A longer road ahead...

Doug and I met with my oncologist today. Unfortunately, the news is not what I really wanted or hoped to hear.

The oncologist felt that I did have a dramatic response to my chemotherapy. The four lymph nodes that had small islands of cancer in them had residual cancer from 1mm to 3mm in size. The small deposits were towards the edge of the lymph glands (extracapsular extension). The oncologist felt that I probably had alot more cancer there and it was reduced to these small deposits from the chemo.

Radiation is not really an option, it is definitely required. However, the oncologist also suggested that I go on another course of chemotherapy. He is not sure it will help and has no proof that it will be beneficial, but he does not have high confidence that the tamoxifen that I need to go on after radiation is going to have enough effect because I am only weakly estrogen-positive and it works best when the cancer has positive estrogen reception. The reason that he is unsure is because there are no studies with results yet on using a second round of chemo.

He wants me to go through four rounds of another kind of chemo lasting three months. This is to kill any cancer cells that may have moved beyond the area that would be radiated (armpit, chest, breastbone). He wants to switch me to another chemo because he feels that at this point there will be some resistance to the existing chemo. He wants me to go on Gemzar and Navelbine a month after my surgery. These chemo drugs are supposed to have roughly the same effect as the last ones. So much for hair...After the chemo, I would then go for the radiation then start Tamoxifen.

Some more questions I asked and answers:

• How likely do you feel that there was microscopic spread of cancer given four positive nodes? - High
• If you had known that I was positive in four nodes, would you have changed my chemo or treatment at all? - No
• Will radiation improve my overall chance of survival or just recurrence of the cancer - Yes to both
• Has my prognosis changed? - Yes, the survival rate is lower but it is still good and if I go through the chemo, it will be better.

So, this is really heavy news but I feel relieved that my oncologist had a Plan B for me. I do feel though, that it might be wise to consult another doctor for a second opinion so I'll probably be looking into this.

I am seeing my plastic surgeon tomorrow and we'll see if the drains can be removed.

Stay hopeful for me.

Mo