2B or not 2B?

Frank and I saw Dr. Kuan today, to go over the pathology report and to discuss chemotherapy. What a long appointment.

First, the details. The CT scan showed the breast lump and the rather large lymph node in my armpit, but that's it. So, yay, we get a zero on the M(etastisis) for the TNM staging for breast cancer. We told Dr. Kuan that Dr. Broderick had said I was staged at 3A (67% survival rate) and she looked confused. She said, no, a T(umor)2 and N(odes)1 meant a 2B. She looked through the pathology report and we talked about lymph nodes that are "matted," which can move a stage 2B to a 3A, but she said the pathology report showed no indication of this, so we're going to take that 2B with no further argument, thank you very much. All in all, given the TNM "score" combined with the fact that the tumor was "high grade" (i.e. aggressive), gives me a 75% survival rate. (But as my oncologist friend, Carla, reminds us, "these statistics refer to large numbers of people, not to individuals.")

After clarifying those details, Dr. Kuan let me know that the cancer center is doing a clinical test on Taxol infusions. If I sign up for the test, my chemotherapy would consist of 4 bi-weekly infusions of Doxorubicin (Adriamycin) and cyclophosphamide [abbreviated AC], and then either 12 weekly infusions or 6 bi-weekly infusions of paclitaxel (Taxol). The benefit of taking part in a clinical trial, of course, is that you have even more doctors watching your condition. So, despite the fact that weekly infusions would be a drag from the perspective of getting on with life, we are considering it.

We got to meet the nurse for Dr. Kuan's practice, Lisa Mune, who showed us how the "port" works for the chemo infusions. You can go here for an image of where the port goes. This port, which is surgically inserted under the skin, enables the nurses to give me my chemo meds and to draw blood without having to find a vein every other week. We're hoping that Dr. Broderick can put in the port when he's doing the recision to get more of the margins (still no word on when that will occur, yet).

But, if you look at the image, you'll note that meds go right into the vena cava, which leads right to the heart. So, to make sure my heart can handle all this (the Adriamycin, the "A" part of the AC, is hard on the heart) I'm having a heart scan (MUGA) on Thursday morning.

Whew. What a day.

On a positive note--I went camping this past weekend with the moms and daughters in Maggie's girl scout troop. There were four girls and four moms in Marin and it was lovely. I came home on Sunday utterly exhausted. But I'm figuring I won't be doing much of that kind of thing for at least the next six to nine months, and I wanted the Maggie time.

Houston, we have a "stage"

My surgeon removed the drain today--yay! I had no idea how much it was irritating me. No, I mean, I know it was bugging me, but I didn't realize how much of the discomfort in my armpit was due to the little plastic tube up there. Now it's out and I feel better already. :-)

Bad(ish) news--the margins on the tumor were a bit close, so he wants to go back in and remove more of the edge around the existing "cavity" (where the tumor was). (The tumor was about 2.5 cm.) Since there definitely won't be lymph node involvement this time, it actually *will* be same day surgery. But, of course, we have to go through the approval process (again) first. So, everyone be thinking positive thoughts along the lines of "surgery next week, surgery next week, surgery next week".

And of the 18 lymph nodes they removed, 3 of them were positive.

This makes me T2 and N1 in the cancer staging. We're assuming (hopinghopinghoping) that the M (metastisis) is a 0. Hopefully the CT scan taken last week confirms this. I'll know more, I'm sure, when I meet with the oncologist on Monday.

The surgeon says they're staging this as a 3A. Not fantastic, but not end of the world, by any means. And, we're lucky enough to live in a nice metropolitan area, with access to extremely fine care.

Meanwhile, we continue to be touched by the genuine help and good thoughts we're continuously receiving. We can't thank folks enough. Please just know how much we do appreciate your thoughts and words.