Don't get me wrong, I still feel really confident and have a positive outlook as to the outcomes of this obstacle. I'm just getting tired of the surprises and bad news.
A few days ago, I felt triumphant. The sentinel node biopsy had indicated that my lymph nodes were clear. Dr. Weinberg had mentioned that she'd sent the 3 nodes they removed to pathology, mostly as a precaution. The nodes looked clear and there was "less than a 10% chance" that pathology would show a different result. She called yesterday to report that I'm part of that 10%.
Here's the best explanation I can give: There is a threshold. When a node has a certain number of malignant cells (meeting that threshold), the cancer has officially metastasized (meaning that it's trying to move out of the breast and elsewhere in my body). The first of my sentinel nodes met that criteria, having "clusters of malignant cells" throughout the node, according to the pathology report. The two nodes behind that node have malignant cells, but not enough in each to be considered malignant nodes. It only takes one malignant node to disrupt the plan and change the overall condition of the cancer. At this point, I'm considered Grade 2, Stage 2B (but this could move to stage 3 depending on results of upcoming tests). Chemo is now likely and radiation is back on the table, too.
Dr. Kotz spent nearly 2 hours with me (and my family members) today, explaining in detail all of the choices, issues and considerations we now face. He and his staff were great!
The highlights of that discussion include:
- I'm scheduled for a CT Scan (with oral and IV Contrast) of my chest and abdomen and a Bone Scan of my entire body this Tuesday. But no worries.... the "chances are slim" they'll find cancer anywhere else in my body [insert sarcastic voice here].
- Dr. Kotz participates in a monthly breast cancer board, where local physicians get together to review cases and discuss additional options. He'll be presenting my case to the board on Wednesday morning. I'll meet with him later that afternoon to narrow down treatment choices and we'll go over what the board discussed/recommended at that time.
- I'm going to have an Oncotype test done on my cancer cells. This is a genomic test that will reveal the genetic disposition of the cancer. The results are measured as low/medium/high and let us know, genetically speaking, how likely the cancer is to recur and how likely it is to spread. A very low result may mean I won't need chemo. A medium result would indicate the need for TC Chemo. A high result indicates the need for TAC chemo. TC chemo is a two compound chemotherapy, 4 treatments over a 12 week period. TAC is harsher, 3 compound chemotherapy, 6 treatments over an 18 week period. Both are given intravenously. For women in their 30's, chemo is highly likely to land me in the hot-flash, night sweats, mood swing world of menopause. Oh the joys.
- Radiation is a possibility. Generally, if a patient opts for a lumpectomy, radiation is a given. With a mastectomy, it's not. If more than 4 nodes are malignant, radiation is also a given. When 1-3 nodes are malignant, the need for radiation is somewhat of an unknown. There isn't a lot of research to support that it increases survivability with so few nodes impacted. On the other hand, radiation works better than chemotherapy on areas with known clusters of cancer cells. This recommendation is one that will be discussed at the board mentioned earlier. No answers as to radiation yet.
- I'm going to have the BRCA test done. If this comes back with a positive result, I will also likely have an oophorectomy. This is the removal of the ovaries and sometimes includes the removal of the fallopian tubes. A BRCA1 or BRCA2 positive result significantly increases my ovarian cancer risk. The results take about a month. If I'd had the test done when it was first suggested, I might have saved myself an extra surgery, because they could've done the mastectomy and oophorectomy at the same time. I guess, for now, we'll leave that category as pending...
- Doug and I need to discuss our future in terms of babies. If we want to have a child together, we need to see a fertility specialist in the next few days and start working on harvesting any eggs I currently have (can't use estrogen to produce more because my cancer thinks estrogen is candy, or chips, or whatever it's snack preference is...).
Oh, my friend Beth told me about a great book called The China Study. I'll be ordering that in the next few days to read up on evidence-based practices involving nutrition and cancer. If any of you happen to know of other really great resources, books, etc., please let me know.
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