Today we met Dr. Susan Pierce, my Radiation Oncologist. We arrived at the Fairfax Cancer Center a bit early, and after filling forms, I looked around the waiting room to see who else was there. There were 5 other patients with their families – 3 women in their 50s or 60s, a man in his 60s and a young boy about 4 or 5. It was so sad to see such a young child in treatment. His parents looked exhausted. When his turn came to go in, they were trying really hard to be upbeat for him but he wasn’t in the mood. His cap came off as he went in crying, and you could see that he’s already undergone chemo. We were called a few minutes later. It was only the consultation with Dr. Pierce where she goes over my case, and explains what could be involved. This post covers most of what she explained.
1. There were 3 main options – do nothing, mastectomy, radiation plus lumpectomy. The chances of recurrence in 10 years if I did nothing was about 35%, but with either mastectomy or rad plus lumpectomy, it was 8%.
2. What to expect from the treatment. There would be about 3-4 weeks where a larger area was treated, and 2-3 weeks of more localized treatment. Towards the end my skin would be quite red but that there were creams that would help. She said the area may stay darker for a while but that was temporary. The skin in the area would also become tougher and thicken, but that was also temporary.
3. Since the lump was near the center of my chest, though within the left breast, it would have been difficult for them to get a good view in the mammogram. Because of that, Fairfax Radiology had also done an ultrasound back in April, but still the report indicated that it appeared benign (or something to that effect, not exactly definitive).
4. The position of the lump would make the radiation plan more tricky, not routine, since they would have to use an angle that would avoid the heart.
5. Radiation could not be scheduled until after chemo, if necessary, so we would have to wait to find out what Dr. Robert, the Medical Oncologist, recommended in terms of overall treatment. The possibilities were:
a. Hormone Treatment (HT)
b. HT + Radiation (R)
c. HT + R + Chemo
d. Doing nothing – not an option since the recurrence rate is on the order of 35% in 10 years
6. We are to meet Dr. Robert on Wednesday. He would base the decision on how to proceed on the chances of recurrence of cancer of similar type and size for others in the past, and would provide us with the probability of recurrence within 10 years assuming the various levels of treatment and considering the following: the stage of the cancer, the grade, my age, our preference, etc. Dr. Pierce said he may suggest a DNA test of the cancer cells (oncotype) to provide additional info for making the determination of whether chemo was necessary. She said we could leave our appt on Wednesday with his answer if he did not feel that test was necessary. She mentioned that Dr. Robert was a very good and famous doctor, and was also not very aggressive and would recommend chemo only if he absolutely felt it was necessary.
7. She wanted us to do a Breast MRI and was a bit surprised the Dr. Moynihan hadn’t suggested one. She scheduled it herself for Tuesday at 11:30. She said that MRI’s are great because they are comprehensive – they show what’s going on in both breasts, and also show the nodes below the sternum and the area of the lump. Those were of interest to her and there was no way to biopsy them. She warned us that the MRI could reveal more areas of concern and lead to more ultrasounds, and biopsies, but it was worth getting the additional information.
8. She told us of other risk factors of radiation: temporary cough due to impact on lung, slight risk of onset of cardiac problems, etc. The bottom line was that the benefits outweighed the risks.
9. She offered to speak to Dr. Au, the only radiation oncologist at Loudoun Hospital, but we told her that we were not comfortable with the fact that he worked alone and was not part of a larger practice. She said one advantage she has in being in a large practice is that she’s been able to specialize in breast cancers. We told her at the end of the appt that we had decided to choose her.
We left the appt feeling encouraged that God had provided us with a doctor who communicated well with us, and appeared thorough.
Today, I decided to change my appt at Johns Hopkins to only a second opinion of the decision that Dr. Robert will present us with. Once again I had to make a choice - between two doctors they offered, one a younger lady who was part time at the Cancer Center, and a much older doctor who also practices in Annapolis. I went with Dr. Watkins (older man) since I saw he has given recent presentations on breast cancer research… I’d prefer to have had a referral but don’t have anyone to ask.
I’m feeling good tonight, and as the song goes, God has calmed another storm in my life…
I thank God for another day!
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