The Oncologist Appointment!

The day I've been awaiting since my diagnosis has finally come! Mom, Dad and I met with Dr. M., my oncologist, today at 4:00. She was really nice, as everyone said, and comes highly recommended by just about everyone in town, it seems. She's Romanian, but I was too shy to try out my Romanian on her. I can say hi, how are you, fine, and garlic. We ended up having to go out a special exit because she stayed well after closing to answer our questions, which was really nice. Another thing that was great was that she told me right off the bat that I would be leaving with a plan for treatment. What a relief! All this talking, all these appointments, and now finally I will know what the hell is going to happen!

(BTW, I'm posting ALL this old stuff weeks after it happened because I'm really behind. So I've probably forgotten a lot of stuff. I apologize. This was a pretty important one, but most of the others are just so I remember. I don't even know if people are going back to these old ones to see what's been added. Hmmm. Just FYI.)

We talked about all sorts of stuff, so I guess I'll rehash as it comes back to me. She did some background on breast cancer with us, but that was review since every doctor had done that and we'd all done our fair share of reading. She explained that based on the size of my tumors, whether measured alone or together, would still qualify my cancer as a Stage 2 Infiltrating Ductal Carcinoma. I was under the impression that staging had to be done in conjunction with surgery, so it was good to hear she thought I was Stage 2 and not more advanced, although we don't know much as to the lymph involvement.

She told me that she was pretty certain I won't be infertile after treatment. She was an absolute whiz with statistics, and she said she thought I had a 15-20% chance that my period wouldn't come back, meaning I would be infertile and have to go through menopause early (ugh). I think that's still a pretty high percentage, but it's not that bad. And maybe if I am infertile, it's some sort of sign that I was meant to either not be a parent because I'd suck or hate it, or that I'm meant to do it through other venues. Either way, I took the 80-85% chance of maintaining my fertility status as good news.

She also explained to us that my tumor was ER/PR-, which means it isn't stimulated by hormones. That's good news because these tumors respond really well to chemotherapy, as Dr. S. told us. It's bad news because it rules out all hormonal treatments, thus narrowing my scope of treatment.

She discussed and educated us on how we find out whether cancer has spread and how to learn more about lymph node involvement. Essentially, so far we hadn't seen anything on the imaging to suggest that the cancer has spread to my lymph nodes, but after having a something called a PET Scan, which is more sensitive and will scan my body from head to mid-thigh, we'll know a little more. Surgically speaking, there are two methods to determine whether cancer has spread to the lymph nodes: a sentinel node dissection and an axillary node dissection. I'm hoping to have a sentinel node dissection because lymphedema sounds really sucky.

I told Dr. M. about my two meeting with the surgeons and how I was confused about what my options really are. I expressed to her that I am really hoping to "preserve the breast," as she put it, but that I'm prepared to do what I have to do. She seemed more skeptical than I had hoped about the lumpectomy (and I cried a little :( ), saying that as there are two tumors, taking them out might leave me cosmetically unhappy. She also brought up the topic of genetic testing, which both surgeons mentioned, and I think that deserves its own paragraph (actually, I had an educational course about genetic testing, so I'll get into further detail on that post).

Apparently there is now a genetic test that can determine whether a breast cancer patient has mutations to the two known breast cancer genes, BRCA1 and BRCA2. While there are probably unknown breast cancer-causing genes, these two constitute 85% of genetic breast cancers. It's a simple blood test. And since I have no family history of breast cancer because I have no family medical history whatsoever due to the fact that I was adopted, Dr. M. strongly recommended that I consider and pursue the test. Which costs over $3,000, but we'll get into that later. Anyway, the results of a genetic test would be very important to all surgical decisions because a patient with a genetic mutation has a significantly higher risk of a second primary breast cancer (an entirely new cancer) and ovarian cancer. Hooray. So for a patient who gets a positive result, a mastectomy would certainly be the recommended course of action, as would an oophorectomy (removal of the ovaries) once child bearing is completed, but ideally before the age of 35. You can see why you don't want your genetic test to come back positive.

We talked about chemo ports, which are port implanted under the skin with a catheter (not for peeing) attached so that you don't have to get an IV put in every time. Sounds nice. Plus they can draw blood from it. I'll have to get that put in sometime next week I guess. And we agreed that Dr. S. would be my surgeon, so Dr. M. said she'd give her a call to get on the same page.

We talked a little about clinical trials, but those scared me. I know that each participant receives the standard treatment, but I worry about unknown side effects later down the road. Dr. M. could see the idea just stressed me out further, and anyway, there weren't any trials for people opting to do chemo first.

We also talked about the fact that chemo before surgery is equally effective as chemo after surgery. Since I'm hoping still for a lumpectomy, though she was fair and DID warn me that that may not be a possibility for me, we decided that chemo first was going to be part of my plan.

Then Dr. M. presented the choice of doing the drug Taxol in either a large dose, once every two weeks for a duration of 8 weeks, or in a smaller dose, every week for a duration of 12 weeks. I didn't have much time to think about it, but I decided that the smaller dose sounded better. The side effects were supposed to be lesser, and it's not like I'm exactly on a time crunch, though I don't want treatment to last forever.

So doing the lighter dose means Taxol will be first, then followed by another drug (whose name I don't remember) in 4 doses every other week for a duration of 8 weeks. So 20 weeks of chemotherapy treatment, or 5 months.

This lead me to ask about skiing. In 20 weeks from now, it'll be approximately Christmas, when it's safe to assume there will indeed be moguls. Dr. M. broke the bad news that there will probably be no skiing for me this year. After chemo, I'll have a month of recovery before surgery. And if it's a mastectomy, then there will be no skiing because boob bouncing cannot happen, and the recovery is pretty long. Oh well, next year I guess.

So the plan is in place, and I have to do a bunch of appointments next week. But Dr. M. implied I'll be starting chemo soon-- sometime around August 4. They're going to call me on Monday to schedule them.

To clarify, it looks likes this:

1. Chemotherapy for 5 months.
2. Do the genetic test. If positive-- probably mastectomy followed by reconstruction. If negative-- probably lumpectomy followed by radiation for 6 weeks.

Then Dr. M. told me she was going on vacation (to Keystone! Why not WP?) for the next week but that there would be people I could talk to at the office or I could email her.

It felt really good to have a plan in place, but I was really disappointed that she wasn't as confident or enthusiastic about a lumpectomy as I had hoped. I tried not to get my hopes up about it because I hate being disappointed, but it didn't work. Oh well. Roll with the punches. And get ready for another week of appointments. Whew.