Pack up the hats and hooters - it's crying time again

Back in the day I'm sure we've all experienced something like this:

In grammar school (it seemed that) too much homework was always being assigned.  Some of those assignments were long-term: book report; science project; art project; term paper.  Throughout the quarterly grading period, teachers would remind the class about these ongoing assignments.  If you were really lucky, one of these may have been forgotten by the teacher.  So the moral decision was: should I still do it, or chance it and not do it?

I always did it anyway and this has served me well throughout my life.  However, there were many times when the assignment was never asked to be turned in.  Some classmates (you know who you are) would laugh and say I was a loser for doing the work when I didn't have to, but I innately saw the bigger picture and found that completion held intangible rewards and one never knew when "out of the blue", the assignment would be requested for submission. You never know.

Riding on my cancer-free high since yesterday, I was hopeful for a short, sweet follow-up with Dr. Mehta.  I arrived early wanting to give myself enough time to find their temporary quarters resulting from the construction of the new wing to reflect their Dana Farber affiliation. I was greeted and  quickly seen by a professional who took my vitals.  After, I was told that the doctor would see me shortly.  50 minutes later, Dr. Mehta arrived and extended an apologetic handshake.  He recapped on what transpired since my last visit (pre-surgeries) and validated that the last surgery confirmed that all the cancer was indeed gone.  YAY!

Turning the page in my medical file, his demeanor changed as he mentioned that test he talked about when we were discussing the pathology of the biopsy. [Now I was feeling like that forgotten assignment from school was being requested just before my receiving my diploma.] Oh yes, that panel test for other types of cancer I'd be prone to?  Pausing as he pulled the report, "Yes, the OncotypeDX."

Basically, using 21 genes in the tumor tissue, a recurrence score would be determined based on  comparative date of 650-700 patients who had the exact criteria (as I). My score was 35.  Which he said was very high.  He then showed be a few X/Y axis graphs.

The first graft demonstrates a prognosis: 10-year risk of distant recurrence after 5 years of Tamoxifen only.  (This is what I expected as my treatment plan post cancer removal). Based on my recurrence score and 10 year risk of recurrence and curve of clinical results, I had a 24% chance of cancer returning.  Dr. Mehta was quick to point out that my cancer is gone from the breast, but there could be cells that have traveled though-out my body.  Based on the type of cancer I had, and based on the clinical data, there's a 24% chance of having the cancer metastasize in the lungs, liver, bones or other large organ.  [For joy.]

"Those are fairly high risks", he said.  "So what can we do about bringing that number down?" He said, "Chemo and Tamoxifen". He then showed me that next graph.

The second graph demonstrates a prediction of chemotherapy benefit after 5 years of Tamoxifen. Based on my recurrence score, 10 year risk of recurrence and curve of clinical results, I had a 7% chance of cancer returning. Clearly those numbers look better, but with chemo.  What can I expect?

Dr. Mehta said that chemo has come a long way since some of the traditional approaches.  He began to explain his recommendation and approach.

At the highest level, the regimen would be over a twelve week span.  Four times (every three weeks) I would be given the chemo intravenously along with the tamoxifen (which was a given anyway). The side effects (for most choosing this approach) include: hair loss, nausea, low white cell count, fatigue, risk of infection(s), loss of appetite, weight loss and/or gain, constipation, frequent urination and neuropathy.   I stopped him there.  Having a family history of neuropathic maladies, I was most concerned with what this meant. [Not discounting any of the preceding side affects.]

Lawyers are all to familiar with 'it depends'.  Apparently they haven't cornered the market on that expression because Dr. Mehta said, "It depends on the individual - case by case".  The discussion left me thinking that this would affect my fine motor skills (being a musician).  Although he wasn't emphatic, I got the sense that this could be the deal breaker.  He said that in some people the neuropathy dissipates after the treatment, others up to a year, and others never.  He did start to talk about the alternative to this, the traditional approach, but he said that there is a high risk of heart damage, early and latent and a small risk of developing leukemia. [Bring up the violin soundtrack.]

Here I am at the cross roads again, needing to make a decision.  So, what if I do nothing, I ask?

Dr. Mehta said that chemo usually starts about four weeks after surgery.  Since my first surgery was April 27th, he thinks the chemo should start early June.  My doing nothing there is that risk that a rogue cell could begin to metastasize by attaching to an organ that has a big supply of blood.  He said he would have no problems with a second opinion.  I had mentioned that I had previously had consultation with Dr Overmeyer at Dana Farber, which he said that Beth is his 'go to person'.  He even offered to have his staff schedule the appointment for me. [At this writing it's scheduled for 6/3 and 6/4 back with Dr. Mehta.]

I asked about my reconstruction surgery and Triple A.  He said that he had had a long conversation with Dr. Kansal (at St Elizabeth's -  Triple A consult) and that can wait.  The reconstruction will need to wait because of the infection risk.  At this point it's gather information, make a decision on chemo (type) based on research and consultation, do the chemo, wait until I'm able to have reconstruction (October/November) deal with Triple A (see how it's progressing if at all) and take the appropriate action.

So the 'cancer-free' celebration was glorious - for a day at least.  Hats and hooters, champagne and caviar will keep until New Years Eve. In the interim it's a very tough road ahead that I have to travel.

More to come.