Thursday, August 19, 2010

No more surgery!

Well Nicole has emerged from a second surgery on Tuesday and today was blessed with 'clean margins' from Pathology. That essentially means they have removed enough tissue that the tumor can officially be considered gone! Nicole is sore but feeling much better already than the last surgery.

We meet again with the surgeon tomorrow and expect to get a hug and a hand-off to the next stage.

Much time and many treatments ahead, but for now, we'll take the positive tone and run with it.

Thanks!

Monday, August 16, 2010

Sloan-Kettering Visit

Nicole and I are back from a trip to NYC and Sloan-Kettering. Sloan has one of the best cancer centers and research facilities in the world, so we figured why not have an enjoyable few days in the city and get a second look from Sloan?

We sent all the same records, reports, and films from the Charlotte docs up to Sloan. The doctor was a nice guy and ran us through everything from the beginning, providing his commentary and experiences as he went. We really didn't learn anything new from him, just a different perspective. One major update we did pick up from him....

was the arrival of the Oncotype score, which we had sent to Sloan and received while there. Nicole scored a 25, which is pretty much right in the middle of the chart, and that translates to an average recurrence risk of 17% ( I stress 'average,' the range is quite broad and goes from 13 - 20%). So faced with a 17% average recurrence risk, and the knowledge that Chemotherapy along with Tamoxifen could take that down to 10-12%, the doctor there recommended chemo, and it's looking increasingly likely Nicole will have it.

So with that said, tomorrow is surgery #2, a cleanup of surgery #1. After that, she will be left to heal for a month before treatments begin. 4 rounds of chemotherapy, one every 3 weeks, followed by 6 weeks of radiation, followed by years of hormone drugs. The timing and sequence of treatment isn't official, but it likely won't sway much from the above.

As for the blog, you can see from the timeline, my posts will be less frequent as time goes by. We will be doing our best to live a 'normal' life around these treatments, and there will be a certain routine for awhile as Nicole returns to work and we check off the necessary milestones. I will definitely keep everyone updated as things change and as to Nicole's reaction to treatments.

Thanks for the continued thoughts, prayers, and support. I certainly feel like Nicole is battling this thing with an army beside her, and I have no doubt the optimism created in her mind from all of you can only help Nicole decide she's just not going to lose.

Sunday, August 1, 2010

More meetings, more waiting...

We met with the surgeon and the oncologist this week and are getting closer to a treatment plan.

The surgeon confirmed that Nicole needs about 3-4 more millimeters of tissue removed from the one edge of the tumor for it to be a 'clear margin.' In the most simple explanation, they want to have enough space between good cells and cancer cells and they didn't get that during the first surgery. So Nicole will head back to surgery on 8/17.

In the meantime, the tumor has been sent to California for a test known as Oncotype DX. It is a new procedure that's only been around a few years but is gaining wide acceptance. The tumor itself is broken down into 21 genes and their biologic activity is tested. The test is able to gauge based on the activity of the genes in the cancer whether it's considered low, medium, or high risk of recurrence and aggression. The test is enough of an accurate predictor that, if Nicole lands in the low score, she will not get chemo. Similarly, if it's a high score, she will definitely get chemo. The moderate scores are the gray area, and if Nicole's score falls there, the decision will likely come down to a discussion between the docs and Nic about pros and cons.

So while we wait for more tests and results and surgery, we're headed up to NYC for some R&R but also for a complete second opinion at Sloan-Kettering. Nicole's case is relatively simple as far as breast cancer, but the decision to get chemotherapy still remains unclear. Having another set of doctors examine everything can only help to increase our certainty and comfort with what's next. But despite the 'hurry up and wait' nature of this process, each day that goes by gets us closer to a clean bill of health and I can turn this blog into one about weather and sports!

Thanks again, and let's hope for a really low Oncotype score!