Day 3

Monday, May 13. Four appointments starting at 2pm. First up was the nurse coordinator who provided me with information about breast cancer, my team of doctors (oncologist, radiation oncologist, and surgeon) and gave me some general reading on support groups and dealing with this diagnosis. Second on the docket, a meeting with my oncologist who I adore. She was incredibly thorough, spoke slowly and calmly while drawing diagrams and writing things down for me to see so that it "clicked". I have a better understanding of the tumor and the treatment and know what to expect which has lifted a giant weight off my shoulders. I feared the unknown. Probably why I spent much of Saturday and Sunday Googling the little information I did have from the pathology report. It came in handy as she asked if I had a friend that was a physicist. Guess I was asking the right questions while demonstrating my newly acquired knowledge as I asked questions about the treatment and what to expect. Third meeting was with the radiation oncologist and confirmation that I would be receiving radiation when the time comes. He informed that if I elect to have a lumpectomy, I receive radiation no questions asked; however, with a mastectomy it's sometimes unnecessary to followup with radiation. However, the size of my tumor and it's aggressive nature has guaranteed that I will receive radiation no matter if I choose to lump it or lop it. The last appointment was supposed to be with the social worker, but it didn't happen as it was already 5pm and I had had enough information for the day; plus, we figured she wanted to go home, so we rescheduled. I ended up going downstairs to the lab to have blood drawn to knock out one more of the many tests I'll have this week.

As I understand, my hormone levels are an aspect of my tumor. Something about Estrogen Receptors (ER) and Progesterone Receptors (PR) and the HER2/neu gene. My HER2/neu was a 2+ which is not negative (0 or 1+), but is not positive (3+). So, it had to be sent for a FISH test. (see below from http://breastcancer.about.com/od/diagnosis/p/her2_diagnosis.htm)

What are the tests for HER2 breast cancer?:

• IHC: ImmunoHistoChemistry - this test measures the production of the HER2 protein by the tumor. The test results are ranked as 0, 1+, 2+, or 3+. If the results are 3+, your cancer is HER2-positive.
• FISH: Fluorescence In Situ Hybridization - this test uses fluorescent probes to look at the number of HER2 gene copies in a tumor cell. If there are more than 2 copies of the HER2 gene, then the cancer is HER2 positive.

Chemotherapy
Chemotherapy will be necessary and will likely last 5-6 months. Two medications will be given at the start, every other week for 4 cycles; followed by one medication given every week for 12 cycles; radiation will be administered after I have surgery, daily for 33 treatments (approximately 6 weeks). We didn't discuss the side affects in great detail, but I found most of the information on this Mayo Clinic webpage to be accurate to what my doctor and I discussed. http://www.mayoclinic.com/health/chemotherapy-for-breast-cancer/MY01368/DSECTION=what-you-can-expect

Radiation
Radiation will come much later. First, I must navigate the chemotherapy and surgery. As the lump is in my left breast, they worry about exposing the heart and lungs to too much radiation. My doctor seemed pleased that I would be open to laying on my stomach during radiation treatments as they could better target the radiation to the affected area and that position would also allow them to shield the heart much better than if I were on my back. The most common side affect is the breakdown of tissue and redness (similar to a sunburn) that is caused by the radiation.