Really, really scared tonight

I wish I knew more to tell you -- this is an area that is new to me.  Just about the only thing I can tell you is that in a 2002 paper reporting that docetaxel (Taxotere) was significantly more effective than an older chemo in reducing tumor size before surgery, the Methods says that they measured tumor size with calipers only AT BASELINE and then after the LAST of four 21-day treatment cycles. (http://jco.ascopubs.org/cgi/content/abstract/20/6/1456)

I hope someone with personal experience will have more to say.

How did BC assess size for comparison?  With any kind of instrument, or just by feel?  I don't know how these things are measured (above paper said calipers, while a 2000 European paper says "by helical CT scan" -- but I don't know if that's still too new, or standard practice, or already outmoded) but it seems to me it ought to be with some kind of instrument.

Hugs, and I hope you get a chance to talk to doctors soon,

Ann

I wish I knew what to tell you too. I don't though other than...try not to panic 'til you know for sure it's time to panic. (I know...yea, right...)

Hang in there girl!

Hugs, Traci

Hi Annie,

I think any oncologist would agree that 10 days is really too early to determine whether a regimen works or not.  Remember, 1cm tumor contains 10,000,000,000 cancer cells.  So if you just killed 1,000,000 cells within the last week and a half, you may not see any shrinkage at all on that 1cm.  You need some time to give the drug a chance to kill that many little guys.

Another thing that may encourage you to stay "patient":  My oncologist once told me that she has seen cases of patients where their tumors are dying "inside out" instead of shrinking from outside in.  A CT scan sometimes can't tell if the treatment is working because the tumor's diameter is not smaller, but in reality the tumor just becomes less dense.  These kind of cases are usually seen on patients taking the newer biological therapies such as yourself taking Avastin.

Best wishes for you.

Anne

This is called the 'nadir' and here is more information on this low point in chemotherapy.

Nadir

What Is Nadir?

When discussing chemotherapy side effects often you will hear the word nadir, mainly in reference to the blood counts, particularly white blood cell count and platelet count.  Nadir basically means low point, however further explanation may clarify this term in connection with chemotherapy treatment.

Nadir Affects White and Red Blood Cell Counts as well as Platelet Count.

When chemotherapy is given it not only affects the rapidly dividing cancer cells but it also affects some of the normal cells of the body.  These effects particularly occur on normal cells that divide rapidly such as, the hair, the lining of the mouth, the cells lining the intestinal tract and the blood cells (white and red blood cells as well as platelets). 

In the bone marrow, the spongy inner core of the larger bones in the body is where blood cells are made.  There are very immature cells called stem cells, from which the various types of blood cells develop.  These stem cells do not reproduce quickly and are less likely to be affected by chemotherapy.  As cells are maturing there are certain phases in which they divide faster.  It is during these times that the cells are most sensitive to chemotherapy.  The more mature cells can continue to become fully mature cells for several days after chemotherapy is given.  When these cells live out their life span, the circulating supply is depleted and the blood counts fall to a low point, the nadir.

Emerging from the Nadir and Returning to Normal  

The blood counts will return to normal within three to four weeks, after the body's feedback system has told the stem cells in the bone marrow to increase production and begin making new cells.   If chemotherapy is given at the time that the stem cells in the bone marrow are increasing their production this could cause permanent bone marrow damage.  The timing of chemotherapy cycles takes this process into account.  For example some chemotherapy drugs are given on day 1 and day 8 of a 28-day cycle.  The second dose of chemotherapy, one week after the first, is tolerated because the stem cells have not yet increased their production (they are still at the nadir).  They have not increased their production because the second treatment is given before the count of the circulating blood has reached its nadir.

The nadir time is usually about 10 days after treatment, although this may vary depending on the drugs given.  The concern during the nadir time is that the body's first line of defense against infection, white blood cells (WBC) and the platelets, which help to clot the blood, are low leaving a person more susceptible to infection and bleeding.  The next dose of chemotherapy is given only after a person's blood counts have left the nadir and recovered to a safe level.

Anne

You should be set up to either get neulasta to help stabilize your white counts or neuprogen.  I got neuprogen shots on day 11 and 12 of my chemo cycle with FAC but the new generation of this is neulasta and from what I understand is given once the day after the treatment.  You will experience bone pain from neulasta and neuprogen as it stimulates your bone marrow to overproduce white cells.

I would expect an experienced oncologist to have many backup plans for their patients.  And remember, you can always get a second opinion if you are unsure.

hi annie

trip neg here  i also had a tumor that was the size of yours and thankfully with no mets  i did chemo first then had surgery dbl mast and reconstruction  when they did the surgery they did not find ANY CANCER left in my breast or lymph nodes ! trip neg reacts well to chemo  hang in there and speak to your doctor so you feel better about the plan he has in place  its been 2 years for me and i just had a bone scan and MRI and all clear !!

feel free to PM me and ask me anything you want

love from a fellow TN