys my hematopoietic function. I can only rely on Neulasta to keep my white blood cell count up, but this also has unpleasant side effects like back pain and low-grade fever. For these I use Tylenol to help. Another thing is that it negatively affects the heart, but my heart seemed to be indestructible, so nothing serious there.   After three cycles of Doxil, the outcome was not looking good. My CA-125 level rose from 87 to 242 (but it is hard to know how to interpret that because one of the side effects can be an increase in CA-125 levels). What was unbearable for me was the skin reactions I got under my arms, which were like abrasions. Dr. E gave me a cream that helped my skin quickly recover very well. I like this one! The insurance company finally ended up being reasonable and gave me the green light to use Avastin. Dr. E had already fully considered and thought I should use Topotecan and Avastin, expecting it to be most effective, with milder side effects. Topotecan’s mechanism of action is on DNA replication. Avastin is mainly an angiogenesis inhibitor. Because cancer cells have a shorter growth cycle and faster metabolism relative to other tissues, their blood vessel supply is accordingly more abundant. If you cut off blood circulation around the cancer cells, they will naturally be starved to death and cancer tissue can thus be eliminated. Combination chemotherapy increases the odds of success, but will also lead to more side effects. The first- and second-line treatments are fairly established, but at the third and fourth line, it all depends on the doctor’s experience, the patient’s ability to tolerate treatment, and fate. It is especially important for doctors and patients to have good communication. But this is just my humble opinion. I want to thank my sister-in-law for taking care of me during this time. She was not only continuing her own education, she accompanied me to chemo treatments and helped with chores. I also want to thank my friend J for constantly checking up on me and helping with anything at the drop of a hat: having lunches with me, and helping to answer my questions. My days are a repeated battle with cancer. I believe my attitude toward cancer treatment affected my younger daughter growing up. In May, she graduated from middle school, and the friendships of three years of car pools with students and parents became fond memories. I thank my daughter for everything she has given me: since elementary school she woke up, ate breakfast, and prepared her lunch all by herself; in middle school she started doing laundry for the whole family and her grades started going up as well. All while being constantly cheerful, without a contention with anyone. After going through one cycle of Topotecan and Avastin, in August 2011 my CA-125 level dropped to 77! It is effective!