I really liked her. We did not feel rushed. She answered all of our questions, but even better … She walked in, sat down and apologized that I was going through this. Then, knowing we had already been to an oncologist so we already knew a lot, she began to explain things to us. She didn’t assume we knew.
A lot of it we had already heard. It was nice to hear confirmation. Other things, we had never heard explained the way she explained them. She was really good at explaining. Other things we had never heard at all.
First, she made a “good/bad” list. She said that she looks at certain things when predicting the prognosis/chance of recurrence. She made my list on the back of her papers:
- Bad — Size of tumor (mine was 5.8 cm). Less than 1 cm would be considered good.
- Good — Estrogen/Progesterone positive (mine was 94 percent Estrogen and 90 percent Progesterone). Less than 80 percent would be considered bad.
- Good — Her2 negative (that’s me). Tumors that are Her2 positive are more aggressive and harder to treat.
- Good — Lymph node involvement (I had only 2 — and more on those later).
- Even — Grade (mine is Grade 2). This shows how aggressive the cancer cells are.
So, I scored pretty well.
Then, she told us that my case was extremely unusual. She said that for a young woman to have lobular cancer is very uncommon. She’s only seen two other cases in her career.
“I usually see this in 76-year-old women who have been on hormone therapy for 15 years.”
I still haven’t decided if that is a compliment or not.
But the good news is that it is better to have lobular cancer. It is less aggressive. We also learned that lobular cancer tends to make its recurrence in your other breast.
I had come to peace with the idea of not cutting off a healthy breast. Dr. Kronowitz is VERY against that. (It’s always been fun to hear him rail about that trend in his industry.) But with this news, I might have reconsidered. Unfortunately, we didn’t know it was lobular until after the tumor was removed.
The bad news is that I have some ductal cancer mixed in. That seems to be Dr. Razaq’s main concern.
Dr. Moulder (MD Anderson oncologist) told us that she was not going to do an OncoDX test on my tumor because of the lymph node involvement. This test gives me an individualized score of my chance of recurrence. You can score low, intermediate or high. Dr. Moulder’s take was that if it came back intermediate or high, she would recommend chemo. But if it came back low, she wouldn’t know what to make of it because of the lymph node involvement. So, even if it came back low, she would have to recommend chemo. She just wants to be the most aggressive she can because of my age. She didn’t want to know the OncoDX test result.
Dr. Razaq had a different outlook. She, like Dr. Moulder, thinks the test will come back intermediate. But she stresses that my case is very rare, so she wants to test it. It’s lobular, so it might be a low score. Probably not, but maybe.And, she doesn’t seem to think that a low score would mean chemo. Hmm … this was beginning to sound familiar … a lot like that visit we had with Dr. Valero in Dr. Moulder’s absence in December. That’s the one that got me all confused because he was suggesting that chemo might not be the answer, depending on the OncoDX test … the test that Dr. Moulder would later elect to not have done.
Dr. Razaq, like Dr. Valero, said that when they found the two to three cells in two of my lymph nodes, they did it using a method that looks at it on such a detailed microscopic level (my words, not hers — and not technical) that most labs wouldn’t use. In fact, she said that there have been no clinical studies that have looked at lymph nodes at that level. My lymph nodes would technically be considered negative had I had them taken out at another hospital.
What does this mean? Well, if we thought that my lymph nodes were negative, and my OncoDX test came back low, it might tell us that having chemo would only lower my chance of recurrence by 1 percent or less. That 1 percent might not be worth the long-term side effects that chemo can cause. Therefore, we could elect to skip chemo and go straight to radiation along with the hormone therapy for five years.
Now, if it is intermediate or high, we would do chemo because now we are talking about it lowering my recurrence chances by another 8 to 10 percent. That’s clearly worth it.
Okay — I’ll stop boring you and get to the point.
Dr. Razaq wants to run the OncoDX test on my tumor, then reconvene and discuss my options. I am truly not too hopeful about not doing chemo. I just don’t think that will be the case. But, I’m happy that we are checking.
In the meantime, she put me on Tamoxifen. That is the hormone therapy that will suppress hormone production in my body. This is the best medicine to reduce the percentage chance of recurrence, since that hormone is what feeds the cancer. Unfortunately, Tamoxifen does fun things like cause hot flashes, mood swings, weight gain and lots of other fun things. It can also push you into menopause early. Sounds fun, eh? Alan is SO, SO lucky.
I’ll stop taking this when chemo starts, but since we are AT LEAST three weeks out, we might as well be doing something to kick cancer’s butt.
Oh, and one more thing … Dr. Razaq’s chemo is similar to Dr. Moulder’s with only a few differences that Dr. Moulder told us to expect (and that she is okay with). The best one is that she gives the doses of chemo differently so that instead of getting Taxol once a week for 12 weeks, I will have four rounds once every two weeks.
Did you do the math? That just cut my treatment down by a month.
She also gives the Adriamycin/Cytoxan differently which cuts a month off that, too.
I just went from six months of treatment to four months of treatment.
That’s worth another … Woohoo!