Posts tagged Oncotype Dx

fightlikeagirl

No Chemotherapy!

May 11th

Posted by Sarah in Updates

12 comments

Just the Facts: The Oncotype Dx test results are in, as are results from the CT scan and bone scan.  It’s ALL good news:  NO CHEMOTHERAPY for me, and all scans were NORMAL!

Details: Last Friday I spent the day having pictures made.  ;-) I had a CT scan of the chest, abdomen, and pelvis and a bone scan.  Drinking the contrast was only slightly gross. The worst part was that it took most of the day to complete. The scans themselves were easy.

Today I met with a new oncologist for a second opinion.  I also met with my original oncologist to receive the results from the Oncotype Dx test.  We will be working with her going forward and we realized how much we like her.  The best part, of course, was the news she had for us:  NO CHEMOTHERAPY.  The Oncotype Dx is a test that evaluates the actual tumor (or tumors, in my case) based on 21 genes.  It is offered to a certain group of women, who had no cancer in the lymph nodes and whose breast cancer is hormone receptor positive.  A result is returned for each tumor, classifying it as LOW, INTERMEDIATE or HIGH RISK for recurrence.  Those who fall into the low risk category are NOT given chemo.  High risk patients are given chemo, and those who fall in between must weigh their options and make a decision based on all the factors.  No decision was needed for me because BOTH of my tumors rated LOW RISK according to the Oncotype Dx test!!!! YESSSSSSSSSSSSSSSS! Radiation will not be part of my treatment either.

That isn’t quite the end of the story, though.  Because my tumors were hormone receptor positive (they especially depend on estrogen to grow) any remaining cancer cells will respond well to the drug, tamoxifen.  All the doctors agree that this should serve as the “magic pill” for me, essentially stopping the cancer dead in it’s tracks.  I am not excited about taking any type of hormone pill, but do understand the need in this case.  If I were to reject the drug and do nothing further, my risk of recurrence would double.  Tamoxifen is a serious medication and has significant side effects.  I am told that I should fare much better than most women who take it since I am younger and active.  I will be taking it for the next FIVE years.  I’m really not looking forward to it, but I am counting my blessings.  I’m also making some other changes in my diet and lifestyle to further support an anti-cancer environment

I have been blessed to get this far without much discomfort.  In the last few days, the area below one of the tissue expanders has become very painful, though there are no signs of infection. Research on the ‘net (only partially reliable) suggested I could have a fractured rib caused by pressure from the expander, but my oncologist didn’t think that was the cause.  She believes it’s inflammation in the serratus muscle.  Whatever the source, it is VERY annoying and is causing me more pain than I have had since the first few days after surgery.  I will see my plastic surgeon on Thursday anyway.  We’ll see what he has to say.  I hope the pain doesn’t continue until I have the expanders replaced (August-ish)!!!  I am temporarily suspending kettlebell work until I can get the pain under control (you know it’s serious when  . . .) The oncologist made some recommendations for pain management for the time being, which I am embracing!

Me: SO PSYCHED that chemotherapy is not needed!!!!!!!! At the same time, feeling a bit shell shocked.  It has been 3 months, almost to the day, since I was diagnosed with breast cancer.  I will be taking hormone therapy for the next five years and will be closely monitored (oncologist visits every 3 months for 3 years, then less frequently) and of course, am still in the breast reconstruction phase.  I believe most of the hard stuff is behind me.  It’s a wonderful feeling, but I also barely know what hit me.  In some ways, I am still dealing with my diagnosis!! The bottom line is that the cancer is under control, we have a drug to fight off what may remain, and my future is bright.  The rest will fall into place.  :-)

What’s Coming Up? One or two more appointments with the plastic surgeon, and then a three-month waiting period.  At the end of that, I will have the exchange surgery (implants in, expanders out).  Later, further reconstruction will be considered if we choose.  Also, I have my tamoxifen prescription.  I am told to start it soon.  I’ll be blogging about how that goes.

Other: Thank you!! Thank you for the prayers. Thank you for the good thoughts.  Thank you for the comments here.  Thank you for the tweets and the Facebook comments. Thank you for encouraging me and for just reading the blog!!  I purchased this shirt at the oncologist’s office today.  Lots of the hard work is already done (WHEW!) but I will continue to do this:

Stay with me as I fight and continue to become stronger. :-)

Research, Options, and Back to my Kettlebells

May 1st

Posted by Sarah in Updates

4 comments

Just the Facts: This week I saw my plastic surgeon for more “expansion” and may now be done with that. We’ve been thinking through all that was said at the oncology appointment and doing lots of our own research as we wait for the results from the Oncotype Dx test. In the meantime, I have set the wheels in motion to see a second oncologist.  Happily, I have been given the OK to proceed with my kettlebell workouts.

Details: Every week seems to have at least one fairly major thing going on and this week is no different.  This week we have been doing lots of research on tamoxifen and chemotherapy, recurrence rates and natural therapies.  We wait to hear results on the Oncotype Dx test, which will have a big impact on whether or not I take chemotherapy.  We have discussed our options with each other, with friends who have gone through the same or similar things, and have read lots about our choices.  There really is no “good” option.  We continue to work through it all and try to figure out what is right for me.

