Treatment Phase 2 begins on 2009.06.01

i'm going to call the radiation+chemo treatment i received in 2008.12 and 2009.01 Phase 1. At the time, i thought it was the only treatment i was going to get for my cancer, but i had totally underestimated my adversary's power over me. Phase 1 was completed in Toronto. Now i've moved to Taipei and will begin Phase 2 on 2009.06.01.

Phase 2 includes radiation and chemotherapy, similar to Phase 1.

The chemo will be the same, except that in Taiwan, i will check in at noon and stay overnight at the hospital to receive the weekly chemo. The medicine used is called Cisplatin. It is the same as what i had received in Phase 1. This medicine needs a lot of fluids to wash out in order to preserve my kidneys. Therefore, i'll be given several bags of saline solution during my chemo stays at the hospital. (In Canada, i was simply told to drink 2 litres of water a day. My chemo sessions there only consisted of 1 bag of saline and 1 bag of Cisplatin.) As such, i'm not so hopeful that i would be unaffected by the side effects. But the good thing is that i won't need any catheter (人工血管) installed on my chest or arm for the i.v. Cisplatin is covered by insurance (健保) but hospital stays are only partially covered. Double room is NT$2,200 per day and single room is NT$4250 per day. Hospital food is about NT$390 per day. i will receive 6 chemo sessions in Phase 2. (In Phase 1 i only received 5 sessions of chemo.)

Radiation will be targeted at my abdomen area, as opposed to pelvic area in Phase 1. i was told that the upcoming radiation will go easier on me compared with Phase 1 because i'm paying a little extra money (about NT$28,000 for the course of Phase 2) to receive a better targeted radiation treatment. My Phase 1 radiation was basically a boxed-area treatment - hence the damages to my intestines. Hopefully Phase 2 radiation will only aim at the cancer cells and avoid my good cells, so as to minimize damages and side effects.

The radiation oncologist believes i will be able to work during treatment. However, i'm not so optimistic after speaking to the chemo oncologist.. In any case, whatever they say i may or may not experience is really irrelevant to me, because everybody reacts differently to these treatments. i will know how i feel when the time comes.. which is soon enough!!

Phase 2 is expected to be 6 weeks but the exact time frame isn't determined yet. i will go to the hospital 5 days a week to receive radiation, and stay overnight one day per week to receive chemo.

i was told that there's some unidentified water in my abdomen (腹水) that needs to be monitored. The dr said it could be cancerous, or it could be my body's reaction to the existing tumor. In any case the water is too little to be analyzed right now so we'll have to wait and see.

Phase 3, adjuvant chemotherapy, will begin a few weeks after Phase 2 ends. The date is not determined yet because it depends on how i react to Phase 2. Phase 3 will be chemo only. There are two options for me: 1) Cisplatin + Taxol and 2) Cisplatin + Topotecan. i will be given chemo once every 3 weeks, and i will need 6 cycles = 18 weeks in total. Cisplatin is covered by insurance but Taxol and Topotecan are self-paid. Option 1 will cost about NT$30,000 per session with 1 day of hospital stay, and option 2 will cost about NT$20,000 per session with 2 days of hospital stay. The dr said both provide about the same results but the side effects are different. i'm still trying to understand more about the two before i decide which to go with.

Cancer it is.

i just received the call from Dr. Chung at Sun Yat-Sen Cancer Center. He confirmed that the thing giving me trouble is indeed cancer. I'm glad we didn't get an inconclusive biopsy result because if we did then the treatment will be very difficult to plan. As it is now, we have no more doubt, and the dr can let us know precisely what our next steps are. We will see him first thing tomorrow morning and i will also have my radiation treatment planning session then. i think it means i'll get tatooed again (just a few tiny black spots) which will help aligning my body under the radiation machine so they can accurately beam me every time. i think radiation will start on Monday and it will be everyday from Monday to Friday, 10 minutes per day, and I will receive supplementary chemo once a week that will strengthen the radiation treatment. This treatment will take approximately 6 weeks. Then i'll get a couple months break before the chemo regime. Anyways. More details to follow on that.

