I realize I never updated after going over the pathology report with my oncologist and the reason is this: I did not like that meeting. It's the first time that I have ever seen my oncologist less than thrilled with the progress that was made and it honestly took quite a while to get the image of him standing there saying, "I'm not very happy" out of my mind. But I've had time to process it now, so here goes.
Now, before you freak out about that statement, the "I'm not very happy", like Matt and I did, there is something you need to know, that's not what he meant - it came out totally wrong. Dr. K's bedside manner is a bit dodgy at times and this was one of those times. The reason I know it's not what he meant is because he said so after he looked at me all confused while I was sitting there on the verge of tears and said, "You don't seem very happy?" to which I replied, "Umm...why would I be happy when you just said YOU aren't happy?". He then went on to explain basically that he WISHED I had had a complete response {don't we all?} and that my nodes had been completely cleared {of course!} and that I didn't have to to radiation {again, don't we all?}. I really believe he was just disappointed that he hadn't given me that miracle, "Oh my goodness it looks like you never even had cancer!", that we had all hoped for in our hearts but knew in our brains wasn't super likely. Next he told me that the features of the cancer that was removed were very favorable, so I did what I didn't think I would ever do {because I never really wanted to know}, and I blatantly asked him what he thought my prognosis was and this is what he said:
"I BELIEVE YOUR PROGNOSIS IS EXCELLENT. I DO NOT THINK YOU WILL RECUR."
I fully realize that he doesn't have a crystal ball and that there is always, always, always a chance for recurrence, no matter how "sure" you are that it won't happen. After all, I have seen stories of women who were stage 1 with no nodes {I am stage 2, with nodes} who go on to recur when everything says they shouldn't. This is a nasty mean little a-hole of a disease. I fully understand that we need to be vigilant and watchful with my care and health and that we will need to do so for years and years and years. I have no intention of getting all cocky about this and slacking on my care because, frankly, that would be stupid on my part and it's unrealistic to think that every.single.cell got annihilated, because we ALL have them floating around! But, I also fully recognize that Dr. K has been doing this for a while and he has seen a lot of patients and read a lot of pathology reports. I trust Dr. K to be my doctor and care for me in the best way he knows how.
Dr. K then proceeded to show me the reasons he believes I have an excellent {his word} prognosis. The fact that the removed cancer {which was small} responded to the herceptin as evidenced by the change in HER2 receptor status was encouraging. There have been studies indicating that change in receptor status has positive effects on outcome. The fact that what remains is HIGHLY estrogen receptor positive is also encouraging. We already know that ER+ cells don't respond all that well to traditional chemotherapy, but it is the ER+ cells that respond to Tamoxifen, so IF there are any cells left floating around in there, they will hopefully be rendered dormant by the little wonder pill, Tamoxifen. In addition to the Tamoxifen, I am also having my ovaries suppressed with Zoladex injections every 3 months in an attempt to shut down estrogen production. If the cells don't have the estrogen, because it's either not there or it's being blocked, they can't divide all willy-nilly like they want. Finally, one of the MOST encouraging things is that my KI67 status {the number that shows how fast the cells are dividing} went from 35% to ONE PERCENT!!!! There have been several studies indicating that people who were not lucky enough to have a pathologically complete response to neoadjuvant chemotherapy, but had a clinical response, had low post-treatment KI67 status, and were ER+ have a comparable prognosis to those people who DO have a complete response {which is excellent!}.
So all in all, the meeting wasn't BAD, it was actually pretty good, as indicated by the only statement that really matters, the one in bold above. But the initial shock of "I'm not very happy." was hard to swallow. Thank GOD Dr. K's wonderful nurse practitioner was in the room to step in and let us know what he was really trying to say. Thank GOD Dr. K spoke up when he was confused about my "unhappiness" so that he could clarify why he said he wasn't happy. Thank GOD that the nurse practitioner was willing to sit with us for an extra 30+ minutes to reassure us and answer our questions. Thank GOD I live in a place where I can get the kind of treatment and care I am getting.
I don't know what the future holds, but I do know who holds the future and I completely trust Him to take care of me and my family.
Now we move forward. Onward, to radiation and tamoxifen and ovarian suppression and herceptin and healing and reconstruction and GETTING BUSY LIVING!!
Thanks for being there friends, and for waiting extra long for this update. XO
