Saw Fred today

I saw the doctors at Fred Hutchinson yesterday and they passed on the information from the PET/CT scan – no metastases were seen in the rest of the body. There was the breast cancer that I had mistaken for a rib head out of place (not a lymph node, but actual breast tissue) as well as a couple of lymph nodes under the arm showing cancer. There was also a deep mammary lymph node under the sternum positive for cancer and some nodules in the breast suspicious for cancer as well. They recommended that I start with chemotherapy to shrink the tumors so that it would also make surgery easier and maybe they wouldn’t have to take out much, if any, muscle. I would have to have a modified radical mastectomy, meaning they would take the breast including two levels of lymph nodes. And then after all of that I would need to go through 6 weeks of radiation therapy to make sure that all cancer cells were killed.

Fred Hutchinson’s has found that they have slightly better results if they give chemotherapy once a week at a slightly lower dose, rather than every 2 weeks that most other places do; however, the treatment would then be extended over a longer period of time. They would be treating with one chemotherapy drug for 12 weeks and the second one over 15 weeks. My oncologist doctor, Dr. Lechner, has been having good results with giving 4 doses of one chemotherapy drug at 2 week intervals, and then starting the second drug at the same intervals. This means that we would be done in 4 months compared to 7 months with the Fred Hutchinson plan. I jumped on his plan, especially as there doesn’t seem to be any big differences in results between the two treatment plans.

The PET/CT scan also showed that I had 3 nodules in my lungs. The doctors didn’t seem to be too worried about these as they were pretty small and most people have them from scarring or something else. However, Dr. Lechner had me get the CT scan to have a better picture of the nodules and after starting the chemotherapy I would be getting another CT scan to see if the nodules had disappeared or not. If they do disappear that means they WERE cancerous which is not good news as that means I was at a stage IV rather than II-III. Supposedly IV is not considered ‘curable’ where the others are. I was confused that if they do disappear isn’t that a good thing???? But he said not. However, none of the doctors could really explain it so that I could understand this concept.

I do have a nodule on my other breast that they want to have checked with ultrasound before starting chemotherapy. They are thinking it is a cyst and as it did not show up on the PET scan it seems most likely that is what it is, but we need to rule everything out. I am having the ultrasound done tomorrow morning and then I am supposed to meet with Dr. Lechner Friday morning to go over the last tests and to finalize our treatment plan. He will then order chemotherapy which needs to be approved by the insurance company, this can take from 48-72 hours to be approved. I am assuming that chemotherapy will not be started until the middle of next week.