From the category archives:

OncoDX Test

iStock_000005554894XSmall[1]

Dr. Weary’s office is crowded and a bit shabby. His nurse weighs me, takes my blood pressure and draws several vials of blood. The work area is cramped and cluttered. Staff bumps into each other as they reach for needles, gauze, and other paraphernalia. I walk towards my meeting with Dr. Weary himself  through a narrow hallway which is lined with a long row of vinyl chairs. Each is equipped with a rod from which the dreaded chemo bottle will hang (or does chemo come in bags?) I shudder.

Dr. Weary runs late, but quickly pulls his chair up to the desk. He is fiftyish, speaks with a slight Southern drawl. He has kind brown eyes, and smiles easily, but looks a bit tired.

In front of him, on the desk, is a file and a brochure entitled “Shared Decision Making Chart.”  I notice that it has the same adjuvant statistical grahps as  Dr. Guru’s, except these bars are in full color. Dr. Weary’s assessment is different too:  My improved survival with chemo is not one in a hundred, but four in a hundred. I feel my hands start to tremble and get clammy.

“How can that be?” I ask. (I should be delighted that it is four in a hundred not forty, but I am focused on disaster. I am so petrified of the chemo that I have also completely lost sight of its purpose.)

“Well, Guru based his on first generation chemo, ” he says. Now we have a much more effective therapy. We give six rounds, not four, and we give it every three weeks.

“We give cytoxan/adriamyacin/5FOX in six cycles. Your beautiful hair, ” Dr. Weary looks up to glance at my head, “will be gone, of course. With Andriamycin the hair falls out after the first cycle, but it ALL comes back,” he assures me.

I want to joke that the hair is more Van Michael’s than my own, but I am too shocked at the thought of chemo, and I try hard not to get weepy.

I have been so prepared to skip the chemo poisons. But  the issue again looms before me, like some growling, nasty pit bulldog in my path.

{ 0 comments }

IMG00045

Although no cancer cells may have been found in a patient’s lymph nodes during surgery, 20 percent of these “node negative” patients still have cancer cells somewhere outside the breast area. Not surprising perhaps, since once a tumor reaches  1 cm, you have one billion cancer cells, like this one below, in your body.

iStock_000009444336XSmall[1]

In the past, oncologists have tended to administer chemo therapy to all patients, not knowing which ones were among those 80 percent not at great risk.  They  know that once your breast cancer spreads to other organs, you become Humpty Dumpty. They cannot put you back together again.  At best, they can  keep you stable.

But now one company, the only one in the world, California based Genomic Health has a way to test cancer tumors to predict distant recurrence. Based on the examination of 21 different genes in a tumor, they come up with a “recurrence score.’  The scale goes from 1, lowest, to 100 ( highest probability that your cancer will spread in the next ten years.)

iStock_000004344754XSmall[1]

While I anxiously wait for my OncoDX test results, I pour over probabilities and statistics for my cohort. Given the size of my tumor, 1.5 cm, the mitotic activity report, the nuclear grade, etc, I am guessing my score will not be the lowest. Nineteen maybe?  Twenty? OncoDX score 30 or higher: you should have chemo. OncoDx scores under 18, no chemo.  If I have a score of 19 or 20 ,  would it be “safe” enough to skip it? I  keep telling myself it would be.

My score was 23.  Right smack in the  middle of  the intermediate danger zone. Borderline for chemo.

“Right in the middle of the gray area, “ Dr. Guru tells me on the phone. “Do you want me to fax it?” Well, yes,  but my office is big and faxes have a tendency to go astray. He promises that Joy will fax it right away. I worry as I stroll over to the fax room.

Am I  an idiot for trusting that he will do it “right away?” Maybe his “right away” is the same day, not within five minutes. I do not want anyone else to see my OncoDX  fax.  But as soon as I enter the room, the OncoDx test result rolls out of the fax machine. I make a regular copy and leave, clutching it to my chest. Back at my desk I study the $3800.00 piece of paper more carefully than I would a sales contract for a $500,000.00  IBM server.

I note that Dr. Guru’s office   received the score already two days earlier. Do they not have any idea of the anxiety level of a patient who is trying to figure out if she needs chemo?

My recurrence score of 23 means that in the next 10 years I have a 14 % risk of  metastatic cancer, of becoming Stage IV. I read the words “distant recurrence” over and over. I taste lead in my mouth. The taste of fear.

Does this mean chemo? I feel lightheaded. When will it start? How long will it take? Which toxins will they use?

At home, I pour over chemo books and surf the web to try to figure it out. It looks like my stage will require four rounds. I start to feel resigned to the reality of nausea, aches and vomit; to loosing my hair, my mind, my ability to have an orgasm –yes, that is a possible side effect, possibly even permanent– and to gaining  30 pounds without the pleasure of eating more.

But then I read in Dr. Susan Love’s book:  chemo reduces recurrence to one third, i.e only five percent in my case.  And, most importantly, she states “chemo less effective in post-menopausal women.”

If it is less effective, it must mean there is not much help, not even chemo, for post-menopausal women whose cells have spread. Should I been happy or have a heart attack?.

{ 0 comments }