Monday, July 8, 2013

First Official Oncology Meeting - Let's play a numbers game!

I love, love, love my new oncologist!
A new oncologist? Already Stace? But you only met the first one once.

While very nice and certainly capable, she came across as low energy and I seemed to put her ill-at-ease with my jokes. 
Basically, we just didn't mesh.
So, at the  6/28 post-op follow-up with my surgeon, I asked for a new one. 
Actually, it played out a little differently:

"So, I'd like YOU to be my oncologist but, since that may entail more schooling for you, I'd be happy to take a recommendation," I announced.
"Who do you have now?" she asked.
"Dr. A is who we met at the 'wacky Wednesday' event on 6/5," I said. "But she didn't really get my jokes and in the couple of times we've seen her since, she still didn't seem to understand my vibe. I think I scared her."
"Hmm. She's good," she smiled.
"I need someone who is a bit more energetic, who understands that I'd rather laugh than cry at all of this," I said.
"I send all of my favorite patients to Dr. J.," she deadpanned. "Dr. J is no nonsense, very straightforward," she explained. "I think you'd like her."
"So..." I began, "How could I start THAT process?" I asked.
She was already typing into the computer.

My first appointment with Dr. J was on Tuesday, July 2nd and the expectation was a review of the pathology and histology reports as well as laying out the rest of the treatment plan. Much of the pathology information had already 'leaked out' and I knew the radiation doc had signed off on me - no need to radiate what's no longer there. I also knew hormone therapy would be a recommendation.

And then there was the topic of chemo.

When all this began, chemotherapy wasn't really on my radar. More to the point, the idea of chemo scared the shit out of me more than surgery. I've spent my life being relatively picky about what I put in my body; avoiding chemicals and pesticides; shunning artificial sweeteners and anything else that could be considered a carcinogen.

A helluva lot of good that did, right?

Chemo drugs are just poison and I wanted nothing to do with them.

Thankfully, chemo wasn't part of a treatment plan for DCIS. But, when invasive cancer was found in the breast, everything began to change.

As I mentioned before, there were two areas of invasive cancer found in Lefty after the mastectomy and the DCIS was diffuse and pervasive as expected. 

Officially, these are the specifics:

Infiltrating ductal carcinoma + Ductal carcinoma in situ

The cancer was restaged from a 0 (DCIS) to a 1B (not so bad) with a grade of 1 (which is awesomely low). The larger of the two invasive tumors was 0.9cm and, while there were cancer cells found in the sentinel node, the low number of cells reflect a 'node negative' result and the axillary node was cancer free. All of this is very good news - once you get your head around the invasive cancer bit.

But chemotherapy is now a very real option.

A few years ago, based on the above information, chemo would have been the recommendation. Today there is something called the Oncotype test which can help determine whether or not chemo will make a difference with the cancer cells I've got. Results are given as a number between 0 - 100. The higher the number, the more likely I would benefit from chemo. 

Unfortunately the scale is a little wonky:
  • Low recurrence: <18 li="">
  • Intermediate recurrence 18-30
  • High recurrence >30

So, we could play the numbers and say I've got a 17% chance of NOT needing chemo. 

Instead, I'm sticking by the fact my favorite number is, and has always been, 16.
*fingers crossed*

Results of the oncotype testing should be back in the next week.

If required, my chemotherapy course, would be short. An infusion of Cyclophosphamide and Docetaxel every three weeks for four sessions. 
Essentially twelve weeks total. 
I feel pretty good thinking that the worst case treatment scenario really isn't that bad - I can do 3 months of anything.

Meanwhile, I'm walking, hiking and, as of this weekend, now back on the bicycle! Since surgery three weeks ago, I'm focused less on the simple mastectomy recovery and more on really just getting back to living life the way I enjoy living it.