We met with the radiology oncologist today. It seems most likely I will need radiation, but they won't know for certain until after the surgery. If four or more lymph nodes are involved the recommendation becomes yes. We already know one is involved based on the earlier needle biopsy. Another factor that leans toward yes is my age. He explained that there are four levels of lymph nodes. He said they will remove levels one and two which will give them all the information they need and reduce the post surgery side effects.
He discussed the option of chemotherapy first followed by surgery. He said this is a valid approach and is most successful when the tumor is fairly aggressive and hormone receptor negative. In this scenario it is possible to shrink the tumor quickly. My tumor is not as aggressive and is hormone receptor positive. The medical oncologist will have more to say about each approach. As for lumpectomy versus mastectomy, my palpable tumor is estimated at a couple of centimeters - not overly large. If that was all, the lumpectomy would suffice, but there is cancer in multiple quadrants in the breast. Somehow playing into all of this, I've got both invasive and non-invasive types going on.
The doctor examined me. I find it funny that they step out to give you privacy while changing into the patient gown as if they're not going to come in and feel your breasts in a minute, not to mention the fact that I couldn't guess how many people I've shown my breasts to in the last few weeks. While he was feeling my armpit he said, "there's nothing very impressive". He was obviously talking about my lymph nodes, but it's just not a comment I've ever heard before while topless.
I wasn't expecting to get any more results until tomorrow, but he had the results of the PET/CT, bone scan, and MRI. He said the PET/CT was fine as well as the bone scan, and the MRI only showed what we already knew. At this point, he looked me in the eyes and said, "this means we're going to cure you". It's hard to express the emotion I felt at that point. It was like I exhaled for the first time in weeks while simultaneously realizing that at some point I had stopped breathing. It's not as though any of the other doctors told me I was doomed or anything, it was just something else for him to stop and say what he said.
He explained that if we go with surgery, followed by chemo, followed by radiation, followed by tamoxifen that each step will get easier. Here I thought laughter was supposed to be the best medicine! He also told me not to get pregnant. I laughed. He told me he was serious. I told him I was pretty motivated to not get pregnant before all of this happened so I'm really committed at this point. He said it makes everyone look bad if I have a baby with flippers or whatever. I guess it didn't take him long to figure out that I don't offend easily.
Tomorrow is the pre-op meeting with the surgeon. Friday is the medical oncologist. April 12th seems a likely day for surgery, but this is not confirmed yet. Saturday I'm doing lunch / pedicures with SP. I'm hoping to connect with a couple of girlfriends over lunch or coffee next week. With any luck, I won't be seeing many doctors next week.
Yeah!
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