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Wednesday, December 4, 2013

Oh the strides they've made.....after so many mistakes...

Good morning....

I went to my Radiation Oncology Therapy appointment yesterday , TUESDAY, DEC. 3RD AT 10:00.......got there early because I knew I'd have paperwork to fill out..........Phew....that's an understatement.  When I finished filling out the 'book' telling them everything they ever wanted to know about me and my health (and then some)....it was near 11:00 (glad my appointment was at 10:00 !)...Anyway, it is a necessary evil and lots of the questions and statements that you have to sign is to protect their rears!  I got the (what seemed like 22 pages) filled out and waited to be called in...

Finally.....SNYDER....yes...here........"The doctor will see you now"  (well sort of -- you know how that goes)...they weigh you and take your vital signs and take you to the room and ask you more questions....(some of the same ones you just spent an hour answering on their questionnaire) and you wait a little longer.

The doctor came in and I liked her from the minute she held out her hand and introduced herself.  Only a couple of years younger than me...(I looked it up)....she presents herself well and her words told me she knows what she's talking about and this is not her first rodeo.  I loved that she made me feel like I was her only patient.  She used language that I could understand and explained everything completely and spent more than 10 minutes with me....giving me time to ask every question I had and answering them in great detail.

Things have changed since my last cancer in 2002.  When I had radiation then I laid perfectly still on a hard metal slab while they adjusted  laser lights to get a cross hair graph and mark  (actually tattoo you with small dots) the exact spot where they would be shooting the beam of radiation in each day that you came for treatment.  She told me that procedure has been replaced with a digital cat scan. When she talked about the tattooing, I asked if I could have
 tattooed on me....She laughed and said, you deserve that for having to go through this twice!

She said I had been presented to the "Tumor Board" on Monday....the "board" consisting of surgeons, oncologists, pathologists, some other people that could give input and herself (the radiation oncologist).  On Mondays, they meet on the patients they are currently treating, giving reports, treatment suggestions etc. The presentation of my case included the fact that they were waiting on the retest of the HER-2/neu test and the Oncotype  DX tissue test.  The HER-2/neu test in my last cancer (2002) was negative.  This one was equivocal (unsure of positive or negative result)....a positive result would mean I would definitely do chemo....negative would indicate that I might not need chemo.  The Oncotype DX test is relatively new (only in the last 5 years) and although doctors were very skeptical of the power of the results of this test (purported by the scientist), time and time again, the test results proved to "spot on". This is a brief synopsis of what the test does:

The Oncotype DX test is a genomic test that analyzes the activity of a group of genes that can affect how a cancer is likely to behave and respond to treatment. The Oncotype DX is used in two ways:
  • To help doctors figure out a woman’s risk of early-stage, estrogen-receptor-positive breast cancer coming back (recurrence), as well as how likely she is to benefit from chemotherapy after breast cancer surgery.
The results of the Oncotype DX test, combined with other features of the cancer, can help you make a more informed decision about whether or not to have chemotherapy to treat early-stage hormone-receptor-positive breast cancer or radiation therapy to treat DCIS

For further more detailed information go to :

http://www.breastcancer.org/symptoms/testing/types/oncotype_dx

The test results come back in 3 catagories:  LOW (0-17), INTERMEDIATE(18-31), HIGH (32-100)
LOW - chemo usually not required
INTERMEDIATE - discussion with oncologist and patient to include all aspects of patient's history and current cancer to determine benefits of chemo
HIGH - usually always requires chemo

My oncologist is leaning toward chemo (as am I) mainly based on the fact that this is my second occurrence.............but (and some of my well meaning friends will be thrilled to hear this)  my Radiation doctor said that for many many years patients were given chemo that really did not need it....that even as recently as 2002 it was still a trial and error situation (and even today, there are trials and studies going on to determine if the chemo itself is of more benefit to the patient than the damage done by the side effects of the chemo)....I think that is pretty impressive news and finally a doctor that will admit that unfortunately doctors used the information  they had available) i.e. in 2002 I had 21 lymph nodes removed....all of which were clean.  Probably in hind sight, they didn't need to be removed.  But at the time the Sentenal Node theory was just being tested and not every hospital had the dye available to pin point the first 3 nodes that the cancer might spread to (if it had spread out of the breast).  Because of the size of my tumor in 2002 and because I had let it go longer than I should have....I was advised to do chemo and I do not regret that decision.

Today, I feel  confident that the doctors and pathologist have made so many strides in the field of  available testing that allows a more informative and conclusive decision of treatment.

Although my  oncologist (when I first met her) said she was leaning toward chemo...she did say that if the HER2/nau is negative and the Oncotype DX test result is  LOW....then we will revisit the use of chemo and determine if the side effects would outweigh any benefit the chemo might give.

The Radiation doctor said yesterday, that from what she can see so far, she believes that the HER2/nau test will come back negative and the Oncotype DX will come back LOW and that I will NOT have to do chemo.  We are still wating for the results of those test.  However, she did call me back yesterday afternoon and said she spoke to the lab doing the Oncotype DX test (which takes the longest time to get results of the two test) and they told her they should have the results of my tissue test tomorrow afternoon.  She should be calling me with the results this Friday, December 6th (all right ....I do have something to look forward to on Friday......see my previous post for the side joke here!)

So that's where I stand as of today.....still waiting....but a bit more hopeful that I will not have to do chemo and only 4 weeks of radiation. (Even that has changed...in 2002 I had to do 6 weeks).

I am amazed at the strides that have been made in the world of cancer.  If you are  able and can find a fundraiser that gives 100% of the donation to research....please make a donation.  Your donation might just bring about the research that finds a more accurate test or more conclusive information or a less invasive means of treatment....for someone.....just like me.
   Hugs everyone.....think positive and THINK PINK!

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