Cancer: Medical Oncology

There are good surprises and bad surprises.  A month after my lumpectomy, I sat down with my oncologist expecting to get a prescription for tamoxifen .  Instead, I got a bad surprise.  

I have never been an overachiever.  All through school, my report card had the comments, “Does not live up to her potential.”  (In my defense, I think they were looking at the wrong potential.  I’m just sayin’.)  Ace my SATs?  No.  Four point GPA?  No.  Have a glamorous and high-paying career?  Nooooo.  Get a high grade on my tumor?  Yeah, here’s where I exceeded expectations.

The early biopsy indicated a Stage 1, Grade 2 cancer, but when the entire tumor was removed, the pathology was a Grade 3.  [Science lesson for today:  Stages 0 to 4 refer to how far the cancer has spread.  I was at Stage 1.  Grade describes how much the cells within the tumor have changed.  Grade One means the cells look pretty normal and grow slowly.  Grade Two cells are somewhat deformed and grow faster.  Grade Three cells are both abnormal and aggressive.]  

A Grade Two with my other signifiers -- clear margins, no lymph node involvement, accompanying biopsy data -- indicated I did not need chemo, but a Grade Three meant reevaluation.  Instead of hustling an IV in my vein to pump me full of life-saving poison, my oncologist sent my tumor to a special lab in California. 

Wait.  They saved the tumor?!  I envisioned a Raiders of the Lost Ark warehouse filled with shelf upon shelf of squishy blobs floating in formaldehyde, perhaps intermittently wriggling with an alien life force.  I was almost sad when nurse-friend informed me that all excised tissue is saved by being frozen.  

They pulled my tumor and sent it off for an oncotype test.  This is a relatively new method of analysis that examines 21 genes in the tissue (Pretty skippy!) and predicts the probability of the cancer’s recurrence anywhere in the body ten years into the future.  A low score means you go straight to radiation therapy.  An intermediate score means more indecision as you and your doctor figure out what treatment to follow (and you’d probably want a second opinion which means more difficult waiting).  A high score and you have to face chemo.

The test takes 10 business days, and the doctor cleared personal time to see me 14 real days later.  I worried the results would not be in by then, but his next available appointment was a whole month off.  I am incredibly lucky that he cared enough to set aside time for me.   

I had already scheduled my radiation simulation for the afternoon of my oncology appointment.  There wasn't time to cancel, but in the four hours between appointments, the oncologist had already called the radiologist!  We went ahead with a consultation, but if I needed chemo, radiation had to follow it, and any preparation done now would have to be re-done.  There was no point taking extra rads with a possibly useless preparatory CAT scan.  We put the simulation on hold.  I waited. 

I felt like I’d been thrown in monopoly jail:  no passing Go, no collecting $200, no moving forward:  just sitting idly in my holding pen trying to mentally parse out possible futures.  Fourteen more days waiting.  Waiting is all fear and anxiety.  It sucks.

I’ll take pity on you:  I won’t make you wait until my next blog post for the results.  At 3:30 on a Saturday afternoon,  just as I was counseling myself that I’d waited 12 days and could make it two more, the oncologist called.  “I have an early Mother’s Day present for you.”  My oncotype was low.  Low!  Low was happy and safe and unambiguous.  No worrying, no waffling, and best of all, no chemo. 

We were finally able to discuss medications.  If you’re, ahem, younger, you get Tamoxifen (an estrogen blocker).  I am not younger.  I am on an aromatase inhibitor.  (It’s not called an estrogen inhibitor. I don’t know why.)  I got my prescription and with it my Get Out of Jail Free card.  

The Monday after Mother’s Day, I called for my radiation simulation appointment.  No one was ever happier about it than I!