TMI

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We saw the radiation oncologist today. Dr. Meredith Wendland is a lovely, intelligent and compassionate woman and I felt an instant connection with her. She spent far longer than I would have expected explaining options and procedures to us.

She told us that there is no reason I cannot tolerate more radiation therapy. The risks are slight. There is some small risk that the portion of the lung exposed to radiation could be damaged but it would not be significant in her estimation. Any tissue on my lower breast that was previously affected by radiation when they did the full abdominal radiation in 1996, could be at risk for scarring or tissue deterioration/necrosis. Again, that would be rare and treatable with surgery. All things considered, the benefits of eliminating any lingering cancer cells would outweigh the small risks connected with the radiation. The treatment would be daily for approximately six and a half weeks.

On the other hand, if I opt for a mastectomy and there is no indication of cancer in the lymph system, I would probably just have chemo therapy. If there is cancer in the lymph system, I would have the radiation and chemo. In that sense, it is definitely a good thing that we do not have to rule out radiation as an option. I may learn more about this when I see the medical oncologist on Thursday.

We learned two additional things that we did not know before. My cancer is a high grade 3 which means it is very aggressive and it is also triple negative. This refers to the hormone receptor test which shows whether the tissue has certain hormone receptors.

• Hormone receptor test: This test shows whether the tissue has certain hormone receptors. Tissue with these receptors needs hormones (estrogen or progesterone) to grow.
• HER2 test: This test shows whether the tissue has a protein called human epidermal growth factor receptor-2 (HER2) or the HER2/neu gene. Having too much protein or too many copies of the gene in the tissue may increase the chance that the breast cancer will come back after treatment.

SOURCE: The National Cancer Institute web site

It sounds like being negative might be a good thing but I am not sure if that is true. One thing they indicate is that Tamoxifen is not an option for me. Since my cancer is not fed by estrogen, the estrogen blocking effects of Tamoxifen do not offer any benefit.

All this doesn’t answer my basic question which is whether to have a lumpectomy or a mastectomy. There are so many factors to consider. Dr. Wendland says that the recurrence rate with a lumpectomy is slightly higher than with a mastectomy but the survival rate is almost identical. The more radical surgery does not necessarily increase survival although it may reduce recurrence somewhat.

The question then is how much insult can my body stand and which treatments are less painful and debilitating with the best long term outcome.

My daughter recommends that I sleep on it and listen for the answer that emerges in the morning. My husband says I already know the answer. The decision is inside me but I’m not ready to stop worrying about it.

I feel like a dog with a bone. I shake it and nudge around it; bury it and dig it back up again. I think I should put it away and see what it looks like tomorrow.

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