First Meeting with Medical Oncologist

Here is the summary that Windy provided from her phone consultation during my appointment with the medical oncologist (Dr. Graff) today.

1)      The tumor is very small, and Stage 1A.  This means it is curable. 

2)      The markers are sort of a dud, which means it will be more of a pain in the butt to cure.

3)      In order to keep this little bugger from coming back, you need systemic therapy.  This means chemo. Traditional chemo.  The kind you think of when you think of chemo. 

4)      You will also need surgery, but how aggressive the surgery is will depend on the MRI and the genetic testing.  

5)      Your medical team recommends chemo before surgery.  This has the advantages of starting to attack the tumor before the genetic markers are back, and giving us a chance to see (at the time of surgery) how the chemo is kicking the cancer in the butt.  No, in the ass. 

6)      Now, back to that chemo thing (wish we didn’t have to come back here, but we do).  Your doctor anticipates

a.       16 total weeks of treatment, with one infusion every 2 weeks (8 total infusions).  Each infusion will take about  6 hours.

b.       Halfway through they will switch medications (Adriamycin/Cytoxan first, then Paclitaxel)

c.       On the day after each infusion, you will return to the clinic for a shot that will help protect your bone marrow and prevent infections (Neulasta)

d.       There will be side effects. You will lose your hair (unless you do that freezy thing). (Freezy thing not going to happen. ☺)  You will have nausea.  Your fingers may tingle. Your team has lots of ways to help treat symptoms, and wants to know about them.

      7)   Radiation will be very targeted.  5 days a week for 3 to 6 weeks

8)      So, what is next?

a.       Because one of the meds (Adriamycin) can stress your heart, you will have an echo before you start so they have a baseline

b.       Since chemo is best in a big blood vessel, Interventional Radiology will place a port, which is an IV with the hub under your skin on your chest. 

c.       The MRI will happen soon, but will likely only impact surgical planning, and not chemo.  (Scheduled for December 1 at 8:15 p.m.)

This crappy little tumor will start getting its ass kicked on December 14, assuming all goes as planned. 

Some day your oncologist will fire you because you are too healthy.  You will cry then, too. 

After a visit today with the surgeon, Dr. Nasim Ahmadiyeh, we have only the beginnings of a sense of where we are heading.  What we do now know is that the type of cancer I have does not have the typical profile for an old lady like me.  Unfortunately, it was negative for all three biomarkers regarding what stimulates its growth so some targeted therapies are ruled out.  In order to make any decisions on my care, more information will need to be obtained by an MRI which has not yet been scheduled but will hopefully be very soon.  I will have an appointment in the morning with the medical oncologist, Dr. Stephanie Graff.  She will be our guide.  She will make the recommendations regarding when to do the surgery and if/when chemotherapy will be necessary.  I will also meet with a genetic counselor with the possibility of getting some testing done regarding hereditary factors.

Just a bit of general information

My Nurse Navigator recommended the following pamphlet on breast cancer, stage 1  and 2.  (Mine is stage 1)

https://www.nccn.org/patients/guidelines/stage_i_ii_breast/index.html#102

This Is How It All Began

On October 28, 2016, I went in for an annual mammogram at the Menorah Breast Center where I have been going for years.  All my previous mammograms have been negative so it was a bit of a surprise when I was informed that I needed to come back in for a sonogram because of something they saw on the latest mammogram that had not been seen before.  They were very reassuring.  On November 3, I went in for the sonogram.  Clearly there were two small round masses that were adjacent and maybe even attached. Again my treatment was very professional but gentle and kind.  Before I left the office I was told that a biopsy was advised.  Since we were going to visit Matt in Arizona, for the next week or so, we scheduled the biopsy for Monday, November 21, right before Thanksgiving.  Gary accompanied me for this appointment at the same Menorah Breast Center...that was really comforting to have Gary and to be going back to a familiar setting. The biopsy was sonogram assisted so I was able to watch the screen and see the masses as they were suctioned.  After the biopsy they told me it might not be until Monday that I would hear any results because of the holiday.  But on Wednesday before Thanksgiving I got a call from the nurse navigator.  She was very professional and asked if I wanted hear the results or to wait to talk with my primary care physician with whom she had already talked and who had said she was fine with the Breast Center providing the information to me. (I had just changed primary care physicians because my last doctor had left the practice.  Dr. Humphreys had seen me only once on November 4, the day after the sonogram and before any other results had been obtained.)  I opted to hear what they had to say right away so the nurse navigator explained what she could.  I was diagnosed with Invasive Ductal Carcinoma.  Here's where the magic began. The nurse navigator has the job of coordinating my treatment.  That is a huge thing for me.  I would not have had a clue as to where to begin.  What a relief to have someone else contacting doctors' offices and scheduling appointments!  First she reassured me that she would only recommend the best doctors...after getting the doctors' names I did a quick Google search that showed each had excellent references.  All are women who specialize in breast cancer.  I feel like I am getting and will continue to get the best care.  So for now the first visit is with the surgeon on Tuesday, November 29.  Next is a visit with the medical oncologist on November 30.  Hopefully a plan will be developed and we will get the ball rolling on my treatment immediately.