Pathology "check"

I’ve realize that I’m not very good at the “real-time” updating of this blog. It is hard to explain, but every time I receive news from the doctor it takes a few days to write about it. Immediately after I just don’t want to think or talk about it, the next day I’m in information seeking mode and then the next day I seem to be able to think about what it means for and to me. So with that here is the belated update from the three doctors visits on Wednesday, January 14 (i.e. Surgical follow-up visit including pathology report, Medical Oncology Visit and Fertility Preservation Visit).

• Drains from surgery are out. The drains were a minor inconvenience and not at all as bad as described by some folks on Internet discussion boards, but none the less I am glad they were removed.
  
• Of the 7.5 cm mass in the breast found by MRI, 2 cm was Invasive Ductal Carcinoma (bad cancer) and the remaining was Ductal Carcinoma In Situ (“good“-stay-put-cancer). This was very good news.
  
• Tumor had Estrogen and Progesterone Positive Receptors. This is good news as there are drug therapies that significantly reduce the risk of recurrence with positive receptors.
  
• Tumor is Her2/neu positive (3+). From what I can tell this is good and bad news. Bad news, because tumors with this characteristic are more aggressive. Good news, because there are drug therapies that are very efficacious in shutting down the production of these cancer cells and thus reducing the risk of recurrence.
  
• 3 sentinel nodes were removed during surgery and 2 lymph nodes were identified in the breast tissue during the pathology process. 1 sentinel node and 1 lymph node have cancer in them. This is bad news as it means the cancer is on the move. To put this in perspective, I recall something that I read - no one ever dies of breast cancer in the breast, people die of breast cancer that has moved to other areas of the body (i.e. liver, brain, bones etc). All of this means I have to have another surgery called Ancillary Node Resection.
  
• Surgery is schedule for Tuesday, Jan 20th. Ancillary Node Resection is basically the removal of lymph nodes under my arm. This is also inauguration day, so out with Bush and out with cancer! The two seem synonymous don‘t they? I’m not at all crazy about another surgery and recovery period as I thought I already “checked” surgery off the list. I feel a bit defeated, but I know it is certainly too soon in this process to feel defeated, so I know I have to shake this off. This will be another overnight hospital stay and I‘ve been warned by the surgeon that the recovery for this surgery is often more difficult than the mastectomy recovery. Speaking of the mastectomy and sentinel node recovery, 1 week post surgery, I can say the recovery was not that bad, with the help of pain medication. The incision site is really quite impressive, Mike and I just measured it and it is 10 inches. Not real sure how a plastic surgeon is going to make this “look good” but I’ve been told that they can. Best of all my range of motion in my left arm is about 80%. Unfortunately, I still can’t lift Katie but I‘m still able to get plenty of hugs and kisses. It is amazing how insightful a two year old can be, she is very aware that Mommy has a “boo boo” and is acting completely appropriate.
  
• I am negative for the BRCA gene mutation. This is good news.
  

Next Steps:

• Pathology on Nodes due back Jan 28th during post surgical follow-up.
  
• Chemo to start 3 - 6 weeks after surgery. I met with Dr. Dees (Medical Oncologist) after my meeting with the surgeon to discuss "What's next" given the Pathology results. She has suggested an aggressive adjuvant treatment regimen given my age and other factors. This regimen will not change regardless of the pathology results of the nodes. She used words like "early stage" and "curable" which I found to be very comforting. The treatment regime is about 1 year followed by 5 years of hormone therapy. I’ve also been approached about an international clinical trial, called ALTTO, but I need to consult all of the medical and statistical professionals that I know before I make any decision about the trial.


• Radiation Treatment is still uncertain and will be based on the node pathology.

• Fertility Preservation is a bit up in the air for me for reasons I will write about later. We actually ran out of time on Wednesday and we did not have much time to spend with that doctor.


• Chest and Abdominal CT scan and Bone scan are still needed for what I hope are just baseline negative results. The doctor does not anticipate finding anything (i.e. cancer that has spread to any of these area) but I will still not sleep soundly until all the data are in. These will be done next Friday, Jan 23 and should have results no later than the following Monday, Jan 26.
  
• Heart MUGA , scheduled for Jan 26, is also needed for baseline results as two of the chemo drugs have a slight risk (2%) of causing heart damage.
  

Since the last posting, despite the surgery, recovery and doctors visits, I have managed to keep pretty busy with fun stuff and lots and lots of support.

My parents came up the day before surgery and stayed several days to help out around the house. In addition to Mama and Daddy, Mike, Mike’s Mom Vicki, my brother Roy and cousin Carrie were at the hospital during the surgery and Randy and Karen paid me visit after I was out of recovery Thank also go out to Gina for hooking me up with the finest person to put me to sleep.

Mike's sister Debbie took care of Katie the night of surgery and the day of surgery and also brought a delicious dinner my first night home.

Mike’s Dad and Beverly stopped by for a visit and brought a plate of goodies.

Carrie and my girlfriends organized a "game afternoon" where everyone (Carrie, Devonn, Randy, Lisa, Ella, Armide, Laura and Alyssa) came out to our house with snacks, games, DVDs and magazines and we all hung out, played games and ate my mama's wonderful Thanksgiving dinner (complete with my favorite Oyster dressing...mmmm!). Randy also brought yummy burritos. Lisa came with Chicken Cacciatore which is in the freezer and I can’t wait to eat. Mike’s Mom and Lloyd also stopped by the Chicken Pie in hand which is Mike’s favorite. Thanks you all so much for being so supportive and helping me pass the time.

I received flowers from my brother Roy, his wife Paula and son Charlie, which was such a pleasant surprise.

Monday, Mike and I took in the new Clint Eastwood movie and on Tuesday, Carrie organized people from my office to get together for lunch. Mike and I met up with everyone at TGI-Fridays near the office. Kate, Elisa, Katherine, Marlo, Dexter, Crystal, Latrice, Gaye, Diane and Carrie - Thanks for coming out to lunch on Tuesday it was really great to see everyone. And congratulation to Dexter, whose wife just gave birth to a new baby boy.

Wednesday was the big day at the doctor and Thursday we came down to the beach with Mama and Daddy and will be here until Sunday.

As always, thanks to everyone for all of your love and support and cards and gifts! I hope I am one day able to convey to all of you how much I appreciate all of your help and support how important all of you are to me and Mike and Katie.

Love,
Gail