Friday, April 03, 2009

First oncology appointment

We had our first appointment with the oncologist today. In summary, I would say the appointment was sobering but hopeful, punctuated by a few light moments, mostly dealing with hair loss.

The most sobering point was that the "micrometastatic tumor" in the lymph node was bigger than we had been told. It's still not clear in my mind exactly what happened in the surgery, as the oncologist told us that the surgeon took out and tested three lymph nodes. I wonder now if he was confused with the three stains the surgeon recounted (?), or maybe the surgeon didn't clearly inform us that in fact three lymph nodes had been removed. In any case, one of the three tests (nodes?) had cancer cells in it. The oncologist told us that the cancer cells were in a mass about 2mm in size. Not big, but definitely bigger than "one or two cells" as the surgeon initially said (or implied).

Another sobering point came when the oncologist told us that in some cases, the cancer will return in either the other breast or in another part of the body, and if that happens, they can't cure it--only fight it and prolong life. Without chemotherapy, for Sherrie's circumstances, the odds are one in three that the cancer will return somewhere at some time.

The good news is that if Sherrie has chemo, the odds of a recurrence are cut in half (to one in six). So, chemo is definitely indicated for us.

Another piece of good news is that tumors which are estrogen-positive like Sherrie's respond better to the chemo than the ones that aren't estrogen-positive.

Sherrie needs to heal before beginning chemotherapy. The oncologist said we should begin four to five weeks after the surgery, so we are scheduled for our first treatment on the 7th of May.

The course of treatment will be six cycles, separated three weeks apart. In the first week of the cycle, she will receive three drugs via IV. The next week, she will receive one of the drugs again, and the third week is a "rest" week. Concurrent with the administration of these drugs will be frequent blood tests to measure counts, particularly white cell counts. We had been expecting the chemo to last six months, so the fact that it will be over around the first of September (assuming no problems) is good news.

Prior to beginning the course of treatment, the oncologist wants Sherrie to do a nuclear medicine imaging test of the heart. Evidently, the chemo drugs can be hard on a heart that isn't healthy, so he wants to be sure her heart is strong.

Sherrie will have a semi-permanent catheter installed in her upper chest near/under the collarbone. This provides an easy and safe way to draw blood and to administer the IV drugs. The surgeon will install this catheter in an out-patient procedure sometime soon, and it will be removed after the course of treatment.

She can expect to feel quite nauseous for one to two days after each treatment. The oncologist will give as many anti-nausea medicines as are required ("we just keep adding them") until she is able to deal with the nausea.

A serious concern for patients on chemotherapy is infection. Sherrie could literally go from feeling fine to being in a life-threatening situation within the course of a couple of hours. A fever of over 100.5 is a medical emergency, necessitating a trip to the emergency room. If her blood count is low, she'll be in the hospital on IV antibiotics for a few days. School in May might not be recommended--too many germ carriers!

Sherrie will lose her hair, within days of the first treatment. It won't really start growing back in earnest until several weeks after the last treatment. Summer is probably not a bad time to lose one's hair and wear a hat.

Through all of this ordeal, I've been grateful for Medicine and its ability to help people. Modern medical care saved Sherrie (and Jared) when Jared was born, and it's saving her life again. For that I am profoundly grateful.

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