172: Cindy Koerner survived breast cancer | epirubicin | zoladex | cyclophosphamide | estradiol

In 2018, for Cindy Koerner, pain in her right breast led to a diagnosis of Stage 3A breast cancer.  She was put on a three-pronged, high-dosage chemotherapy regimen of epirubicin, nab-paclitataxel and cyclophosphamide.  The cyclophosphamide compromised her immune system, resulting in fatigue and fever.  The chemo regimen shut down her ovaries, but when they became active about a year later, Cindy was told if they remained active, the possibility of a relapse would increase, so she opted to have them removed.  These days, Cindy believes her health is at approximately 80 percent of what it was before her diagnosis, but she admits she gets tired easily, which prevents her from doing activities that she thinks would leave her exhausted.   Cindy's cancer journey began in 2018 when she felt pain behind the nipple in her right breast.  The pain would leave, only to return when her menstrual cycle returned.  She saw her gynecologist, who called for an ultrasound, which the doctor said did not reveal anything abnormal.  When the pain continued to come and go, she went back to the gynecologist.  Another ultrasound, the gynecologist said revealed nothing unusual.   However, in 2020, she noticed a change in the shape of her breast and that it included a dimple.  Another trip to the doctor and another scan indicated a tumor and a diagnosis of Stage 3A breast cancer.  Cindy later learned that such a diagnosis should have provided her with multiple treatment options, but at the time her care team told her she would be going on an aggressive regimen of chemotherapy.  Because of the advent of COVID, treatment was made more difficult for Cindy from an emotional perspective because she had to remain in isolation.   The regimen included epirubicin, nab-paclitaxel and cyclophosphamide.  She had to come in for a dosage every two weeks.  Like many on chemotherapy, Cindy suffered hair loss, but she said the cyclophosphamide was the roughest.  It played havoc with her immune system, leading to fatigue, fever and depression.  However, this was not the only hurdle in her journey.   Cindy's tumor was hormone receptor positive, which reacted to the estradiol in her body.  This had implications for her ovaries.  The chemo had rendered them inactive, but about a year later, they became active again.  She was told when the ovaries are active, that increases the possibility of the cancer returning.  As a result, with injections of zoladex, a GnRH analogon, she opted to have her ovaries removed.   Cindy Koerner has returned to work as a cancer biologist with the German Cancer Research Center in Heidelberg.  She says her health is about 80 percent of what it was before her diagnosis and there are some activities she avoids because she fears they would leave her exhausted.   Cindy is also a cancer patient advocate.  Among her messages to patients is to have a heightened awareness of their treatment options, which she admits she didn't have at the time of her diagnosis.