From the category archives:

Prognosis

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The Breast Consultants at Vanderbilt University confirm the previous findings in my pathology report. And Dr. Guru assures me that “he would not do a re-excision on his own wife.”  That does it for me. I cancel the appointment  with the second surgeon, the one set by my sister-in-law.

After all, the second surgeon has not been inside my boob. Dr Guru has.  And I find Dr. Guru’s statement that he would “not redo the surgery on his own wife”  more compelling than anything he could have told me. His wife was my anesthesiologist: attractive, funny, smart, a bit sassy. I believe that Dr. Guru has every reason to want her around.

For the first time in weeks, months really, I begin to relax. I don’t have to delay further treatments. I will have radiation for sure, but I can deal with that. No worries.

I still feel tremendously weary and anxious at the mere thought of chemo therapy though.  But Dr. Guru rolls that stone off  my heart with a few words: “Not much benefit for someone like you,”  he says, and shares with me a chart that shows only a one percent benefit of chemo therapy in my case.

-Why did you not say so right away? I ask him. You know I have been petrified.

-Well, I wanted it to be your decision, he says. Some women will opt for chemo even for a one percent benefit.

In a jiffy, life looks simple and uncomplicated.  No speed bumps ahead.  No re-excision. No chemo therapy. Now that I have dodged that scary chemo bullet, I promise myself to be a good person. I will be more patient, kinder, less judgmental. From this day on forward, I will be a new me to show the whole world my gratitude. Always.

I have an appointment, arranged by my sister-in-law, with Dr. Weary a much respected oncologist whose specialty, it seems, is to keep cancer patients alive long after others would have tossed in the towel. The day after, I have an appointment with another oncologist, at the Medical School, arranged by Dr. Guru’s office. I might as well hear two opinions, have two physicians confirm in unison that all is A-OK.

I am on cloud nine.

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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.

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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.)

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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?.

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All Other Edges Free of Carcinoma. Meaning?

October 10, 2009

Three weeks after after my lumpectomy, and after some prodding and probing,  my pathology report arrives in the mail. I polish my bifocals. — the better to see you my dear —  and sink down in my favorite reading chair. On page one, I immediately zero in on these worrisome phrases: “All other surgical resection […]

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Stumbling on a Piece of Humble Pie

September 22, 2009

“Yesterday was horrific, “ says  Dr. Guru’s assistant when I call to complain that he never called with the pathology results, as promised. “I had to snatch him to even get one second.” She lets out a deep sigh, the kind that seems to come from  the bone marrow, not from the lungs. I feel […]

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Procrastinations on Pathology Report

September 17, 2009

Friday. No news on the oncogene.  No news from Dr. Guru’s office all day Monday. Finally, I call his assistant just before closing time. “We are waiting for your pathology report,”  she says. “Have you been to post op yet?” “Yes, I had my ten second post-op  a week ago.” It seems like his office […]

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Full Circle In One Month

August 12, 2009

In the morning, as soon as Dr. Guru’s office opens,  I call to nail down my surgery date. “We can not plan anything until we have your MRI results,” his assistant sounds tired. “We don’t know what we’re dealing with yet. Yes, you can have a lumpectomy next Tuesday.  Anything more involved, requiring more time, […]

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“Ask an Expert” – It May Save Your Life

August 1, 2009

You don’t understand your doctor’s mumbo-jumbo, or have doubts?  You are confused about the correctness of your diagnosis or your pathology report? You are too scared to wait six months to find out what may lurk inside your boob?  You have a family member, or a friend, with breast cancer and you want to figure […]

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Finally – First Meeting with the Surgical Oncologist

July 5, 2009

Finally, I meet with Dr. Guru, my surgeon oncologist, after a two week wait. It seems like ten light years. The waiting room is enormous, empty except for an elderly couple. I notice that they do not carry an over-sized,  brown x-ray envelope, like I do. The staff in the reception  is slow and overweight, […]

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No Self-Pity, Just Curiosity.

July 3, 2009

I am reading in the garden, pool side, when I notice the gathering clouds and hear the rumble in the distance, so I dart inside the house to lie down on the living room sofa. My husband is already napping upstairs. Claps of thunder before rain begins to drum against the tall windows as I drift […]

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Are My Cells Undifferentiated?

June 27, 2009

Three days have passed since my diagnosis. When office work slows down, I feel panicky and restless. I debate whether to leave the office, but instead I turn to Google and type in “ductal invasive carcinoma” and “undifferentiated cells.” It turns out to be extremely bad news. Undifferentiated cells are abnormal looking cells that have […]

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