WHAT IS TRIPLE-NEGATIVE BREAST CANCER? (TNBC)
This type of cancer is called triple-negative because it lacks the 3 receptors related to other types of breast cancer (estrogen, progesterone, or HER2) (Tawfik et al, 2022). According to the American Cancer Society, TNBC is the rarest form of all breast cancers. It accounts for 10-15% of all breast cancers that host the worst outcomes, and it is more likely to return after treatment (www.cancer.org). The growth factor, in addition to the rate at which it spreads, is much faster than any other breast cancer. According to my results, the growth factor for my tumor was 90%.
Initially, in October, I felt lumps in both breasts; both were small and tender. Initially, I thought it was due to my menstrual cycle. However, afterward, the mass in the left breast disappeared and the mass in the right breast remained. After a while, the pain in the right breast became constant. By the time I was able to go in for a diagnostic mammogram, in December of 2021, the lump was more palpable, and according to test results, the size of the mass was 2.24 cm. By the time an MRI was done in January, the mass had grown to 3.3 cm. This was alarming, yet understandable knowing the growth factor.
TREATMENT
My treatment plan consists of 8 cycles of chemotherapy. During the 1st four (4) cycles, I went to treatment once a week (One cycle was three (3) weeks). The first day of each cycle is what I called my long day. Here are the medications as followed:
PREMEDS
Emend (fosaprepitant) – helps prevent nausea and vomiting caused by chemotherapy drugs.
Benadryl (diphenhydramine) – helps prevent allergic reactions.
Pepcid (famotidine) – treats heartburn, nausea, and chest pains associated with chemotherapy.
Dexamethasone – helps prevent or control nausea and vomiting.
CHEMOTHERAPY REGIMEN
Keytruda (pembrolizumab) – an immunotherapy drug that works with the immune system to help fight cancer.
Taxol (paclitaxel) – anti-cancer chemotherapy drug.
Paraplatin (carboplatin) – anti-cancer chemotherapy drug.
On the short days, treatment consisted of Taxol and the premeds, excluding the Emend.
Although this was the recommended plan of care for TNBC, I could have opted to take a different route. However, after doing my own research, I agreed to this treatment regimen with the understanding that there would be a greater chance of controlling the progression of the tumor. Data also showed that there was a greater reduction in the risk of recurrence, ultimately, increasing survival rates (Kramer et al. 2022).
I STILL HAVE MY HAIR…
“But I just got my locks!” I remember thinking as the treatment team discussed the treatment plan and potential side effects. Then I remember thinking, “How important is hair when there are so many more important things to be concerned about?”
I began to brace myself and prepare myself mentally for the change. At one point I stopped doing my hair thinking, “What’s the point? It’s going to fall out, anyway.” I even thought about having my hair shaved, prematurely, thinking it would ease the blow of me waking up to finding my hair on my pillow.
Well, I’m ending my 4th cycle of chemotherapy, and I still have my hair.
I know, right! I’m surprised, too… yet praising God for his mighty outstretched hand!
I was expecting to lose my hair within 2-4 weeks of treatment. Until this point, I have experienced a mild burning of the scalp, a change in the texture of new growth of hair, some slight thinning throughout, and some hair loss around the edges. With this next set of chemotherapy, the doctor says I’m sure to lose my hair within 2 weeks after the initial dose.
The process hasn’t been as bad as I was expecting it to be. It’s been bearable. I can definitely, say that I do not look like what I’m going through. When people see me that know what I’m going through, they say, “You look good.” All I can say is, “It’s all God.”
