Today I met with the radiologist. She said with the total original size of my tumors (7.3 cm), I would be considered a stage 3 and standard protocol states that even after a bi-lateral mastectomy I qualify for radiation therapy. Now, radiation is not like chemo. It doesn't make me sick. It's basically putting my breast/armpit through a microwave and the biggest side effect she mentioned was my skin may sunburn. She said after my surgery, and after my expanders are fully expanded and healed (approximately 6-8 weeks) is when I would begin radiation. It's 33 treatments, 15 minutes each treatment, and I would go in Monday-Friday. So it takes about 6 1/2 weeks. Then, once my sunburn was all healed I would go in for my expanders to be removed and my implants could be put in. Then I'd start my 12 rounds of herceptin and tamoxifen but that's another part of the story...
So here's the twist: I spoke with Dr. Link my oncologist on Wednesday. He says he doesn't think I'm going to need radiation. He wants to wait until after my breasts are removed and we can truly see how my tumors reacted to the chemo before we decide. We already know it's a partial response, but he doesn't think radiation is going to be necessary because he thinks the surgery will take care of all of the cancer cells and if there are any others left in my blood or whatever, the herceptin and tamoxifen will take care of them. It's more than a little bit concerning when everybody on your treatment team is not in agreeance.
This afternoon I met with Dr. West who is a breast surgeon that works out of St. Joseph's Hospital so I could get a second opinion on it all. He gave me a lot to think about as far as options go. He said that if I do choose radiation therapy, having expanders put in delays when I could start it because we have to not only wait for surgery to heal, but we also wait until the breasts are fully expanded before treatments could start. So he says there is always the option of bi-lateral mastectomy and getting reconstruction later. Yes, that would mean NO boobs for 6-12 months. I am pretty sure that would freak me the (BEEP) out. He has been a surgeon since 1968, and his son is the one doing my expanders. So I asked him a lot of questions and put him in the hot seat for awhile. It was good to get the different opinion, but instead of reassuring me like I had hoped, it left me even more undecided about everything.
Right after my appointment with him, I got my PET/CT scan. It was so much easier this time around. The facility in Orange is so much nicer than the creepy one I was at in Riverside last time. It was the same routine though- they gave me some radiation to drink, took my blood sugar (it was 110, so I was good to go), put some radiation in my arm which made my mouth taste like metal, then gave me more to drink. I sat in a room with the lights off for about an hour so it could all soak in. Then I got to lay with my hands over my head for 27 minutes straight. There were pillows around my head and I was so comfortable I may have dozed off a little. It went by really fast. Last time it was torture, and this time was a walk in the park. I hope to get the results early next week, but Dr. Link is out of town for 3 weeks so we shall see what happens there.
So what would you do? Would you use Dr. West (the old school, conservative surgeon) with Dr. West (his son, the plastic surgeon) at St. Joseph's Hospital OR Dr. Bremner (the newer, but more innovative surgeon) with Dr. West (same plastic surgeon) at Placentia Linda Community Hospital? And would you risk delaying radiation for the sake of having expanders? Or get reconstruction later? Would you keep your nipples when radiation would just kill any residual cancer anyway or get rid of them and reconstruct new ones later? Would you forget radiation because your oncologist says it's unnecessary, even though a radiologist highly recommends it for a young person with my tumor size? Or would you get it as a precaution because it seems the benefits outweigh the risks?
I have a lot of decisions to make and I need to make them this weekend. Thank God I am going back to work on Monday. Listening to the petty problems of teenagers will be a welcome relief to the problems of my own. I thought that finally ending chemo meant that my cancer journey was almost done. I am starting to realize I have only just begun.