University of Iowa Oncology Visit

Today was our appointment at the University of Iowa Oncology Clinic. I saw Dr. Alex Thomson, a female oncologist. She was very nice and appeared to be quite informed in her specialty. She spent a significant amount of time with us and covered my test results quite thoroughly. After much explanation this is basically what it all boils down to.... I am exhibiting some distinct characteristics in my pathology reports that they don't normally see... all of this can be quite confusing but here goes....

My pathology report showed that my tumor in the left breast was approximately 1.6 cm in size. According to Dr. Thomas, that would have been small 5 years ago, but today they consider it "quite large." My HER2/neu test was negative ( about 1/3 of breast cancers have too much of a growth promoting protein called HER2 and too many copies of the gene that instructs the cells to produce that protein. These tumors tend to grow more aggressively than other breast cancers and are treated differently than some other cancers.) This basically says that I don't have this type of cancer which right now sounds like a good thing.

My tumor does have hormone positive receptors on it which means that women with these cancers tend to have a better prognosis and are much more likely to respond to hormone therapy than women with cancers without these receptors.

Here is the kicker with me... the pathology report for almost all women with hormone receptor positive cancer test around 90% positive. My pathology showed that I am just 0% to 10% positive which is extremly low and quite different from what they usually see. Dr. Thomas' concern is that if they rely on the 0-10% positive results and treat my cancer with the drugs that they generally use with hormone positive cancer that they might be undertreating me and that could lead to be trouble.

On the other hand, they try to use the alternative treatment only when necessary since the regimine is significantly longer and stronger which means more discomfort and side effects. Because of these results UIHC have asked pathology at ORHC to send them the slides for their pathologist to review. They reassurred us that ORHC has done an excellent job with all of their testing it is just that UIHC have pathologists that specialize only in breast cancer and by actually looking at the actual tissue slides and the shapes and characteristics of the cells they can be more definitive in their diagnosis and their treatment recomendation.

Also, because of the unusual hormone receptor test results they are going to contact the National Institute of Cancer for their recommendation and they are going to take my results to a meeting of a variety of cancer specialists (pathologist, oncologists, radiologists, etc., ) on Friday, February 20th for their opinions and recommendations. They don't want to undertreat, but overtreating isn't as easy as taking antibiotics for 10 days instead of 7. There are a lot of things to be considerd.

I feel very comfortable with Dr. Thomas' plan and with her expertise and personality. I also like that she has just 1 nurse that works only with her their continuity of care is optimal. Dr. Thomas agrees that a second surgery is the best course of action at this time and agrees entirely with Dr. Ortell. She too said that although there are some who believe that "micrometastisis" isn't enough reason to remove more lymph nodes she agrees that the chance of reoccurrence is just too high without it at this time.

So...... if the worse case scenario holds true and I have to have the max chemo, my schedule would be to start chemo right after we return from spring break (at the end of March and yeah, I'll still have hair for spring break). I would go every other week for 8 treatments which will be about 16 weeks. We would adjust the schedule around graduation time so I would be feeling good so this would add another week or so to my schedule. With this plan I would be done right around 7/14/09. After I finish chemo I could begin my reconstructive surgery so I could potentially be completely finished by fall.

This is all I know right now. I am still scheduled for surgery on 2/18 and Dr. Thomas will call me the week of 2/23 with their expert opinion. I know this is a really long explanation, but believe me I really did give you the short version! Thanks to everyone for continuing to follow us and for the cards, calls, food and prayers.

Happiness is an attitude of mind, born of the simple determination
to be happy under all outward circumstances.
J. Donald Walters