Biology Lesson

Have you ever said "I have no idea why I am taking "...fill in the blank...I'll never need to use that!" I usually filled in the blank with "Geometry", or "Calculus", or "Physics", and yes "Russian History".  I am sure you have your own. 


Was high school biology ever on that list? Based on today's meeting with the oncologist, I wish I had paid more attention in high school biology! (Another caveat to this post - I am not a biologist, chemist or any other "ist".  I hope I was a good listener and got all this right.  I am also sure I have oversimplified it.)


Today we met with Julie's oncologist, Dr. Sue Kim.  While the information was frequently over our heads, the bottom line was that the information was fascinating and encouraging.


The good news: Her clinical diagnosis based on the original biopsy, and her exam of Julie, including Julie's lymph nodes, was that there is a good chance Julie won't need chemotherapy. (Yeah!) That "good chance" is based on a few factors, the primary being that the post-operative pathology report is the same (or close to the same) as the clinical diagnosis.  This means that they find no cancer in the lymph nodes and the size of the original tumor is the same size as they think it is.  We will get that report and review it with Dr. Lee on the 20th of July.


If there is cancer in the lymph nodes, we are probably back to chemo.  If there is not cancer in the lymph nodes, and the tumor is larger than the diagnosis, we are in a grey area.  If we are in a grey area, then there is a special test that Julie is eligible for, particularly given that her mom, Katy, has had bilateral breast cancer (and thankfully is a survivor!). That test is called the Oncotype DX test.


The Oncotype DX test is a genetic test for the likelihood of cancer recurrence. In overly simplistic terms it determines if Julie has the "cancer gene".  If she has the gene, then we are in a different situation. If she has the gene, there is an 80% probability she will develop breast cancer (well that one is already determined), and a 50% probability of other cancer (likely ovarian).  If its positive, we are likely (but not for sure) back to chemo, and it has repercussions for down stream treatment/surgery (like removal of ovaries).  If its negative, we are back to the grey area.  


Here is a link to the Oncotype DX website.  I have not gone through it, but am passing information based solely on the information from the oncologist. Oncotype DX


Grey area options:
If we are in the grey area, there is a series of questions we will sort through, and data and analysis (largely from the from the Adjuvant website) that outlines probabilities of recurrence of cancer based on post mastectomy treatment.  Based on the probabilities of cancer recurrence, we have to choose an option for post surgical treatment. While there are many options, the the two major ones are as follows:

1. Chemotherapy - Chemo is a chemical cocktail that is delivered through IV to basically attack the cancer cells. Its non-discriminatory in that it attacks good cells as well as bad ones.  Its also attacks DNA structures.  Good news is that based on the predicted cancer type and stage, Julie would only need about 4 treatments.  Bad news - it still has bad side effects, including temporary hair loss.
2. Hormonal Endocrine Therapy.  Since the tumor is estrogen positive, this is a good (and likely) alternative.  There is a medication called Tamoxifen that is designed to attack the estrogen receptors that are attached to the cancer cells.  The medication does not block estrogen production (good news), but stops the ability of the estrogen receptor on the cancer cell to use estrogen as a growth tool. (The cancer cell wants to use estrogen to grow since its estrogen positive).  If for some reason there would be a need to remove the ovaries, there is another medicine that works like Tamoxifen, but doesn't work through estrogen receptors (no ovaries = no estrogen production = estrogen receptors have nothing to block).

The analysis tool allows you to put in information (age, cancer type, size, stage, grade, etc), and it "spits back" a graph that shows, based on years of data of breast cancer patients, the probability of recurrence. Right now, based on clinical diagnosis (not pathological), there is a 24% chance of cancer recurrence post surgery with no post surgery treatment. Then it shows how that probability changes with chemotherapy or hormonal endocrine therapy.  We will go over all of this during our visit with the oncologist on the 20th.

Sorry for the science lesson and length....

Other information

• We have set the surgery date for the 14th
• Julie has decided on a bilateral mastectomy
• We still don't know exactly which reconstructive surgery will look like, but more on that post surgery
• Julie has a bunch of pre-op stuff to do next week, including going back to the primary care physician for "release" to surgery, EKGs, etc.
• We are heading up to my sister's in Conifer tomorrow for specific prayer (thank you Lori!)

Specific prayer points:

1. That God will remove the tumor.  Julie felt like it was actually smaller today during the exam with the Oncologist
2. That the insurance stuff (very complex) will get sorted out
3. Again, that there is no cancer in the lymph nodes
4. The peace that passes all understanding and that we keep our hearts and minds focused on Jesus!

Thank you all for your prayers and support!

Until next time, 

God is good.  All the time.