Wednesday, January 3, 2018

Okay, We're Getting Started

The first appointment was today.  We met with Dr. Miggins and her staff for over 2 1/2 hours to go over everything done so far and to figure out a preliminary plan.

We know it's invasive ductal carcinoma, currently Stage II.  (T2, N1, Mx (unknown) - if you're into specifics.)  That staging could change after the next few scans, after chemo, and/or after surgery.

The cancer is in my right breast and right axilla (armpit) lymph nodes.  The number of nodes affected is unknown currently, but is "multiple."

The current plan:

  1. Get a complete nodal basin ultrasound.  This ultrasound will look at the lymph nodes around the clavicle and breast bone to see if they are affected.  If the are enlarged, biopsies will be done.  If cancer is present there, the treatment plan will be affected.
  2. Get a bilateral breast MRI.  This MRI will give better imaging of both breasts.  It will (hopefully) confirm that no cancer is present in the left breast, and will give a better picture of how the cancer is growing (toward the nipple or not) in the right breast, which will give the surgeon a better picture of how to operate.
  3. Get staging studies done  - CT Scan of the chest, abdomen, and pelvis; and a Bone Scan.  These studies will show any evidence of cancer in the chest wall, lungs, liver, or bones, which are the most likely places for breast cancer to spread after it has invaded the lymph nodes.
  4. Visit with the Medical Oncologist, who will prescribe the chemo cocktail.
  5. Visit with the genetics counselor and have genetic testing done.  If I have the BRCA 1 or 2 mutation, treatment will change.  (A positive result - which is bad - would mean that the cancer has a much higher chance of recurrence, and that I have a very high chance of developing ovarian cancer.)
  6. Visit with the radiation oncologist.
  7. Follow-up with the surgeon, Dr. Miggins, about test results and to touch base about the treatment plan.

We do know that, unless the treatment plan changes based on the scans and genetic testing, I will be doing chemo first (to shrink the tumor), followed by surgery, then radiation (necessary because of the lymph node involvement).  Reconstruction will follow about 9 months or so after radiation is done.

We're all hoping the scans - steps 1-3 - can be done in the next couple of days.  If that happens, the meetings with the Medical Oncologist and Genetics Counselor could happen early next week.  My case is also being presented to the tumor board next week after the results of the scans come in, so everyone can be in agreement as to the best treatment plan.

That's what we know for now.  I don't have to decide on the type of surgery yet, because the options may change after chemo.  We do know, however, that every lymph node under my right arm will be removed, which comes with its own complications down the line.

So on to the next step - scheduling all of the appointments for scans.

Trish signature for blog


Mindy said...

A game plan! Yes! Now you’re starting to get your armor in place. It sounds like you’re in very good hands, Trish. I’m so glad.

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