First appointment with the oncologist

Craig and I met with Dr. Block, my oncologist yesterday (with his sister, Anne, as our scribe).  Luckily she was able to squeeze us in this week.  Friday morning I was in really rough shape.  I felt like I could not breathe.  I was happy to get a plan in place but was terrified about what Dr. Block would say.  Luckily, the appointment could not have gone better and I felt like I could breathe again. 

This is what we learned...

Based on the initial pathology of the small sample the radiologist took this week, it looks to be a very slow growing cancer (Grade 1, which is different from Stage 1) with similar characteristics to my original tumor (ER/PR+ and likely HER2- but there is more testing the be done there). The oncologist thinks either (1) Tamoxifen (the drug I have been taking for the last 3 years to prevent recurrence) does not work for me or (2) the cancer is encapsulated in scar tissue with little blood flow and therefore the Tamoxifen is not reaching it.   In any event, I will stop taking tamoxifen and switch to something else, an aromatase inhibitor.   These drugs shut down estrogen production but only work in postmenopausal women, so I'll get shots to put me into menopause.    (Therefore, in January when it is 0 degrees outside, I am sweating, you'll know I am having hot flashes. ;) 

Standard course of action is surgery to remove cancerous tissue followed by 6 weeks of radiation to zap whatever might be left. After the surgery is done and they can test all the cancerous tissue, we'll make a decision about chemo.  She thinks probably no but we need overall pathology to make that determination.   You might think that chemo is the most conservative thing to do and why wouldn't I just have it this time...   There are studies that seem to show in cases like mine (or how we think my case will be) that the chemo really provides no additional benefit and does more harm than good.  I promise to attack this recurrence with everything that makes medical sense!)

We will meet with the breast surgeon (Dr. Cahill) on Monday to talk about the surgery.   It will have to be a little creative since I already had the bilateral mastectomy 3 years ago and now have implants.   We don't know if they'll have to remove the implant all together, swap it out, etc.  The breast surgeon will work closely with my plastic surgeon to figure that all out.  Radiation also complicates things as it can have an adverse effect on the implants. 

They took blood at the appointment and Dr. Block called me Friday evening to let me know the tests came back all normal - tumor markers, liver enzymes, bone something - basically anything that would indicate the cancer had spread came back indicating that is definitely has not.   PHEW!   

I'll have a Pet Scan on Monday just to make absolutely sure the rest of my body looks clear.  The doctor said multiple times this is just standard course of action and that she is not worried about it having spread since the tumor appears to be very slow growing.  They are referring to it as a "local recurrence."  That was the biggest relief for us and I walked out of her office with a huge smile on my face.