Two Months

Today marks two months since we found out Robin had breast cancer. At this point she is cancer free and will be starting chemotherapy next week.

What we now realize is how important it was that she was able to have surgery first. We initially were considering neoadjuvant chemotherapy, which is receiving drug treatment before any surgery. Doing this, however, would cloud the issue of possible lymph node involvement and the tumor margins (chemo may have cleared affected lymph nodes and decreased the tumor size). If she received chemotherapy first, she would have received a 3-drug regimen over six months and would have needed radiation. But with surgery first confirming clear lymph nodes and margins, she only has to have a 2-drug regimen over three months and no radiation. Robin feels very fortunate to have had the surgery quickly so that she did not have to be exposed to unnecessary treatment.

Chemotherapy Plan

We arrived back home from Boston this evening. It is a long drive to go over and back in two days but Robin and I enjoy our alone time during these trips.

This morning we met with the medical oncologist at Dana-Farber. She explained that the cancer is HER2 negative, based on the more extensive pathology testing that we were waiting on. It's nice to finally put this issue to rest. Remember the initial pathology results from the biopsy looked like it was HER2 positive. The difference is that they were able to look at a larger sample with a more advanced test.

She also told us that Robin had the option of not getting any chemotherapy based on all of these results. However, she advised that the most aggressive approach is to get a 2-drug regimen. Robin decided that this is what she needed to do. The chemo will be once every three weeks for a total of four cycles. Earlier we thought that she may need eight cycles over six months, followed by an additional six months of Herceptin. Now getting just four cycles and no Herceptin, we are down to just three months! Chemotherapy also does not have to start as soon as we initially thought. It will probably start in the first week or so of May.

After this appointment we went over to the plastic surgery office to get the first fill of saline for the tissue expanders. Robin was pretty nervous about this and was worried it would be painful. To her relief, it went very smooth and she had no discomfort at all.

Given that the cancer was throughout the breast and not catching it very early, we feel like we now have the best case scenario going forward. Robin was excited to explain to Cader how she may be done with all of this, including her final reconstruction surgery, by his birthday in September.

Boston Trip Postponed, Radiation, and Drains

We are not travelling to Boston today. The HER2 analysis from the outside lab is not yet finalized. The medical oncologist at Dana-Farber did not want to meet yet without this information. The HER2 status will determine what her therapy plan will be.

The surgical oncologist also called Robin this week about radiation therapy. She presented Robin's case to an oncology panel there (surgical oncologists, radiation oncologists, medical oncologists and pathologists) and everyone was in agreement that radiation was NOT recommended. This is very good news for us.

And this past Monday Robin was finally able to have her drains removed. She feels so much more comfortable now and is able to take showers (we are all thankful for that!). Although she is still fairly sore, she is doing better each day now.

Now we plan to go to Boston this coming Tuesday for the rescheduled medical oncology appointment and another follow-up with the plastic surgeon's office.

Surgical Follow-Up News

We are back home from Boston once again. Robin had a scheduled follow-up with the plastic surgeon Thursday afternoon. We were also able to meet with the surgical oncologist (who performed the mastectomy) and review the final pathology results, which answered many of our questions.

Most importantly, the lymph nodes were confirmed negative. No cancer was found in the right breast. There were three total tumors in the left breast: 3cm, 1.6cm, and 0.8cm. Robin's three tumors were "invasive" or "infiltrating" ductal carcinoma, or cancer that has already broken through the milk duct. She also had many areas of DCIS throughout the left breast. DCIS, or ductal carcinoma in situ, is early stage 0 cancer that is confined to the individual milk ducts. These are areas that over time can become "invasive" tumors. Considering all of this, it looks like we are dealing with stage IIa breast cancer.

