Friday's Appointment

Sorry for the delay, but Mom was in for the weekend and I'm just now getting around to posting.

Friday, we had another appointment with Dr. L. We didn't learn much new information, but did get a chance to ask some more questions and get the rest of the tests on the calendar.

First of all both the MRI and mammogram were clear, so they haven't found any other tumors in my breasts. I asked a couple of questions:
1. What is my chance of recurrence? I didn't get a straight answer, but she did say that I have a higher risk because of my age. Because I have more years left to live, there is more time for the cancer to come back. I think most people have a misconception that being young is a good thing in regards to breast cancer. Age is good as far as the risk of developing cancer, but once you've got it, it seems to be an uphill bottle.
2. What Stage is my cancer? We won't know until we get the lymph node results. If no lymph node involvement, it'll be Stage I. If lymph nodes are involved it will be Stage II.
3. What will my Recovery after lymph node surgery be like? It will be more involved than the lumpectomy. I'll be off work for 2 to 4 weeks and will not be able to lift anything. Yikes! I better get my work stuff in order this week.
4. I read something about HER-2. It's a protein that can make the tumor grow faster, however, there is a drug that seems to work on HER-2 positive cancers. Mine was HER-2 positive, so I'll need to ask the chemo doctor about it.
5. Will genetic counseling show that my Mom could be at risk? Not necessarily. The gene (if found) could be passed by either mother or father. I still think I need to do the testing.

Dr. L did say that at the conference (panel of doctors reviewing my case) one of the radiologist suggested that I may be a candidate for a double masectomy. I think the age thing is still the concern. With my age and no logical reason, there is probably a decent chance of recurrence. If they remove my breasts, I wouldn't get breast cancer. She said it's not something we have to decide right now, but we should think about it for the future. The genetic testing could also sway the decision. She said if I tested positive for the gene, I would also be at increased risk for ovarian cancer. She said that I may even want to consider having my ovaries removed once we finish having children. Later, I asked Eric if he thought she mentioned the masectomy just because it was mentioned at the conference and she needed to bring it up or if he thought it was something she really wanted me to consider because they may recommend it in the future. He seems to think they may recommend it.

We also set up more appointments:
Monday 9/3 2:30 p.m. Appt. with Dr. Y (chemo doctor)
Tuesday 9/4 11:00 a.m. (should take about 4 hours)CT of lungs, abdomen, and pelvis & Entire body Bone Scan
Wednesday 9/12 11:00 a.m. Sentinal Lymph Node Mapping Surgery

I've been trying to do a little research about my prognosis. Here are the characteristics of the cancer and what I know about how they affect prognosis.
- Breast cancer can be either In Situ or Invasive. Mine is invasive.
- Tumor Size. Mine was 1.6cm which is relatively small.
Large tumors pose a higher risk than small tumors
- Tumor Location. Mine was in the middle of the breast, but probably close to the skin.
Tumors that develop toward the outside of the breast tend to be less serious than those that occur more toward the middle of the breast. (I'm not sure if this means deeper tissue (middle) is more serious than close to the skin (outside) or if it has to do with location as in quadrant.
- Nuclear Grade. Mine is Grade 3.
Grade 1 is a well-differentiated (appears close to normal) and is slower-growing. Grade 3 is poorly-differentiated (abnormal looking) and is fast growing.
- Hormone Receptors can be positive or negative. Mine is negative.
Hormone-receptor positive cells grow more slowly than receptor negative cells. Women have a better prognosis if their tumors are receptor-positive because these cells grow more slowly than receptor-negative cells and they have more treatment options. (Hormone receptor-negative tumors can only be treated with chemotherapy.)
- HER-2 status positive or negative. Mine is positive.
HER-2. The HER-2 protein is part of the epidermal growth factor receptor family and is becoming an important marker in breast cancer. It is involved in the growth and spread of breast cancer cells, and about 25% to 30% of breast cancer patients have high levels of this protein. The presence of HER-2 may suggest aggressive cancer.

Other Statistics
Stage I - 98% 5-year survival rate, 92% after 7 years
Stage II - 88% 5-year survival rate, 71% after 7 years

- Less than 5% of breast cancer cases occur in women under age 40
- Only 1.5% of breast cancer cases occur in women under age 30

Cancer still recurs in 9-30% of node-negative cancers

The seriousness of this is starting to sink in. I think I have excellent care and we're doing all that we can, but this isn't going to be an easy road.