Chemo week 6 – uno mas

I saw my oncologist this morning and he remarked about how well I was tolerating chemo. My white cell count had dropped a little from the previous week, but nothing to worry about. I had been feeling more fatigued during the past week especially the past weekend. I spent most of Saturday either sleeping in bed or dozing in my recliner. Sunday morning wasn’t much better, but I started feeling better later that afternoon. Yesterday started out okay at work. However, around 11:00 AM things started to deteriorate quickly. I continued working a couple of more hours, but I had to throw in the towel around 1:30 PM and went home. That’s the odd thing about being on treatment; you never know when fatigue is going to hit you.

I hadn’t experienced shortness of breath until this week. It just happened a couple of times, once on Thursday and again on Saturday and only last a few moments. My oncologist wasn’t too concerned as I didn’t have any chest pain and the episodes were very short. Shortness of breath can be a concern if the episodes are frequent and or prolonged, which can result in hypoxia (low oxygen). It’s important that the tumor tissue does not become hypoxic because it could cause up regulation of hypoxia inducible factors, e.g. HIF-1 alpha, which in turn can stimulate vascular endothelial cell growth factor (VEGF), thus triggering angiogenesis, i.e. formation of new blood vessels. This must be avoided, as it will interfere with success of treatment. The idea is to fly under the radar and kill tumor cells slowly using radiation and a continuous low dose chemotherapeutic agent, e.g. 5-FU. Placing the tumor in a hypoxic state would cause it to mount a strong defense by triggering angiogenesis, which could increase the risk of metastasis. So the upshot is tumor hypoxia es no bueno.

This afternoon I went back to the oncology office for my last chemo exchange. I have to wear my European carry-all just one more week and then I’ll be done with neoadjuvant therapy.  My last day of radiation is tomorrow and it will be so nice to put that part of the treatment behind me.