Long day for me today, but I did learn one very important lesson. When the doctor calls and all she says is "the margins were clear" you should ask a few more questions. I simply assumed that the original diagnosis of Grade 1, Stage 1 hadn't changed. Well--as I learned at the oncologist's office today my tumor was Grade 2, Stage 1.
Stage 1 simply means that the tumor has not spread to the lymph nodes. Research is begining to show that looking at lymph nodes may not be the best indicator of whether or not breast cancer is not going to spread to other organs.
For reference: Grade 1 cancer means that the cells still for the most part look like the original cells (duct cells in this case) they can still carry out some of the original functions and their growth is slow and somewhat controlled--sometimes this is called well differentiated. Grade 2 cancer means that the cells are beginning to lose the appearance of the original duct cells, they tend to grow quicker and they begin to not respond to growth control--these cells are moderately differentiated. Grade 3 means that cells have resorted to an almost primitive cell and these cancers tend to grow quickly and are more aggressive--they are called poorly differentiated.
The other thing that I never asked was how big the tumor was which plays a role in how patients are treated. It turns out that the there were several small tumors and a large tumor that was around 1.5cm.
When you plug in the grade and size of my cancer in the old treatment algorithm I would automatically receive chemotherapy since my chance of recurrence would be greater than 25%. Research in Europe and here in the States is beginning to showing that not all patients with greater than 1 cm, Grade 2 ductal carcinomas (breast cancer) need to be treated with chemotherapy and therefore the school of thought is to look more closely at the genetic profile of the tumors before automatically giving chemo. That's where the OncoType test that I talked about last week comes in. This test will give a chance of recurrence based on the genetic profile of my tumor and a low score means that I have about a 5% chance of having a recurrence in another organ (metastasis which means mortality) after radiation and 5yrs of tamoxifen. The test has about a 2 week turn around and after I get the results I will know whether or not I need chemo. Intermediate and high scores mean I will have at least 4 rounds of chemo (which means I might as well throw away my flat iron since my hair will come back even curlier).
So, the bottom line is I still don't know what is going to happen in the next few months but I'm keeping my fingers crossed that I get a low score and only have to undergo radiation and tamoxifen.
The surgeon loved how my incisions looked and is very happy with my recovery. For the most part I've reached the point where it's just uncomfortable when Tiger Lily hugs me really hard.
So, not the best news today but I still have hope that news will be good in the end.
Stay tuned and have a great weekend.