Before the surgery, the surgical oncologist said that she would need remove breast tissue as close as possible to the skin on the front of the breast because the tumor seemed to be close. After she did this in surgery, she was concerned that she had to get so close that some of the skin may not have enough blood supply and would possibly die. This would cause problems and make the reconstruction more complicated. The plastic surgeon was also concerned that the blood flow would not be adequate after he completed his part of the surgery, although he was cautiously optimistic. Everyone agreed that aggressive removal of all possible tumor was the priority over cosmetic concerns. The pathology indicated that the tumor did indeed extend all the way to the edge of the removed tissue. The surgical oncologist was very confident that she had "hugged" the skin during the procedure so closely that there would be no breast tissue left behind. The good news now is that the cancer was fully removed AND the skin did not die in this area. The plastic surgeon said this was no longer a concern, everything looked excellent and Robin was healing very well.

The bad news for Robin was that the drains were not quite ready to be removed. The drainage has not yet decreased enough. Hopefully they are ready by Monday morning, when we are scheduled to see a plastic surgeon in Syracuse that has agreed to help us. 

The general criteria for receiving radiation is having lymph node involvement (Robin has none), size of largest tumor over 3-5cm (Robin is 3cm), and having little to no clear margins around the removed tumor. Not having a clear margin is the issue that may indicate radiation for her. Robin's was not necessarily clear but the surgical oncologist was convinced that this is because they was no more tissue beyond that could possibly be taken out. In fact, she said that she plans to reach out to the radiation oncologist and explain how thorough she was in surgery. She wants to make sure they take that into account when reviewing the case and advising on the need for radiation. Her opinion is that radiation will not be necessary.

Next Thursday we find our way back to Boston to meet with the medical oncologist. This is where we will review all of the information and determine the next phase of treatment, including chemotherapy and the possibility of radiation. 

This is finally starting to feel like a much more manageable situation for us. It went from one tumor to three tumors to six tumors, then maybe one large 7cm mass to the very scary possibility of stage IV metastatic disease in her spine to what we know today. I guess it's better to go in that direction than the opposite. The high points of the stress and anxiety of not knowing are hopefully behind us now. We went from being legitimately concerned for her life and leaving her family, especially our three boys, to now dealing with uncomfortable drains and the upcoming hair loss. Now that she knows this is something she can fight and win, she is ready to give it her all. Robin is the most amazing person I know. She is an unbelievable wife, mother and friend and I know that she will also become an awesome breast cancer survivor.

Back at Home

We made it back home from Boston Saturday afternoon. Everyone was glad to be back in Skaneateles. Robin is recovering well but she hates the two drains that are in place. They exit under each armpit and are extremely painful and uncomfortable. She is not able to do much for herself and this is really discouraging to her. Hopefully they can be removed later this week.

The kids had a great time in Boston. They got to visit the Science Museum twice, the Children's Museum, the Boston Duck Tour, and other neat places. It really was a nice getaway for them while we were dealing with the hospital and recovery.

More information about the actual surgery...the breast surgeon said she was not able to visualize the tumor well when she removed it. She has to get the pathology report to determine what size tumor we are dealing with. Final pathology results should be available sometime this week. If the lymph nodes are confirmed negative and the tumor is not large, Robin should not have to have any radiation therapy.

So this coming Thursday morning we are leaving again for Boston to meet with plastic surgeon for a follow-up appointment. We plan to spend the night and come back Friday.

And the following Thursday (April 18th), we will go back to Boston to meet with the oncologist there to decide on the treatment plan. Most likely, the chemotherapy will begin shortly after this visit. We plan to get the chemotherapy administered locally at her oncology office in Syracuse.

Leaving the hospital

Smiling

Surgical Success!

The breast surgeon said her part was a success. She biopsied three lymph nodes and preliminary results are that they are negative (to be confirmed by further pathology later). She could not estimate the tumor size at this time until the pathologists look at it. Hopefully this means she can avoid radiation.

The plastic surgeon felt good about his part of the surgery as well.

She is waking up now. I will get to see her soon.