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!