Thursday, March 12, 2009

Biopsy results

It's a cliche, but we have good news and bad news. First, the bad news: the tumor on Sherrie's left side is cancerous. It is a "ductile carcinoma," meaning it first formed in the ducts of the breast. According to the doctor, about 95% of breast cancers form in this fashion (a few percent form in the lobes, and a few rare cancers in other ways).

The good news is that the cyst on the right side is benign.

We were quite pleased with our doctor and the time he took with us. We had to wait about 90 minutes for our appointment (the doctor was held up in surgery earlier in the day), which is quite symbolic of our life right now, and a bit frustrating. But after we saw the doctor, he took his time to explain simply and in great detail all of the decisions we have to make and our options. He's probably had the same conversation a hundred million times, but we were grateful for his patience in explaining things to us.

The doctor told us that there are four things to do: (1) get rid of the cancer, (2) determine if the lymph nodes are positive for cancer, (3) remove the possibility of any other sites in the breast having cancer, and (4) commence hormone therapy. The latter (hormone therapy) is required because Sherrie's cancer is hormone receptive positive (HR+; about 1/3 of breast cancers are HR+), meaning that estrogen and progesterone help the cancer to grow. There are hormone therapy drugs (e.g., Tamoxifen) which are quite effective at managing this, however. Initially I thought this was a good thing, but now I'm thinking it would be better if it weren't HR+, as it means taking hormone therapy drugs for a long time after surgery (five years or so, according to what the doctor said). The good news is that drugs like Tamoxifen help a lot in preventing a recurrence of the cancer.

On removing the cancer, Sherrie has two options: lumpectomy with radiation treatment, or mastectomy with reconstruction. Sherrie has decided to have a mastectomy. Given the size of the tumor and other considerations, she feels like this is the best option. The doctor said that the long-term prognosis is the same for both approaches, and it comes down to which option makes the patient most comfortable. There are pluses and minuses to each approach, as you can imagine.

During the surgery, the doctor will remove a sentinel lymph node and it will be examined by a pathologist in real time. If it is cancerous, several more lymph nodes will be taken out in an "ancillary dissection." If it is not cancerous, no dissection will be performed.

Item (3) above is accomplished by a complete mastectomy or by radiation after a lumpectomy.

Any decision on chemotherapy will happen after the surgery and the tests done on the lymph nodes, in consultation with an oncologist (a few weeks after surgery).

The timing of the surgery is uncertain at this time. It's possible it may occur as soon as this coming Monday (the 16th). This would happen if Sherrie is able to see the plastic surgeon on Friday (tomorrow). If not, the surgery will likely happen on the 23rd or shortly thereafter.

I asked the doctor if we could be sure that the cancer originated in the breast and didn't migrate there from somewhere else, and he responded affirmatively.

The doctor gave us some good advice on a couple of issues. Many people will have great ideas on where we should go to receive the best care. The simple fact of the matter is that this type of breast cancer is very common and excellent treatment options are available right here in our community. There is nothing unique or exceptional about her cancer, so specialized treatment from elite clinics is not indicated. Additionally, some people will have great ideas on alternative treatment options which are better than anything standard medicine is doing. The plain truth is that if anybody anywhere makes a (proven) breakthrough, doctors everywhere will know immediately and begin to implement the breakthrough as soon as possible, so we shouldn't put much stock in these reports. Finally, some people will tell us horror stories about somebody they knew who had a terrible time with cancer and died. The doctor explained that everybody is unique and responds differently, so no matter how similar such episodes may be to Sherrie's cancer, her outcome is unique to her.

The notion that the surgery could occur as soon as Monday was a bit shocking, and made it all very real. In spite of how much we've thought about the issues and talked about it, until today it was fairly abstract. It is now much more concrete and real.

We are very hopeful and upbeat. Many people have much more dangerous cancers (and other diseases). Sherrie's outlook for a complete and full recovery is very promising. We are grateful to our family and friends for their love and support, and we know that our Heavenly Father and his beloved Son will see us through this trial.

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