Radiation Oncology Consultation

February 4, 2009

When you have cancer, you end up having a LOT of doctors. Trying to keep them straight is difficult for anyone that doesn't have cancer. So let me try to break down the process for you....

I have my Midwife who found the cancer.

She turned my case over to my surgeon, Dr. A.

Pathology dictates who I see next. If my lymph nodes have cancer then I need a Medical Oncologist who does the Chemotherapy.

When Chemo is finished, I have a Radiation Oncologist.

After radiation, I go back to my Medical Oncologist (Chemo doctor) to start any hormone therapies.

When that is all done, I should be able to go back to my midwife.... hopefully.

Today I met with the Radiology Oncologist for the first time (Remember we were not figuring that my cancer had spread to the lymph nodes, so I didn't think I had to make an appointment with the chemo doctor.. but as you all know now. We were wrong). None the less, I had made this appointment so we were going.

It snowed last night and there was snow all over the ground. Thank goodness we decided to leave my car with Chris' parents and he drive us in. My mom (who had come to take care of me for two weeks HATES to drive in MD, so rush hour and the snow would not have helped). After driving for 1 hour and 45 minutes, we finally made it to the doctor's office.

When I met with Dr. S this morning. I found out that my case had been discussed earlier at a Breast Conference with my "Team" (Surgeon, Oncology, Radiation, Pathology, and my Breast Liaison). That was good. She was able to go over a lot of helpful information.

The margins of my lumpectomy were negative for cancer (that is GREAT news, it means they got it all). But 17 out of the 25 lymph nodes they took out were positive for cancer. A shock to everyone including my surgeon. Because of this a few things happened...

1. I would now have to see the medical oncologist (Chemo Dr.) first and go through Chemotherapy before I would have radiation.
2. My cancer was re-staged due to the spreading... The tumor size itself would put me at Stage 2, but since more than 10 lymph nodes were infected, my cancer was now a stage 3C. Damn that sounds horrible. The next stage is 4!! That is the worst!!

Dr. S did say that even though stage 3C sounded horrible, my biology was actually quite good. Since I didn't have any risk factors (age, immediate family with history of breast cancer, etc), my cancer is HER-2 negative, and it was Estrogen and Progesterone Receptive positive there were going to be a lot of different options for me when I get to chemo and they were pretty confident that I would survive.

I was scheduled for a total body PET CT to see if cancer shows up in any other organ on lymph nodes. This is being done on Friday.

She explained that about three weeks after chemotherapy I would need 5 weeks of radiation, 5 days a week, on the whole breast.
Then the last week, she would do a "boost" on just the lumpectomy site.

Dr. S said that I was really fortunate that I was able to get a lumpectomy. Since my lymph nodes were infected I would get radiation even if I got a mastectomy. Having the breast tissue makes it easier on my when it is time for radiation. I can tell you that I would be really PISSED if I had opted for a mastectomy so I wouldn't get radiation and ended up with it anyways!

All in all Dr. S was really nice and the side effects of radiation (sunburn and fatigue) seem like cake after getting through with chemo.

I would just like to stop hurting. I am still in so much pain in and under my arm. My breast has decided to come to the pain party too, so it is just hell. All the doctors have told me that after I make that turn, it is amazing how fast I will heal... Can anyone tell my where that turn is?? Cause this is killing me!!!!