Thanks for all of your prayers for me. Please don't be distressed by my illness. I'm happy about the biopsy result because it provides us a clear direction and there are proven technologies that will be used to take care of my case. And this time around, i have a much better connection with the doctors and nurses - oh man, language really matters in times like these... for me anyways! i'm much more communicative to the doctors and nurses in Taiwan. And i intend to be a good patient. So, please don't worry about me :)

waiting for biopsy results

the biopsy was done yesterday. it was quite painful, not where they poked me (they applied some local aesthetics), but i started having tummy crams half way through the biopsy. the pain was pretty bad. afterwards, they gave me a shot of pain killer, which finally killed the pain for me. but it also made me very super drowsy so i pretty much slept the rest of the day.

now i'm waiting for the biopsy results.

some people say waiting is the worst but i'm not so sure about that. at least right now we are not 100% certain it is cancer.. this might be a better thought than what the results are going to tell me in a couple of days.. whatever.

the doctor is being very realistic with us. he said, if it is cancer, this is going to be my last chance to fight it. we'll discuss the treatment plan in detail based on the biopsy results. but just to give us an idea, i'll most likely get radiation treatment for 6 wks daily with supplementary chemo once a wk. then rest for a month or two. then 4 months chemo. chemo scares me but i have to do it if that's what it takes to get rid of cancer..

these days i keep my mind occupied with shopping and reading (recently, thrillers by James Rollins). i try think less about the upcoming treatment, my sickness, my odds of survival, and what i should do right now in case my life shall end prematurely, etc. i don't want to be strong - what is being strong anyway? i don't think i'm strong. i rather avoid thinking about it altogether. i'm more at peace that way. i'll do what needs to be done to rid of the cancer but i don't want to think about cancer all the time.

i've read somewhere and also heard people telling me if i think positively it would help me get better sooner. but if thinking positively can be so effective, i should never have got cancer in the first place. i was so convinced i was at the height of my health about half a year after delivering evie. i felt good about myself. i was active because of evie; i was eating healthy because of breastfeeding. i was feeling great. then i got cancer. ok, fine. deal with it. i went through the 2 months treatment, all the time thinking after this was over, i'd say goodbye to cancer. i was so confident about returning to health. and now i got this new tumor. so you know what? i don't believe positive thinking has anything to do with this. unless my own thinking isn't powerful enough? people whose mind power stronger than mine are thinking my cancer is going to endanger my life? i don't know. in any case, i don't want to be told to think positively because i don't believe it works. i just want to be myself, which is - being realistic.

so, you got that right. i don't want to be strong, and i don't want to be positive. i just want to be myself. i'm not going to change my personality just because i have cancer. but i am changing my lifestyle. after some reading up, i think the reasons i got cancer is because 1) i used to consume a lot of packaged food and drinks and 2) i had avoided sun exposure for more than 10 years. my having cancer is because of my own wrongdoings.

now we are moving to taiwan because this is where i feel most comfortable fighting my last battle with cancer. i should say i'm considered already moved in. my husband and daughter haven't moved yet because they need to get some paperwork done before they can move here and stay long term. we are staying at my brother's place, which is in the same building as my mom's place. mom has employed a really nice lady for cleaning and now she's cooking for us as well. i feel i'm really super lucky. i've had so much support from stanley's family and my family. as a married daughter, canada is where i should be staying because my home is with stanley and his family. but my mom and bro welcomed me back. stanley is willing to make the move for me and his parents, sis, and bro-in-law are looking after evie for as long as we need them to. (the plan is to move evie here when i'm done and recovered from treatment.) everyone in the family supports us in every way we need, so that i can focus on getting better... i can never say enough "thank you" to everyone. i feel so sorry that my sickness is bringing so much trouble to all our families in canada and in taiwan. but such things are life. i'm thankful for living it.

back to reading thrillers..

I am going to WIN!

I just received word from my Canadian radiation oncologist Dr. Ackerman. After reviewing the PET/CT images I sent her, she says: Your treatment fields were to the pelvis and this looks like it can be treated without overlapping your previous pelvic radiation treatment area.

