Brief Update

No April Fool’s jokes today, just a brief update.  This morning I met with Dr. Singh, who is an oncologist.  He went over the pathology report from my two surgeries.  All and all they found seven microscopic threads of invasive cancer in a few different areas.  The longest of these threads was 4.5 mm, and others were 2 – 3 mm.  So one way of looking at this is to view these individually and say the cancer was not bigger than 5 mm =.5 cm.  This is kind of a magic number because if the tumor is smaller than .5 cm, usually they do not do chemotherapy.   If the tumor is larger than one centimeter, chemotherapy is recommended. 

But the other way of looking at it is more cumulative.  There were 7 threads and if you added all them together they would equal about 3.5 cm.  Which tips the scale in favor of chemo. 

Within the oncology community, there is not a clear consensus on which way to deal with this information.  Dr. Singh’s recommendation is that I do the complete course of chemotherapy, and he spent considerable time explaining the specific drug and potential side effects.  But he also said, there is not a large body of research that specifically deals with this scenario of multiple small threads.  I told him, I had no idea how to make this decision given the information in front of me.  Doing nothing further, my prognosis is very good.  Given that my cancer is Estrogen positive, I will do the hormone therapy (Tamoxifen), which makes my prognosis even better.  Do I put myself through the trauma of chemotherapy – to improve those numbers by a percentage point or two?  Not sure.  Not sure at all.

So Dr. Singh suggested I make a trip to Rochester, and meet with one of the breast cancer specialist at the Mayo Clinic for a second opinion.  That sounded like a good step.  In this world of cancer there are no absolutes.  I know that.  But I like evidence-based decision-making and right now I don’t have enough evidence one way or another to make this decision.  I also do not feel any sense of urgency.  I feel very good about the decisions I have made so far, and I want to feel equally solid about this next decision. 

And today, while my killer cold is only slightly improved, my attitude is much improved.  I was glad I felt well enough to keep my appointment.  I felt overall the information from the pathology report was more positive than I was expecting.  And, I appreciated the open and collaborative way that Dr. Singh approached making decisions about the next steps.   

This afternoon I am going to see my primary care doctor, bring her up to speed on all this and hopefully get a prescription for some cough medicine with codeine.  Tomorrow I will keep my appointment with the physician assistant to learn about the port for chemotherapy.  Then on Wednesday, I am going to fly to Arizona and take a five-day vacation from thinking about cancer.