Meeting with the Oncologist

Phew! What a lot of information in one sitting! I'm soooo thankful that a woman from the breast cancer support group met us at the appointment to take notes for us! She took EIGHT pages of notes!!

Before I start to summarize the information from the meeting, I have to say I am THANKFUL to live so close to the cancer center. It's maybe a 5-10 minutes drive depending on how I 'hit' the street lights along the way.

My cancer is stage 2b and my tumor grade is 1. As I understand it, I'm considered at stage 2b because of node involvement. If no cancer is found in my remaining nodes, I'll be moved to stage 2a.

The tumor grade being "1" is good, because it means I had a slow growing, non-aggressive type of cancer.

Even though the cancer found in my node is microscopic, it is the standard of care to do a full axillary node dissection. One of the reasons this is recommended is because I am "young". Since there is some node involvement, they're just going to treat me as if my nodes are positive for cancer.

The oncologist feels that there is less than a 10% chance of finding more positive nodes, but it's best to have them all removed and tested.

She also agrees with my surgeon that more breast tissue needs to be removed, because the DCIS (ductal carcinoma in situ) did go all the way to the margin of the tissue removed during the first surgery. There's a chance it went beyond the margin.

The next step will be a second surgery to remove the nodes and more breast tissue. I'll meet with the surgeon on Monday and hopefully schedule the next surgery.

I WILL be having treatment, but the second surgery needs to come first, and then I'll have to heal for three to four weeks before starting treatment.

Meanwhile, some things are going to come into play.

One is that my tumor will be sent away for the Oncotype DX test (pray the insurance will cover this--it should). This will give the oncologist information as to my chances of having a reoccurance of this cancer, as well as to if my cancer will respond well to chemotherapy. Moreover, it will give her an idea of how aggressive a chemo drug to use to treat me. The test results take about two weeks to come in.

If my tissue margins are clear of cancer this next time around, then I'll have radiation after the chemo is overwith. If my margins are not clear, I'll have a mastectomy and will not need radiation.

The doctor will do the chemotherapy first. If I need an aggressive chemo drug, I'll have four months of chemo. If I can have a less aggressive form (less toxic), then my treatment will last for eight weeks.

Since my tumor tested STRONGLY positive for estrogen and progesterone. This is a very GOOD thing, because that makes me a candidate for hormone therapy. I'll take hormone therapy (pill form) for 5-10 years. We'll start with a drug that's appropriate for a pre-menopausal patient, and then once I've either been forced into menopause by cancer treatment or go through it naturally, I'll be able to take an even better hormone drug. I guess that estrogen and progesterone positive patients do better with treatment (more options) and have a greater chance of survival.

I tested HER2 NEGATIVE which is a very good thing, she said.

Oh, if the Oncotype DX results show a very low (like ZERO?) percent chance of reoccurance, then I won't need chemo at all. But, I'm not going to allow myself to think in those terms, because I think it's best to be prepared for the likelihood of having chemotherapy. It'd be too disappointing to get my hopes up the other way.

The oncologist put my information into a computer program and came up with a 5% chance that I'll not be alive or cancer free 1o years from now, after having had treatment if I have combined therapies (aggressive chemo, radiation and hormone). That percentage can change for the better or worse once we get the results of the Oncotype DX and lymph node dissection. (More cancer in the nodes would be worse, of course.)

So, in summary, the next step is to have a second surgery while waiting for the Oncotype DX results. The results of those two things will factor into "what next".

The surgeon should be able to conduct the surgery in 1-2 weeks. Then, I'll have to heal for another 3-4 weeks before starting treatment. I asked the oncologist if we're looking at starting treatment in early June. She said "yes". I think the only thing that would delay that would be if I'll need to go for a third surgery (mastectomy).

The crazy, crazy thing that threw me off today is when the nurse told me that because I've had lymph nodes removed I can no longer have my blood pressure taken on the right arm and I can't have blood drawn from there now. I hated feeling like I'd loss control over something so simple. I've ALWAYS had lab workers draw from my right arm, because that side is the most cooperative vein-wise. This just really bugs me!

But, worse than that is that since the cancer went to my node--- there's a chance it's gone into my bloodstream. :-( That is very disturbing. There's no way to check this as it'd be something like a microscopic cell floating around somewhere. My scans didn't find anything, but they can't pick up microscopic cells. I guess this is where chemotherapy would take care of any fragments like that? I'll have to ask to make sure I understand if that is correct. I'm guessing.

Well, long months ahead... I hate to see summer be swallowed up with cancer treatments. :-( Summer's so short here. I feel for my family, because I think it's going to really stink if Mommy's always tired or doesn't feel like going to the beach, etc. But, ya' do what ya' gotta' do. We've got to go through this in order to have a chance of survival. I guess when the kids are older and we explain this to them, they'll be glad to still have their mother around---even if they did miss some trips to the beach one summer.