This is very good news!! Now I know for sure that I can beat this thing with the help of all these good doctors who are looking after me and the great support from my dearest family and friends...

I am going to WIN!

: )

Tumor confirmed

I got the result from last week's PET+CT scan and it is telling the same story as the PET scan from a week before. There is this approximately 2.5cm tumor in my abdominal lymph node. The medical term is "para-aortic recurrence." This is the cause of my strange abdominal pain that is sometimes on the right side, sometimes in the front, sometimes in the back and growing more painful week after week because it is touching some pain nerves there. I've been given pain killers for this - a regular type which I take twice daily, and an enmergency type which I take when needed. I hope the pain will not become worse and worse like the doctor said..

I will get another CT of abdomen so that they can see exactly where this tumor is in order to perform a CT-guided biopsy. The biopsy will take place next Monday, most likely, when I will literally get stabbed in the back. My brother said, "hey at least you know when it's happening. Normally people have no idea when they get stabbed in the back!" Alrighty bro.. The abdominal CT will help them see which path to take because the tumor is located very close to the two thickest veins in my body (主動脈, 主靜脈), as well as my right kidney, and intestines. If they accidentally stabbed any of that, I'll be in big big trouble. However, biopsy is necessary because if it is not cancer then the treatment will be totally different. Also, my cervical biopsy showed two types of cancer cells. It will be good to see what kind of cancer cell is in the new tumor because we have no other way of knowing whether it was there before cervical cancer or if it was originated from the cervical cancer.

The chance is pretty high that it is cancer because this spot is a common place where cervical cancer would move to. So, what next? That's where I'm having a headache right now because my next treatment hinges upon my past treatment. The problem is, there is a upper limit to how much radiation each part of our body can accept in its lifetime. Exceeding the dose will cause the body part to fail in about 6 months after the treatment. Therefore, I need to obtain the 3-D radiotherapy dose distribution and treatment planning data as well as the radiotherapy summary note from Sunnybrook Hospital. The oncologist in Taiwan cannot safely give me radiation without such information. It would make my life worse if they killed the cancer but also blasted my intestines and spinal cord so I'll become paralized and unable to digest food. Therefore, radiation cannot be done if I cannot obtain my previous treatment data.

Treatment back in Canada is an option but I am very reluctant to take this route. If I can indeed receive radiation again, Taiwan will radiate my abdomen as well as my upper body - where the cancer might go next. In the event that there are unseen cancer cells moving up, they will also get killed, and I will have a much higher chance of survival. If I'm receiving radiation in Canada, they might do what they did the last time: just radiate the area they have confirmed visable evidence of cancer cells. I'm afraid a couple months after the localized treatment, I will suffer from another new tumor and there will be no more tolerance for radiation left in me to fight. My treatment this time is crucial. I would prefer the battlefield be in my hometown, in my mother tonge, with the option for paid medical services, rather than in Canada, where I can only accept whatever that will be decided by the doctors with my half understanding of the implications and no opportunities to learn about or pay for more testings that might help with my diagnosis. I just hope Sunnybrook has a way to export the radiation data for the oncologists in Taiwan...

Worst case scenario is that I was already radiated full dosage in my abdomen the last time around. If this was the case, it would mean the new tumor is so strong that it survived the last treatment. There are two other ways they would be able to remove the tumor locally - only a few places in Taiwan have those expensive machines and those procedures will not guarantee a clean kill because they are very localized. If there are any invisible cancer cells left, then eventually I'll get more tumor later on.

Chemotherapy will be my last resort: it will inhibit further growth and spread of the cancer but it will not kill the cancer for me. Choosing chemo alone would mean giving up.

I'm very far from giving up. Right now I'm focusing on obtaining my previous treatment data from Sunnybrook. I just hope their system isn't too old to have the capability of data export... In the mean time, I wish there is something I could do to comfort my hubby, mom, bro, in-laws, and all my friends and family. I want everybody to know that they shouldn't worry about me because the doctors will help me get rid of this cancer.