Hearing about what’s next

We sat down with Dr. Nath yesterday and discussed next steps. PJ was with us, I’m so pleased she was able to get out of work and come to the consultation. She asked thoughtful questions, interpreted a few things for Dave and I, and learned of her own increased (although fractionally) risks of developing breast cancer in the future (.04% v .02% for someone with no family history in the next 5 years).

The plan is as he outlined when he called last week with the results: further surgery, radiation therapy, and possible estrogen-inhibiting drug therapy. But there are a few more components added, all of which are sound recommendations and which I’ve accepted.

Of important note: results of the June 14 biopsy show complete excision of the DCIS (1.3 cm piece), but with micro invasion (0.1 mil). One side of the biopsy showed a very thin margin (within 4 mil.), and he’d like to go back and clear a wider margin. Fine with me. Micro invasion is a tiny spill of cancer cells from the affected duct. The question is whether these have traveled outside the immediate area. The clean margins would suggest they have not moved; we need to be sure.

He would also like to do a sentinel node biopsy to clear the micro invasion. This procedure is done at the same time as the additional excision and involves dropping dye and radioactive markers into the excised area. The dye and markers travel through the blood stream to the nodes; during the procedure he will check nodes (under my arm) and clear any that are “dirty.” At this stage we could revert to a full mastectomy if the situation warrants. He doesn’t think we’ll have to do that, but it’s an option.

He expects that I would go home on the same day as this procedure.

Speaking of mastectomy, that too is an option, in the event I just don’t want to deal with radiation and would be content to get rid of my breast now. While it’s nice to have options, that’s not what I want to do.

We are not rushing to surgery. He says the breast is still tender and healing from the June 14 biopsy (in fact, he’s leaving all of the bandaging in place). He’d like it to be more healed before he goes back in.

Here is the plan:
July 3: MRI to rule out any additional areas of concern
July 11: Next appointment with Dr. Nath
July 16: Appointment with the radiologist to arrange radiation
Last week of July: surgery, further excision and sentinel node biopsy
Mid-August: radiation would begin, 5-day-a-week treatments for six weeks

The only appointment not scheduled is one with an oncologist.

We should be done by early October, in time for a splendid birthday celebration. Mark your calendar.

Possible concerns:
Problem showing on the MRI: is there a need to do more extensive surgery or perhaps consider mastectomy?
Problem showing during the excision/sentinel mode biopsy: again, need for more extensive surgery or mastectomy? I’ll have to leave my wishes and appropriate authorization prior to surgery.
At any point: results may indicate a need for chemotherapy. That door has to remain open, and I accept that possibility.

A clear MRI should eliminate the other potential problems.

I’m not seeking a second opinion. Dr. Nath presented my case to the Winchester Hospital/Dana Farber Tumor Board on June 26, and the board agreed with his analysis and plan.