Wednesday, August 3, 2011

Oncology Update

My update is a little conflicting and I have more investigating to do but here is what I know right now.

Barry and I met with my oncologist, Dr. H at VCU's Massey Cancer Center. According to Dr. H the cancer that was found in my sentinel lymph node following surgery was not "micro-metastatic." She says is was an actual tumor which measured 7 mm. in size which she said is very small but not microscopic as Barry and I remember the surgeon telling us. The good news is that the tumor was self-contained. It had not spread outside the walls of the lymph node structure. I need to ask some more questions of my surgeon to understand why he says it was "micro-metastatic cancer" and my oncologist is saying "tumor." My surgeon was pretty adamant that I would not need chemo but then again - he is a surgeon, not an oncologist. Someone's wires are crossed somewhere and that makes a big difference in the decision to do chemo.

Because of the lymph node involvement, Dr. H recommended I take some chemo - she called it "chemo light" - which would be six rounds of two drugs: taxotere and cytoxan. I would take these drugs every three weeks through an IV. There is a third drug that is often given to breast cancer patients (I can't remember the name - sorry!). This third drug is the one that causes most of the nausea, vomiting and carries a risk of weakening the heart. She said I would not have this third drug. I believe the normal chemo regimen is 8 rounds of all three drugs.

Yes, I will lose my hair on this regimen. Besides the hair loss, my side effects would be mostly tiredness, muscle aches and chemo brain (foggy thinking - worse than what I already have!). There is an increased risk of infection, possible nausea/vomiting and a rare risk of leukemia. Dr. H then recommends radiation following chemo, eventually a complete hysterectomy and then hormonal therapy (either tamoxifen or an aromatase inhibitor) to suppress any estrogen in my body.

I had the oncotype DX test which is a genomic test of my tumor. This test really didn't seem to help much only because my score came out in a "gray" area. The test recommends no chemo for someone with a score of 18 or less. My score was 17 which would indicate no chemo. But it does not take into account the fact that I am pre-menopausal or the fact that I have lymph node involvement. And Dr. H feels that since I was on the high side of "no chemo" and have the lymph node involvement, she believes chemo is necessary. She also said the oncotype DX test people are strongly considering moving that low range from 18 down to 16. If my score was really low - like a 5 - and I had no lymph node involvement, then that would make a decision to not do chemo relatively easy.

In other news... I have developed an infection in my breast in the lumpectomy site, so I have to go on antibiotics over the next 7-10 days before I can start chemo anyway. This gives me some time to sort this out and seek a second opinion. I am strongly inclined to do chemo. I want to make sure I hit this cancer with everything possible.

Even though I have been through surgery, this experience doesn't seem real to me. I am sure it is going to get a whole lot more "real" in the coming weeks.

On a positive note - just think of all the money I will save on haircuts and color this year!

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