I've decided to try to write as honestly as I can about this process in hopes of helping others dealing with it. As such I might get into some details you might now want to know... Just a little warning...
Wednesday, I took care of paperwork -- very smooth process thanks to advance form completion over the internet. I then had the most comprehensive mammogram in the history of mammograms followed by an ultrasound.
On Thursday the real fun began. I met my Surgical Oncologist, Dr. Delliah Black. I really like her. She's very knowledgeable, thorough and concerned about me as a person not just a breast cancer surgery. I learned I have Stage 0 DCIS (ductal carcinoma in situ) intermediate, estrogen negative, progesteron negative, HER2 positive (MD Anderson had already sent my biopsy samples to their pathogist and got a more thorough diagnosis). That means it is non-invasive at this point, but potentially fast growing. The mammogram and ultrasound along with the exam confirmed that they do not believe there is any cancer currently present in the right breast and it does not appear to have spread to the lymph nodes.
She then explained the pros and cons of my 2 options -- segmental mastectomy (otherwise known as a lumpectomy) followed by radiation or complete mastectomy. Survival rates between the 2 are vitually identical. Recurrance rate with the mastectomy is about 5%. With the lumpectomy and radiation the recurrance rate is about 10%.
She also spent a good amount of time examining me from an appearance standpoint. Given the location of my cancer and the amount of tissue affected she was concerned that I be happy not only with the cancer prognosis but also with the appearance prognosis. She also arranged a consult with the plastic surgeon who would be involved in my surgery for reconstruction -- in my case with either procedure. After more exams from an appearance standpoint my options were to likely go down from a C cup to a B cup with the lumpectomy or potentially retain the same size with the mastectomy. However, with the mastectomy I would lose sensitivity and my nipple. In either case they would also do some work on my right breast to make them even in appearance after the cancer treatment is complete.
The other thing Dr. Black explained had to do with the HER2 protein receptor. Currently, they use a couple of different drugs to block the HER2 receptors following surgery to remove invasive cancers with this receptor. These drugs are not approved for use following removal of the non-invasive cancers that are HER2 positive. As it happens they are conducting a couple of studies to look at whether these drugs might reduce recurrence with the non-invasive cancers. So I signed up for one of those studies. The risk of side effects is minimal and it might help others down the road. It also in no way gets in the way of my treatment. Basically, I will take a pill once a day from now until I have surgery. Then after surgery they will check the tissues removed to see if there is any change in the cancer cells. I won't know if I am receiving the drug or the placebo -- unless of course I experience any of the side effects... lol.
So I've decided to go with the lumpectomy followed by radiation. They are working on scheduling surgery for November 8th. That means I will likely be having radiation in December and another surgery in March or April to resize the right breast. Everyone at MDA was great. They took me from place to place and juggled things to make sure I got all the tests and appointments completed that I needed pre-surgery and for the study before I left for the day. The only things I will need to do the day before surgery are meet with the anesthesiologist and have the radioactive seeds implanted to mark the cancer location.
I think that about covers it for now. I feel much better with knowing what I'm doing and with the care team at MDA. I cannot say enough good things about them!
