The Highly Optimistic Medical Oncologist
Before I start with the news, here's a quick update from Seroma Land. I was a bit sore after the aspiration yesterday, but I finally slept for 6 hours last night (a new record since being post-progesterone). This morning, it's much more comfortable and my range of motion in my left arm is greatly improved. Dr. McManus expects the seroma to refill, possibly by Friday, but for now, I'll take the break.
By the way, having a blue/purple crew cut has its advantages. Some of the medical staff at Astera have begun to call me by name before looking at a chart (it could also be because I've been around a fair amount recently, but they see a LOT of people). I'm making a concerted effort to learn all their names, too. It's tough because I'm Deb of Little Brain thanks to no progesterone, but the classic method of repeating and using their names to address people is working for me. I'm also an avid note taker and that helps.
In the late afternoon yesterday, Marilyn and I met Dr. Fein in his Somerset office, not far from my house. I am very grateful to live in an area with so many top medical professionals nearby should I need them (which I do now). He made a very good impression on us both.
Probably the best thing about the meeting was that Dr. Fein was incredibly thorough and took his time walking us through my entire medical journey with breast cancer, as well as what I can expect in the future (about 45 minutes). He used my medical reports as a guide, sitting about 6 feet away in a way that we could watch him writing legibly on a pad for me during notable sections. He also drew pictures when applicable. It made me think that he has studied how people learn new information (visual, auditory, reading/writing, etc.) and applied several different styles.
Much of it had been explained at a higher level by Dr. McManus, but there were a few differences and surprises. The first one being that these two docs use different staging methods. Dr. Fein stages me at 1 rather than 2 using a newer method based on the prognostic features shown in the pathology results from the lumpectomy.
To explain, he divided one of his notes pages into two parts: Major and Minor prognostic features. Under the Major features, he listed the size of the tumor (2 cm) and the aspects of the lymph nodes (1 of 2 are positive for cancer and the amount of cancer on the lymph node was small at 3 mm). Dr. Fein explained to us that because the amount on the lymph node was so small, it was right on the border of being positive. If it were 2 mm, it would have been considered negative. He is of the mind that Dr. McManus got it completely, but still wants to treat me preventatively -- more on that later.
The Minor list had 6 factors: margin of the lumpectomy (negative, which is good), grade (II, which is OK), estrogen and progesterone (both positive, which is good), HER2 (negative, which is good), and the Ki67 proliferation rate (high, which is crappy, but not as crappy as it could be). Based on all of that information, he slots me solidly in Stage 1.
The Ki67 number is concerning because it determines the speed of the cancer's growth. Even with all the positive information we have, he said, if I did nothing, I'd have a 20% chance of the cancer recurring in the same breast. With radiation, that drops down to 5%.
To prevent a systemic recurrence (anywhere in the body since some bits have traveled outside the breast, as evidenced in the lymph node being positive for cancer), we need to determine if I'll need chemo or just an estrogen blocker pill and radiation. No matter what, I'll be getting radiation in my left breast and need to meet with the radiation oncologist at St. Peter's.
Dr. Fein will be ordering the Oncotype test later today, which looks at 21 genes in my positive lymph node. It uses a recurrence score to see if I'm a candidate for chemo or not. A low score means just the estrogen blocker pill. Fifty percent of people tested do not need chemo. I truly hope I fall into that category. He said to expect results around Nov. 18. So, I have a bit of a break for 2 weeks.
He didn't go into a great amount of detail about the chemo because we don't know if that's my treatment plan or not. But, he did say that it's an "easy" chemo in that it would be once a month for 4 months. But we'll jump off that bridge if we come to it.
For the estrogen blocker, we'll need to test my hormone levels. I've been off progesterone for almost 2 months, but that's not long enough, so we need to wait a few more months to see. Since that's the last piece in the puzzle, it will line up fine after the radiation. He also wants to test me for BRCA, but thinks it's highly unlikely given that there isn't breast cancer in my family history.
No treatment in any case will start until after Thanksgiving. If it's chemo, that will come first, then radiation, then the pill. If it's just radiation, then a pill, I'd start that in early December. Dr. Fein expects that I'll need 4 weeks of radiation, but that will be determined by the radiation oncologist.
At the end of the discussion, he said that the prognosis is excellent. While I'm very happy about his optimism and about working with a doc who clearly has his act together when it comes to patient relationships, I'm still holding a wait-and-see attitude. Because stuff happens.
Thanks again to everyone who continues to tune in and send support, love, and prayers. You have been making all the difference in this journey.
P.S.
My fun friend Emily Beekman said lots of folks don't know what to do to help, but want to do something along with praying and supporting emotionally. She suggested that I create an Amazon wish list for stuff I might need/want. Although I feel a bit awkward creating which is essentially a breast cancer registry, I continue to add fun and useful things to it: https://www.amazon.com/hz/wishlist/ls/1F3HNL09N3G7C?ref_=wl_share.
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