The Plan - Part 1

I did not find out as much as I wanted to find out during my visit on Wednesday about my specific disease. The core biopsy did not have enough cells to determine ER/PR or HER2/neu status. I did, however, find out a good bit of general information about the treatment of the disease and how it relates to what they do know about me. There are still some missing pieces of data that we are in the process of collecting.

Of note, I could not have been happier with the level of information presented to me, the amount of attention given to my case and with the way I was treated at UNC. While it was a grueling day from 8 AM - 4 PM, after it was over I was so grateful and felt the overwhelming desire to send everyone who interacted with me a thank you note and in addition I wanted to change my profession. I was also grateful that I was healthy (with the exception of this cancer thing) as I could not imagine having to go through that day with other underlying medical conditions. I mean, the duration was that of a regular work day, but it is amazing the toll stress and processing information pertaining to your medical condition can drain your energy level.

So based on what I learned on Wednesday, this is the current plan to gather the additional information needed to determine my course of treatment and the likely course of treatment based on the information.

Dec 17: Blood drawn for Genetic Testing

Purpose: To determine if my BRCA1 and/or BRCA2 genes have a mutation that predisposes me to breast and also ovarian cancer.

Outcome: If a mutation is present then the likely recommendation would be a prophylactic double mastectomy.

Information of Interest: Everyone has a BRCA1 and BRCA 2 gene, the genes contain tumor suppressors. Genes with a mutation lack the natural tumor suppressors, thus giving way to the likelihood of tumor growth and progression in the breast and/or ovaries. The likelihood of a mutation in this gene is about 7%. Family history of breast cancer does not necessarily mean that a gene mutation is likely. In a conducted study, of the 7% of women with the gene mutation, 6% had NO family history of breast cancer, 12% did have a family history of breast cancer.


Dec 22: Fertility Preservation MD

Purpose: To discuss options for Fertility Preservation in light of any treatment that I may have that would impact my ability to have a brother of sister for Katie.

Outcome: Information
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Dec 23: Bi Lateral MRI.

Purpose: To determine the exact size of the tumor in the left breast and to better determine if anything is going on with the right breast.

Outcome: To give the surgeon additional information regarding the size of the tumor.

Dec 29: Lumpectomy with Sentinel Lymph Node Biopsy

Purpose: To remove the tumor and determine if the disease has spread to the lymph nodes. They will remove the sentinel nodes and a pathologist will freeze and examine them during the surgery. If the pathologist notes cancer in the sentinel nodes then an axillary dissection will be performed at that time.

Outcome: To determine appropriate systemic treatment (i.e. chemotherapy and/or hormone therapy). Will know ER/PR status, HER2/neu and I’m sure many other data points for which I know nothing about.

Dec 29 + Five Days or so: Post operative visit and Meet with Medical Oncologist.

Purpose: To determine systemic treatment.

Outcome: Ensure that the cancer does not return in an other area of my body.

Of note: Given my age and suspected size of the tumor I have already been advised, that independent of the lymph node status, I will likely have chemotherapy.

To Be Determined Next Steps Maybe:

Chemotherapy for 4 to 6 Months (depending on the selected regime)

Followed by Radiation for 5 to 7 weeks five days a week to prevent any local recurrence.

Followed by any prophylactic surgeries if Genetic testing comes back positive.