As usual, I visited my most-excellent plastic surgeon this week to have more saline added to my tissue expanders. This may be the last “expansion” for me since we seem to have achieved a look that fairly closely resembles the former me.  Of course, we have the option of looking different, which is what we are considering now.  :-) What a crazyweird decision THIS is to make! In contrast to the drug/therapy decision, this one is definitely more fun, though still nearly as confusing.  Once we have reached a point we are happy with, the clock starts for a 3-month wait.  I will then be able to have the quite-uncomfortable and very fake-feeling expanders exchanged for real implants in outpatient surgery.

This week I also started the process of getting in to see another oncologist.  We really like our first oncologist and may choose to stay with her, but wanted a second opinion.  Once the second doctor has reviewed my pathology reports, we will be contacted with an appointment date.  I expect that to be in about 2-3 weeks.

My plastic surgeon has given the OK for medium-weight kettlebell workouts.  (Next week I can move up to my “normal” routine.) I’m so happy to be building my strength back!

What’s Coming Up? On Tuesday I will see my surgeon for the last visit with him for a long time.  His portion of this is basically complete and I know he’ll be happy to see how well I am doing. On Friday I will have a CT of the Chest/Abdomen/Pelvis and a Bone Scan.  The oncologist ordered these imaging tests as a baseline.  I am not looking forward to them due to having to drink large amounts of contrast fluid. It will go fine — it’s just one more thing, and a minor one, at that.  The Oncotype Dx results are expect the following week, and we’ll have our appointment with the oncologist on May 11 to discuss those results.  Also that week, I will return to the plastic surgeon for another regular visit.

Prayer Requests:  Please pray for discernment for us in our decision making.  Also, I am still having trouble sleeping well.  This will pass with time, but please pray for that remaining discomfort to pass quickly.

First Oncology Appointment

Apr 25th

Posted by Sarah in Updates

4 comments

Just the Facts: Last Friday, Tracy and I went for an appointment with an oncologist.  We liked her a lot and will probably not interview any others.  She was very optimistic about my outlook but did recommend that we order the Oncotype Dx test in order to make a better decision about whether or not I should have chemotherapy. The fact that chemo is still on the table was a bit shocking to us, but we feel confident things will go well even if I need it.  The Oncotype Dx results are expected in early to mid-May.

Details: The end of the week last week was actually quite eventful.  On Thursday I went in for my weekly appointment with the Plastic Surgeon. It was my first time having saline added to enlarge my tissue expanders. Quite an experience! A little more will be added each week or so, then a few months later, I’ll have another surgery to replace the expanders with implants.

Friday’s appointment with the oncologist went very well.  She spent about an hour with us, going over my pathology report bit by bit.  She pointed out the details that were great (there were several) and the parts that were a little concerning (there were a couple).  The most important thing in the whole pathology report was, of course, that my lymph nodes were clear.  However, that is not the end of the story with regard to whether or not chemo will be necessary, and this was news to us.

She explained that some women with Stage 1 breast cancer can still benefit by chemo.  (For many, the risks of chemo outweigh the benefits.)  In order to figure out if chemo would be right for me, she wanted us to order the Oncotype Dx test.  We already had planned to order the test, but neither Tracy nor I truly understood exactly what it tested, and what it would tell us, until the doctor explained it.  The test will return a a numerical score of 1 to 100, indicating whether my risk is low, intermediate or high for a recurrence of cancer.  Chemo will not be recommended if the score is in the low to low-intermediate range.  For a score of anything above low-intermediate, chemo will be recommended.  We were surprised to hear that this was completely independent of the fact that the nodes and margins came back clear.  The doctor made an educated guess that my score would come back in the low risk range, but she said NOT to count on it, because the actual tumors are genetically tested in this process, and sometimes there are unexpected results.

If my score does come back to in favor of chemo, my course of treatment will be relatively “easier” since my nodes were clear.  It would be 4 rounds of treatment, 3 weeks apart and would include just 2 drugs.  This is a much lighter regimen than it would be otherwise.

The doctor also discussed at length the hormone therapy that I must have.  I went in to the appointment with many questions and reservations about the drug I will be prescribed, tamoxifen.  She could not make me feel good about taking it (impossible) but she did make it clear that this drug is essentially mandatory for my cancer fight.  The side effects that are seen with it pale in comparison to the good it does.  I still do not want to take it, but am basically convinced that I should.

Prayer Requests:  That the Oncotype Dx test would come back indicating I am at low risk of recurrence and therefore, do not need chemo.  I do not want a high risk score or intermediate score.  An intermediate score also may bring the difficulty and stress of having to make a tough decision, so please pray that the result would not be such that we’d have to face that.

Me:  I’m focusing on Romans 8:28, And we know that in all things God works for the good of those who love Him, who have been called according to his purpose. I’m eager for the test results to come back. I’ll take a deep breath and charge forward if those results are in favor of chemotherapy.

Last week’s “expansion” did give me some extra soreness, though it wasn’t exactly as I had expected (not as bad in some ways, worse in others).  A pain free night of sleep is still something I haven’t managed since surgery.  I keep trying new pillow arrangements and what not.  Since I received the OK to do some light workouts, my brain-fog is decreasing.  I’m ready for that to be GONE but suspect I still have a couple weeks of it left.  All in all, I am doing great.

What’s Coming Up? Every Thursday includes an appointment with my plastic surgeon.  I also see my surgeon again in early May, then will see the oncologist for the test results on May 11.