I'll start with our first visit to Lisa's surgeon, Dr. Jennifer Tittensor, a general surgeon who specializes in breast cancer surgery. She reaffirmed what our primary care physician has already told us (covered in the prior blog entry): though the cancer cells showed potential (thus, the high grade mentioned below), it didn't appear to be invasive. We spent about 45 minutes with the surgeon, asking question upon follow up question. It was quite a pleasant visit, and one that I haven't come to expect from a doctor, most of whom seem rushed.
Forgive me if I get rather clinical here for a moment. I'm not one to blog about my wife's breasts, but I am going to frankly discuss this to give you a sense for the kinds of things a breast cancer patient and her husband discuss. If you don't care for the clinical explanation, skip the next few paragraphs.
Based on the initial mammogram and biospy, Dr. Tittensor suggested that Lisa would require either a lumpectomy or a mastectomy followed up by localized radiation once a day for six weeks. The decision between a lumpectomy--where they remove the affected portion of the breast plus a surrounding margin of healthy tissue to make sure they get all the cancer--and a mastectomy--where they remove the entire breast--would largely be based on cosmetics. The challenge with a lumpectomy is that it isn't very conducive to reconstruction: you basically remove part of the breast tissue, and sow it back up. The cosmetic result is, for lack a better phrase, a lopsided chest, which, as you can imagine, most women don't want. The advantage to a lumpectomy is that you keep your breast, nipple included, and all of the functions associated therewith.
The disadvantage of a mastectomy is that your lose your entire breast including the nipple. The advantage of a mastectomy is that it is much more conducive to reconstruction. That reconstruction can be done in such a way that allows a woman's chest to retain relative symmetry.
Beyond the discussion of mastectomies and lumpectomies, we discussed the possible treatments that would follow. Apparently, about 25% of the women who have lumpectomies or mastectomies face a recurrence of cancer. That number drops to 5% if the breast surgery is followed up with radiation treatments. When Dr. Tittensor referenced those statistics, I asked the following question, "So, what are the odds of getting cancer from the radiation therapy?" I've always thought it quite odd that we treat cancer with an agent that causes cancer.
She replied, "Good question, and that risk is there. I suppose you must weigh the benefit of dropping the odds of recurrence from 25% to 5% versus the 1% chance of getting some other kind of cancer from radiation exposure."
Her response to my question pretty much sums up our position at this point: we need to play the odds, particularly because we have a young family of children ranging form 16 to 2. Though Lisa and I tend to be open to alternative forms of medicine, cancer at this stage of our lives makes it difficult for us to experiment with alternative methods. The stakes are too high. At this point, it's about accepting the current medical science--flawed or incomplete as it may be--and playing the odds that we're making the right decision. Obviously, whatever decision we make for long term treatment will not be made in the Vegas spirit of playing the odds--i.e, rolling the dice. Rather, it will be made after asking every imaginable, probing question that we can think of, and gathering as much data as we can, and then making it a matter of thought and prayer.
During that first meeting with Dr. Tittensor, she suggested that because the cancer appeared to be non-invasive that chemotherapy wouldn't be necessary. Fhew! It's funny how Lisa and I left that first appointment, happy that we only had DCIS (described below), and that chemotherapy wouldn't be necessary. Perspective is everything.
Before we left, Dr. Tittensor had her nurse schedule Lisa for an MRI--just to make sure we had a complete handle on where the cancer might be. MRIs can do a better job at detecting cancerous tissue than mammograms. Apparently, a mammogram is the first testing mechanism because it's simply cheaper. MRIs, mammograms, and ultrasounds all reveal different things, and used together, can provide a cohesive set of data for diagnosis. She did warn us that about 25% of the time (there's that percentage again) MRIs will reveal "false positives"--i.e. find cancers that aren't really there. In other words, they can exaggerate. Therefore, any additional MRI findings might need to be confirmed by an additional biopsy and ultrasound.
Lisa's MRI happened the next day, Friday, four days after diagnosis. Until we received its results, we were confident that we had a pretty clear path to treatment.
On Monday, Dr. Tittensor's nurse called to say that the doctor was out of town, but that they had just received and discussed Lisa's MRI results with her. The MRI revealed an additional cancerous region in the same breast, but in a different location. The results confirmed another "gut feeling" that Lisa had that there were other affected parts of the breast (remember my comments on Lisa's intuition--too bad she can't use that intuition to pick stocks). Because of those results, she scheduled another biopsy and ultrasound of the newly revealed cancerous region.
On Tuesday, Dr. Tittensor called Lisa to say that these additional results suggest that the cancer might indeed be invasive--otherwise, it's a rather large occurrence of DCIS, which is uncommon.
If that is the case, everything changes. How does it change? We don't know. But that nasty word chemotherapy may very well come into play. It appears that Edy was right--the diagnosis is evolving; things are moving fast, and we're gearing up for a ride.
Interestingly, the peace is still there. We accept it; we don't get too high or too low. We're intrigued and a little anxious to learn what comes next, but mercifully we have been given peace--an emotion that is impossible to counterfeit.
Good night.
No comments:
Post a Comment