Sunday, February 15, 2015

My Mom's cancer journey since September...m

In late September, my Mom had a lumpectomy and sentinel lymph node biopsy for breast cancer. Pathology reported the tumor was 5.3 cm; all 4 lymph nodes removed were positive, including 3 nodes in which the cancer had extended beyond the nodes.

She was classified as T3 N2a Mx Stage IIIA invasive lobular carcinoma of the left breast.
The stages are based on:
T=the size of tumor, and whether in situ or locally advanced,
N=the number of positive nodes and where located, and
M=whether the cancer had spread (metastasized).

The M in her classification is x, because there is a question of spreading. Her CT scan showed "small subcentimeter lung opacities of uncertain significance" and as well as "lesions in the liver up to 1.4 cm indeterminate for metastatic foci." I think that means they are not sure of both lungs and liver.

My mother had a terrible infection at the surgery site. Between the infection, and her doctors' vacations, and the holidays, further treatments were delayed.
In mid-December, Mom had a second surgery to clean out more lymph nodes in her armpit. She later had a CT scan of her brain and a PET scan of her body.

In the first week of January, Mom met with her oncologist. He says the other organs are clear. His treatment plan is radiation therapy and hormonal therapy. My Dad said he really wanted to make sure they got all the cancer out, and what about chemotherapy? So the oncologist recommended a second opinion. He also gave us the reports from the second surgery.
I read through the pathology reports, with my copy of Dr. Susan Love's Breast Book, 5th Edition close at hand. There were 9 lymph nodes were removed this time: 7 were positive for cancer, and including 5 nodes which were "almost completely replaced by tumor cells." PET/CT report noted "couple of borderline enlarged subpectoral (breast) lymph nodes" and "at least 4 small axillary (armpit) lymph nodes." PET/CT report stated for both Abdomen and Pelvis: "no significant increase uptake is noted," however, mentioned that "small lung nodules are beyond the resolution limit of PET/CT."  I question if there is more cancer in breast and armpit, and are the lungs and liver clear or not?

The amount of cancer, and its aggressiveness is really scaring me. I think my parents don't realize how serious this may be, and they have their heads in the sand. When I expressed my concerns to my brother, I realized that he didn't know how serious this was either. I explained to my brother that her tumor was large, and she had a total of 11 positive lymph nodes. The five-year breast cancer survival rates for patients with tumors 5 cm or larger, with 4 or more positive lymph nodes, is just 45.4%.  I apologized for the rude awakening, and he said he wished he could have left his head in the sand, but he agreed is more important that we help Mom & Dad through this.

So I prepared another list of questions to address these concerns. I mailed Mom (yes, snail mail) the list and I sent 2 copies so she could give one to the doctor. I also emailed the questions to my brother who will be going with them.

In the second week of January, Mom went to Dana-Farber Cancer Institute for her second opinion.  The Dana-Farber oncologist recommended a similar treatment plan is radiation therapy and hormonal therapy. But he suggested adding a clinical trial medication. He agreed that Mom was not a candidate for chemotherapy. He also says the other organs are clear, as far as we can tell. Yes, there are lesions and spots on the scans, which may be just aging. We don't know for sure unless we do a biopsy, which is very invasive, and really doesn't change our treatment plan either way.

My brother noted that neither oncologist talked about curing the cancer. We are managing the cancer.

Mom has started her radiation therapy and hormonal therapy.

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