So yesterday was a long appointment and laden with information ... and choices.
I'll start backwards. We left the appointment feeling encouraged. It wasn't what I was expecting to feel - at all - leading up to the appointment. I expected to feel really sad, or maybe even really happy - but not encouraged, so that was nice - and unexpected. But that seems to be the effect my medical oncologist has on me. She has a way of explaining things to me that is comforting, reassuring and most of all - trustworthy. When I listen to her, I feel like she hears me, understands me - and more importantly - cares about me. Not just as a patient - but as a person ... She respects that I have my own opinions and feelings - and doesn't condescend my questions or information just because I read it on the Internet, or someone told me about it -- she talks to me - to us ... as she is always sure to include Mike in the conversation - and she talks to me like I'm a person, not like I'm not a doctor.
She told me my pathology had a few things in it that concerned her to the point where she felt I needed chemo. First and foremost, the grade of the tumor was a 3 out of 3 - the most aggressive ranking a tumor can receive. This is common however - in younger women who get breast cancer. It's rare to be under 30 and diagnosed with a "nice" tumor. Second, the simple fact of my age was a concern. (The YSC reports that breast cancer is the leading cause of death for women 15 to 54. ) Third, she said that pathology reported "lymphovascular invasion." The way she described it was like this - The lymph node was the exit, and even though the cancer cells didn't make it there, they got on the on ramp. So, they were on their way. They were moving. Invading ...
When I read the pathology report in its entirety Tuesday after we got home from the plastic surgery appointment, I saw those same words -- "lymphovascular invasion" -- it rang a bell. Something else was being invaded.
When she confirmed my suspicion about what I read in the report - I felt something click. I knew I had to do something in addition to the hormone blocker therapy - in addition to the Tamoxifen. It was moving.
She knew before coming in to the exam room that I wasn't on the chemo bus. So she gave me another option. Absolutely, the hormone blocker therapy is needed for a total course of 5 years - my tumor cells feed and grow on the hormones my own body produces, I have to. In conjunction, the possible second treatment in the regimen, she offered me what is popular in Europe, "the European standard", as they don't use chemo as much as we do here in the states. It is a quarterly shot that I receive that shuts down my ovaries - and puts me into a clinically induced menopause. By doing this, I don't produce the hormones that feed my cancer cells. This induced menopause is also a 5 year treatment.
OR, I could opt for the U.S. standard of treatment, which is chemo therapy. She said the chemo she would prescribe for me is a more modern method of chemo, it's 12 weeks and 4 doses, spaced 3 weeks apart. The drugs are "Cytoxan" and "Taxotere" (also seen as CT or TC). I would lose my hair and may have irregular periods, or even a clinical menopause, but after chemo is finished, my periods should return just fine. And my fears about chemo and infertility - she assured me that unless we were already having issues, I should have no issues, no long term side effects -- no harm -- to my ovaries and potential children. I would have the "normal chance" of having a normal, healthy baby.
Given the options, I'm 99% sure I'm choosing the chemo. It's shorter, effective and then over with, hopefully as quickly as it came. I want to be here to experience my children - watch them grow and have their own babies. My cancer didn't just stay in the breast tissue ... it was moving. If it didn't invade the surrounding tissue, this would be a different post - but it did. So that changes things for me.
She wants my stitches to be healed up before we start, so I see her again on 8/17 along with the plastic surgeon, to remove the stitches. If they're healed and things are "ok" we should be starting chemo at the end of August and working in expansions when we can, when my body can handle it. 12 weeks puts me into Thanksgiving and Christmas. Starting the new year with chemo behind me, sounds kinda nice. We can then re-focus on finishing reconstruction and starting the Tamoxifen. I'll be 30.