Last Thursday I tried to get a second-opinion appointment at Dana-Farber with the breast oncologist most recommended by Dr. C., my oncologist, and was told she didn’t take walk-ins, only special requests by other oncologists. So I asked Dr. C. to contact her. He did, she said yes by e-mail on Saturday, and I have an appointment at noon on Friday. So I guess I’m feeling special.

I keep puzzling over what, exactly, requires my actual presence in this second-opinion process (Eric says I should just reread my mom’s book for the answer). I may have questions for her, but in terms of what she needs to know about me, exactly why do I need to show up in front of her? Nevertheless, I’m going. We’re going.

Yesterday Dr. P. the surgeon called while I was out school shopping with Will. She said the final path. report from the re-excision showed “a single minute group of atypical cells consistent with ductal carcinoma,” only showing on the permanent (staining?) and not the frozen section analysis (that they did while I was in surgery).

Yeesh.

She said she’d talk with Dr. C. the oncologist on Tuesday and get back to us with what they thought should happen next. We assume this means that more surgery is not a given. What does “minute” mean? Is this classed like in the nodes, “microscopic” and “submicroscopic” with the latter kind of not counting? More to learn…

Yesterday I looked at lots of abstracts about excision/re-excision margins and their relationship to recurrence rates.

Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy.

Conservation therapy in T1-T2 breast cancer: past, current issues, and future challenges and opportunities.

And I tried to research contralateral breast cancer but the only really relevant thing I found was this: Contralateral breast cancer: clinical characteristics and impact on prognosis.

Here is what my oncologist is leaning towards:
taxotere/cyclophosphamide

because “TC (docetaxel/cyclophosphamide, 4 cycles) has a superior disease-free survival compared to standard AC (doxorubicin/cyclophosphamide) in 1016 women with early stage breast cancer.”

I like that 4 cycles. I would be done by Thanksgiving.

I don’t like being the center of attention. I don’t like giving people bad news. This is not a good recipe for someone who has to go around announcing that she has breast cancer again. Silver Bay, where there were maybe 50 people who needed to be told, was getting a bit agonizing.

Hi, how are you?
Oh, I’ve been better.

Eric told a few people. I told a few people. Spee and Sandy mercifully went around telling some of our friends so I wouldn’t have to…what a relief! I felt so taken care of.

Telling parents is, of course, the worst of the worst, especially now that I am a parent myself.

Here is a timeline of this summer’s breast-cancer adventure:

Late May: found lumpy area in left breast. This was only the second time since my first breast cancer in 1995 that anything had worried me–and the first was in ’97 or ’98.

Early June: went to midwife for annual exam, she agreed area felt worrisome, said to wait a couple of weeks and then (if it didn’t go away) get an ultrasound and a surgical consultation. Waited 6 days, didn’t want to wait anymore (I’ve never had cyclical lumpiness), scheduled ultrasound

June 20: had an ultrasound, knew I was off to see a surgeon, found a good one, scheduled an appt….for 3 weeks later (earliest possible)

June 29: picked up ultrasound report and film, looked at both, got really worried

July 13: met with surgeon, liked her, had needle aspiration biopsy, got call at 6 PM that lab had found cancerous cells. Had pizza for dinner.

July 24: met oncologist who works with the surgeon; liked him

July 28: had surgery to take out the tumor, take out 3 sentinel lymph nodes under my arm, and install a subcutaneous “port” below my right collarbone through which medicine can be given and blood drawn

August 2: met with the oncologist, learned that the surgery had not gotten clean margins–still some cancer clusters in there, more surgery needed to take out more tissue

August 14, one building: CT scan, bone scan (to rule out metastases)
August 14, other building: met with the surgeon, who reassured us that follow-up surgery would be easier to recover from; scheduled for later that week

August 18: had re-excision surgery and was home by 1:30 PM. Watched “Six Feet Under” episodes on videotape.

August 23: met with the oncologist, who had the following news:
–the lab reported that the re-excision margins were clean (yay)
–the bone scan and CT scan were both boring (yay)
–the tumor was estrogen-receptor and progesterone-receptor negative and HER2 negative
–he didn’t have a chemotherapy regimen decided on for me yet and was going to consult with other specialists to get their opinion

Which pretty much brings us up to date on the timeline side of things.