Meeting with Group#1 Radiologist

Well this was the best doc appointment that we have ever been to. ( Fred and I both agreed on this). Either we are getting really good at working with doctors or he had excellent patient manners, I think both.

This was the first time that we were meeting one of the doctors after they had reviewed my case together (from the surgeon, oncologist , radiation oncologist team)

I was all ready and armed with at least 15 questions that I have come up with after talking to several professionals (through personal channels) ,being on internet forums, chat rooms and reading researches , test studies. And before I even had a chance to ask them he already addressed 13! (the last 2 were kind of anal even by my standards ) He went through everything thoroughly .. even the surgery findings.

There was some cancer activity in the lymphatic, vascular part of the breast so that aspect is another concern.
If gone by the text book one would need to have at least 7 nodes to stage correctly ( I had 6 removed) so going by that principle I would need additional surgery to take out the other lymph nodes ( YIKES !! do not want that I already have a slight risk for lymphedema )
However if they take more lymph nodes out and they turn out positive for cancer I will need radiation after chemo.

If they do not turn out positive I still will benefit from radiation however not as much.

According to statistics I have a 18% chance of local recurrence without radiation, however this percentage drops to 6% if I get radiation.

But getting radiation in the long term only increases the long term survival by 2%.

The radiation oncologist stated that he will be targeting pretty much all the right side from the end of the ribs to collarbone.

The clear margin of .3 cm is sufficient, anything above .2 cm is acceptable.

Group#2 oncologist had stated that the long term prognosis for recurrence would be about 19% after surgery,chemo and hormone therapy.. so by rads I will be decreasing this to 17%.

As the radiologist nicely put it '2% seems insignificant unless you are in the 2% yourself'

There is also some possibility of complications with the reconstruction which would be addressed if it arises. There is nothing that can be done at this point. And I will not be allowed to exchange the expanders for the silicone implants for about 1 year ( 5-6 months after rad).. hmm...

And radiation also could lead to lymphedema.. joy !

It might lead to scar tissue on the lung that is on that side however it does not impact the functioning of the lung ( he said I could even run a marathon).

I am not allowed to be a Dolly Parton ( SorryFred) as the expander being too large interferes with the radiation.

Brought up that according to the online algorithm from the National Cancer Institude I should only need surgery and chemo.

I asked him whether I was in the grey area, he answered strongly ' Very much'. So it seems like there is a lot of input that I could have in my treatment which I kind of like. For some people that seems scary but I like having a say on my life ;o) Gives me a sense of control which is lacking big time nowadays !

So as of now I am not favoring additional surgery and am inclined towards rads ( although I have about 6 months to think about it during chemo who knows maybe I can find a way to ditch rads in the meantime )

Proceeding with the plan, getting the muga scan for heart(chemo), starting pumping up the boobs, and probably getting the port put in for the chemo and meeting with Group#2 oncologist to see what they have to say.

Couple of things I learned

- dose dense chemo might not be necessarily beneficial for Breast Cancer chemo
- if it turns out that I have lot more lymph involvement after additional surgery I might be staged 3a, however the treatment protocola for 2b and 3a are similar so whats the point ?


Now I shall enjoy my weekend !