Tuesday, November 29, 2011

My Mom's Follow Up Appointment with the Surgeon

[This medical update is posted with my mom's permission.]
We just returned from my mom's follow up appointment with the surgeon. There was good news and not so good news. 

The appointment started with the doctor noticing that there was a lot of fluid at the node removal site under her arm.  He manually drained 19 cc of fluid, applied some antibiotic, and covered the site with a band-aid.

The margins were negative.  This is good news!  It means that the surrounding tissue from the lumpectomy site are clean and free of cancer.  That is good news! However, the sentinel node that was removed and sampled from under her arm show that the cancer had spread there.  An estimated 20% to 30% of the gland was filled with cancer.

The results of the testing of the original tumor are in.  If you remember, it was tested for the following:

*Hormonal Status:  The tumor is tested for estrogen receptors and progesterone receptors.  This is important when chemo drugs and hormones are picked.  Example: One doesn't want to use a product that encourage or raises estrogen if one's cancer responds positively to that hormone.  RESULT:  The ER (estrogen receptor) is positive at 92%.  The PR (progesterone receptor) is negative.

*HER2:  Certain cancers make human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cell.  Such cancers tend to be more aggressive.  Again, when it comes to chemo drugs and such, one would use a medication that targets HER2 or is at least effective against it.  RESULT:  The HER2 is negative, and that is good news!

*DNA:  Determining the DNA identity of a tumor can give specific information to the doctors as well, such as how nasty or bland the tumor is.  This biological makeup has predictive values to it, such as occurrence statistic, fast or slow growing, etc.  High levels of Ki-67 indicate an aggressive tumor.   RESULT:  Ki-67 was 45%.  A score of over 20% is considered on the high side. This is only a small part of the puzzle so the result should not be taken out of context of the entire picture.

Although the doctor did not stage the cancer, it would appear that she has Stage IIA breast cancer.

Remember that all of this information is painting a unique picture that the oncologist will use to determine the correct type of chemotherapy to use.  None of the information by itself is valuable - it is the entire package which has both good and not so good parts to it.

The next step is that the surgeon's office is sending the message to the primary doctor's office to make a formal referral to the oncologist so that we can have our first appointment with the "Team."

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