Dear Relatives and Friends, After waiting patiently for three weeks, on October 13, we finally had our appointment with the Medical Oncologist, Dr. Blaney, who is also the Oncology Department Head. We first met his Nurse Practitioner, Janice Petrie, who came to give us her excellent presentation that would inform us all about the pathology report and what it means for us. She told us that there are lots of factors involved in describing the tumor and she then drew a diagram of the breast and showed us how the milk forms in the lobules and then travels down the ducts to the nipple. There are two types of Medical Marijuana: invasive ductile carcinoma and lobular carcinoma, which is rarer. Patty has invasive ductile carcinoma which is more common. Janice that told us that the medical profession doesn’t know why women get breast Cancer. We do know that about fifteen percent of all women will get it in their lifetime. We also know that something goes crazy and cells start forming in the single layer lining of the duct. The Cancer can also form calcification in the breast, which is something Patty has; as revealed on the mammogram. A good Radiologist will see the calcifications and that is why they also do a MRI to better identify the tumor. Patty has what is called invasive ducal carcinoma in situ. In situ means, in the site of. In regards to Cancer, it means that it hasnt grown beyond its point of origin an invaded the neighboring tissue. There was, though, a proliferation of cells inside the duct that went crazy and then went outside the duct and that is why it is called invasive. We then learned about the Pathology Report. The tumor came back measuring at one point seven centimeters. It is not a tiny cancer, but then again, it is not huge one either. Anything less than two centimeters is a Stage One Cancer. Pattys Cancer is invasive ductile with a grade three, which is a little more aggressive than the other two grades. The other thing they looked at was the ductal Cancer in situ which was a tumor measuring one point two centimeters, a very small tumor where Patty’s Cancer started before it broke out of the duct and became aggressive. The lymph node they removed was negative meaning there was no Cancer in the lymph node and that is good thing. She had point five centimeter margins all the way around the tumor. which means that Dr. Dirbas GOT ALL IT ALL., which is excellent. They then looked at the biology of the tumor and looked to see if it likes estrogen to grow, something that Patty’s has at a high amount of; coming in at ninety-five percent. As it turns out, all the Cancer cells have little receptors. The estrogen comes along and hooks on to the cell and makes it grow. They can give Patty an anti-estrogen to block the estrogen thus stopping the growth of the cells. They also looked at progesterone. Estrogen and progesterone, kind of regulate a women’s menstrual cycle. A woman needs both to start your period and get ready for a pregnancy. Patty’s looked good, which is also fine. They also looked at how fast the tumor was growing in a test called a KI67, and hers was sixteen to twenty percent which is on the low side. (Thank God!) Another marker on the breast Cancer is Her2, which is a protein on the surface of the cell that also tells the tumor to grow. Hers was negative and that is a good thing. So when they looked at all the features of Pattys breast Cancer, she has Stage One breast Cancer with clean margins and negative lymph nodes and we know that she is estrogen receptor positive. We then learned that the next concern is WILL IT COME BACK? We learned that Dr. Blaney will next use a calculator that predicts what chance there is of the Cancer returning. If you do a Lumpectomy without radiation there is a high risk of the Cancer coming back. Dr. Horst, Dr. Dirbas’s wife, will discuss with us the Radiation, which will sterilize the area so that no Cancer will come back. She then discussed the Cellulitis that Patty had acquired the previous week and arranged for Patty to see Candice, Dr. Dirbas’s Nurse, to check it out. Cellulitis is a skin infection that affects two percent of patients. We did have to go to Emergency to get an antibiotic to kill it. But it is gone, now. We were also advised that Patty should never use her left arm for any medical procedures such as blood taking, blood pressure measuring, injections, ect., to avoid getting lymphedema which causes fluid retention and is very painful. She also wants her to take 1000mg of Calcium and also Vitamin D3, which she believes all women should take. It was a wonderful and highly informative presentation that answered so many questions that we had. We thanked her as she departed. Dr. Blaney arrived and performed an examination of Patty followed by a review of the Pathology Report. He used his computer risk calculator to determine the chance of reoccurrence. With Radiation alone, there is an eighty percent chance the Cancer will not return within ten years and a seven percent chance of dying of other causes. With Hormone treatments, it increases the chance to eighty-four percent. Chemotherapy brings it up to eight-seven percent. Hormone therapy is an easy choice while Chemotherapy lasts four months and could cause hair loss and vomiting. We must look at the risk versus the reward. When Patty asked the Doctor what he would do; he replied that all women face the conundrum of making the decision and that he is going to do a special test on the tumor that will analyze it to determine whether chemotherapy is the best course of action based on the cancer cells properties. We will meet again in two weeks to learn of the results and determine which program will fit Patty best. On the next day, October 14, we had our highly anticipated appointment with Dr. Horst, the Radiation Oncologist. She and Dr. Dirbas are a team of Cancer Killers. She will put together a tentative radiation plan that she can set it up for us on the same day after we see Dr. Blaney on the 28th. We will meet together after that appointment to determine the Radiation program. Even though the tumor was small and didn’t involve the lymph nodes, it can still come back with about a thirty percent chance over ten years. Radiation will take it down to below ten percent. After examining Patty, Dr. Horst told us that that there are options as to the Radiation treatment. Patty can opt to have her whole breast radiated, everyday, excluding weekends, for three weeks with little side effects. Maybe some redding of the skin and tiredness. She can also benefit from targeted radiation to the same spot where the tumor occurred, since that is where it most likely will return. Targeted Radiation occurs for one week, twice a day, with six hours between treatments. The total Radiation delivered is the same for both treatments. Stanford has been using the Targeted Radiation method for over twenty-five years with excellent results. Dr. Horst did mention that there is a lot of physiological stress involved in having Breast Cancer and that is why she is tired most of the time. Tammy asked about doing Radiation more than once, to which Dr. Horst said it would depend on the situation; but normally no. Tammy then asked the Doctor what she would do in the same situation. The Doctor explained that she favored the Targeted Radiation which she has used and has enjoyed wonderful success with. Patty will also be monitored closely for the next five years. So now that we have the recording that I made using the Capture Audio App on the iPad, and the BREASTCANCER.ORG website that Dr. Horst gave us to review; we have enough information to prepare for our next visits with Drs. Blaney and Horst on October 28th. We are simply overjoyed to know that the CANCE IS GONE!!! We are also thankful and ultimately thrilled to know we have not made this Journey Alone. So many have joined with us through their prayers and thoughts that have constantly encouraged us and kept our spirits high throughout the ordeal. You have our undying gratitude and appreciation. Love Always, Joe and Patty
Posted on: Sun, 26 Oct 2014 14:08:24 +0000
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