OTHER SIDE EFFECTS OF CANCER TREATMENT
Alopecia
Anemia
Appetite changes
Arthralgia (joint pain)
Back pain
Bleeding gums
Changes in libido and sexual function
Chemo brain (affects concentration and focus)
Chills
Constipation or diarrhea
Coughing
Decreased appetite
Dizziness
Fatigue
Fertility problems
Fever
Headaches
Infection
Insomnia
Itching
Nausea and vomiting
Lymphedema
Menopausal symptoms in women
Mood changes
Mouth sores
Myalgia (muscle pain)
Nosebleeds
Peripheral neuropathy
Photosensitivity
Rash
Shortness of breath
Skin changes
Upper respiratory infections
Vitiligo
SIDE EFFECTS THAT I’VE EXPERIENCED
As mentioned, alopecia hasn’t set in yet. Anemia is something that I’ve had for a long time. However, my blood count has been better than it has ever been, mainly, because treatment has sent me into a menopausal state. My white blood cell (WBC) count gets low, and I have to take a medication called Nivestym which helps the body produce more white blood cells. More specifically, it aids in producing more neutrophils, which accounts for the largest number of WBCs that aid the body in fighting off infections.
My appetite has changed. My favorite foods don’t taste the same. Water, even, tastes differently. My digestive system fluctuates. I’m constipated one minute, then diarrhea the next. Indigestion is daily. Nausea doesn’t occur as much, but thank God, no vomiting. My appetite seems to have increased and I’ve gained 10 pounds since treatment began. I feel swollen. Everything, including my face, feels inflated.
As treatment has progressed, fatigue has increased. My vision is a little worse. Joint and muscle pain, numbness, and tingling in my fingers and toes come and go. Sometimes, my head feels “foggy”. I’ve learned that it’s a condition called “chemo brain” and it causes one to lose focus and affects one’s ability to concentrate. Headaches and dizziness are frequent, so I find myself lying down more than I’d like to. I have occasional shortness of breath. My nailbeds have started to turn black. As one who has never had a problem with acne in 51 years, it has now shown its face and continues to evolve. My gums are sensitive and when I brush my teeth, my gums bleed. Nosebleeds have become a norm.
When talking to others, their side effects, and the level at which they occur, vary. Sometimes in conversation, they’ll say, “No, I haven’t experienced that.” Or, I’ll say the same. Due to joint pain, dizziness, shortness of breath, etc., I’ve seen some patients come in with canes, walkers, or even wheelchairs.
THE PUPA PHASE
As I continue this process, I see some changes. As I reflect on life, I’m reminded of the butterfly and its life cycle. Now, this cycle can be applied to different areas of life, however, as it relates to now, this is my revelation.
You have the egg that eventually hatches. This is the birthing process. My egg hatched 51.5 years ago. Then there is the caterpillar or feeding stage. This stage could represent so many things. However, right now, it’s going to represent those years prior to the diagnosis. At this stage, I’ve lived my life one way, consuming all the things life had to offer within my reach. I’ve learned quite a bit and have experienced quite a few things. I was set in my ways. So, now, I find myself in the pupa phase or the transition stage. This is where metamorphosis takes place. As I was researching the butterfly, it said that in this stage it may look like there’s nothing going on, but big changes are happening on the inside. That’s exactly how I feel. Spiritually, mentally, and physically, transformations are being made. This butterfly is going to be something else when I make it through the cocoon. I’m trusting in the process. I have been given this cup for a reason, for such a time as this.
WHAT’S NEXT?
In future blogs, I plan to feature breast cancer survivors and those that are currently going through the process. Stay tuned.
References
Krämer, S., Rogmans, C., Saylan, D., Friedrich, D., Kraft, C., Rogmans, G., … & Friedrich, M. (2022). Treatment Progress in Triple-Negative Breast Cancer. European Journal of Gynaecological Oncology, 43(2), 341-352.
Tawfik, N., Sandhu, O. S., Ramjas, V., Jain, A., Lee, R. M., Fioni, F., & Hamid, P. (2022) Analyzing the role of the immune system and Immunotherapy in Triple-Negative Breast Cancer (TNBC) Management. The Journal of Middle East and North Africa Sciences, 8(02), 1-8.