What happens during a radiotherapy planning appointment?

This morning I attending my radiotherapy planning appointment at Liverpool Clatterbridge Centre. I wasn't nervous at all for this one, in fact the only thing that bothered me was that my appointment was at 8.15am - who does that!?!

I gave my name in at reception and waited to be called my one of the nursing team. She took me in to a side room and went through all of my details. I'd already signed a  consent form for my radiotherapy so the nurse went through some health and medication questions with me. After that I was taken in to the CT room for my scan so that the doctor and radiographers can work out the best way to deliver radiation to the area that needs treatment.

The CT scan helps create detailed images of my body to show exactly where the cancer was and how the radiation should be aimed to prevent future reoccurrence.

I hopped on to the bed and I was asked to lie still with my arms above my head in the stirrups.
During the scan a small breathing monitor was placed on my tummy and I was asked to practice holding my breath. It was quite easy and a small screen in front of me showed my breath as a blue line. I needed to keep my breath held for 20 seconds in the green space during the practice. The reason I have to hold my breath is that the area that I am having my radiotherapy on is very close to my heart. Breathing in will ensure that my heart does not get zapped!

Dot worry though, if you cough or cant hold your breath, then as soon as the blue line moves out of the green the radiotherapy automatically stops.

 Once the scan was complete, the team explained that in order to make sure the radiation hits the right spot each time I needed to have three small tattoos (just dots) on my skin as markers. One in the centre (between my boobs) and one on each side - just level with my underams.

The tattoos are tiny and permanent, and will basically guide the radiotherapy team in giving me the correct treatment. The whole process is carefully planned to make sure the radiation targets only the cancerous area and protects the surrounding healthy tissue.

Oncology Appointment

Another nervy day. I'm at Clatterbridge Aintree to discuss the benefits of chemo. My Oncoscore came back as 18. In women over 50 this usually means chemo isn't beneficial however because I'm a pre-menopausal 42 year old, they want to let me have all of the facts. 

The appointment takes place in a separate building to the normal breast clinic. It's bright an airy and John and I arrive on time for my 9am appointment. I check in and wait to be called. 

My oncologist Dr Hart calls be through. We go through my full cancer history since my first diagnosis back in 2017. She explains why my score of 18 is a grey area and discuss that there would be a 1.8% reduction in reoccurrence should I have the chemotherapy. 

The chemo itself would be a 9 week initial phase on one chemo drug and then a further 8/9 weeks on a different chemotherapy drug. Dr Hart explains that pre-menopausal women could in fact be seeing the benefit from chemo just from the side effects of being put in to early menopause. We discuss the side effects and potential issues as well as the benefits. John and I ask lots of questions but having heard the percentage benefit is so low, I immediately confirm that my decision is to avoid chemotherapy.

With the decision made, Dr Hart then talks us through the next steps for endocrine drugs to suppress my oestrogen production and the radiotherapy.

Radiotherapy

I'll start my having an initial consultation with the radiographer. I'll have a CT scan to gain a detailed scan off my top half so they can plan where the radiotherapy is needed. I'm told about the risks of the radiotherapy such as damage to my heart and the skin issues that will inevitably occur. 

I ask about whether tattoos are still needed to ensure my position in the machine. My nurse confirms I'll get 3 small dots tattooed. 

Endocrine Therapy

I'll be having two types of drugs to reduce the risk of reoccurrence. As both cancers have been oestrogen receptor positive - meaning oestrogen helps the cancer cells to grow these drugs will help stop me from producing oestrogen. :

Goserelin (Zoladex)

I'm briefly told that this drug comes in injection form and will be administered every 4 weeks. It will put my in to early menopause by stopping the production of oestrogen from my ovaries. It works by interfering with the signals in my brain, stopping my ovaries from doing their usual hormone producing job. 

Exemestane

Usually pre-menopausal women are prescribed a 5 or 10 year course of Tamoxifen. One of the risks of taking this drug is that in can increase the risk of DVT. As I suffered with a DVT during my second pregnancy, Dr Hart has suggested I take Exemestane, an aromatase inhibitor, as an alternative. I'll let you know more when I've read up on it!

I'm handed a lot of reading material and send off to read up.

So essentially in about a weeks time, I'm going to be thrown in to the menopause without any HRT support. Should I start to panic? Can anyone recommend anything that might help?