"AND" versus "OR"

I met with my oncologist this past Friday (9/2/11). It's interesting how I've been right about my body thus far. When I was told that there's a possibility that my MRI biopsies could come back as showing non-invasive Stage 0 (DCIS) or it could back as showing invasive or it could come back as showing that one biopsy showed non-invasive and 1 biopsy - both taken on the same day - showed invasive, I knew right away which one it would be. Come on, nothing with me is ever easy so OF COURSE I got the result I anticipated. ;-) The pathology report reflected that 1 biopsy came back with non-invasive Stage 0 (which is treated by surgery) and 1 biopsy came back with invasive, probably Stage 1 (which is treated by chemo), I wasn't surprised. I guess I didn't anticipate or realize that if I had both, I needed BOTH surgery AND chemo. I was so hoping for the "or." (surgery OR chemo) Sigh.

So the million dollar question is...which comes first? Answer - don't know yet. My oncologist has presented my case to the "tumor board" (what the...yes, that's the name) which will be meeting next Friday, 9/9/11. The "tumor board" gathers almost every Friday and consists of the following Memorial Hospital doctors: 5 oncologists, 2 breast cancer surgeons, breast radiologist, pathologist and radiologist oncologist (I *think* I got that right). Basically, I am Patient X. I feel like I'm in a real life episode of Gray's Anatomy.

The "invasive" part of my biopsy came back at over 9mm which seems small but makes it now mandatory for me to have chemo.

There are 2 unknown factors I still need to wait to hear back which will solidify the answer as well for the doctors. I have not yet gotten my HER2 test result back yet. HER2-positive breast cancer is a breast cancer that tests positive for a protein called human epidermal growth factor receptor 2 (HER2), which promotes the growth of cancer cells. In about 1 of every 5 breast cancers, the cancer cells make an excess of HER2 due to a gene mutation. This gene mutation and the elevated levels of HER2 that it causes can occur in many types of cancer — not only breast cancer.

HER2-positive breast cancers tend to be more aggressive than other types of breast cancer. They're also less responsive to hormone treatment. However, treatments that specifically target HER2 are very effective, which includes Trastuzumab (Herceptin). Trastuzumab, which specifically targets HER2, kills these cancer cells and decreases the risk of recurrence. Trastuzumab is often used with chemotherapy.Trastuzumab is usually well tolerated, but it does have some potential side effects, such as congestive heart failure and allergic reaction. Oncologist told me if I test positive for HER2, I'll have to have chemo for FIVE months and to take Herceptin for a year IN ADDITION TO the chemo. If I don't have the HER2 gene mutation, I may only need chemo for only 3 months.

I am also waiting to get the results of the BRCA genetic test. If I test positive, my understanding is that the doctors will recommend that I not only get a double mastectomy (bye bye B's, hello C's....I'll let that sink in for those who don't get it, haha). If that's the case, then it makes sense, at least to me, to get chemo first and THEN to have surgery.

It's going to be a long couple of months. I hope it doesn't impact Rotembruary too much. :(

If I need 3 months chemo, I will be getting chemo every 3 weeks, for 4 doses. (I don't really know what that means either....maybe 4 doses a day?)
If I need 5 months chemo, I will be getting chemo weekly for 3 months and then bi-weekly for 2 months.

I'm still digesting all of this info. I am going to do my best to schedule my chemo "sessions" on Fridays. I *may* need to cut down at work and work only 4 days but that's going to be trial and error (no pun intended!). My oncologist tells me people are able to work after chemo but I just don't see how. Maybe those people don't have high stress jobs?!?!

I haven't yet researched the side effects of chemo. I am terrified about....my hair. BUT, for now, I can only handle so much and I'm tabling those emotions and fears for a later date. One day at a time.