Surgical Oncologist # 2 update --- part 2

Doc #2 took us into his office and shuffled through all my paperwork, read reports, asked some basic questions to get up to speed…then he said,

“Are you interested in saving your breast?”

I was immediately perplexed. First of all, was this some kind of trick question? Is anyone not interested in saving their breast? But aside from the ridiculous nature of how the question was posed, all of my research thus far indicates that when there are multiple lumps of invasive cancer there is really no choice – mastectomy. And trust me, I searched, and searched for opposition to that opinion. And how. Boy would I like to hear some opposition!

So in answer to his question I said, ”Well, I am most interested in living as long as possible, with or without breasts.”

He seemed annoyed at my answer and said that went without saying. I bit my tongue in replying that the answer to his question went without saying as well. Um, yes, if I could save my breast I would. Can I just say, “duh!”

So, I am dubious.

(Incidentally, back to Doc #1 for a moment -- you know, that anti-breastfeeding-definitive-mastectomy doc? He said that when I went to NYC they would no doubt tell me what I want to hear, that I could have a lumpectomy. He had no idea where in NYC we were going mind you, he was making an indictment of every single oncologist in the entire city! Now, clearly that man had inferiority issues as an NJ doc. I’ve seen this before, doctors here in the ‘burbs resent us inquiring and thorough types going over the bridge to the city because we think it’s better. But frankly, I don’t have time for bridge & tunnel ego crap now!)

Okay, so anyway, the other thing I don’t like about this Doc #2 is he was pretty dismissive about some treatment methods that I am particularly interested in understanding…but more so this treatment approach would especially make sense if one were trying to save their breast -- so you’d think he would be on top of it.

See, apparently in some cases the trend is to do chemo first, before lumpectomy/mastectomy. The essential reason for this is that even with all the qualifying we can do of cancers now, like that mine is invasive, estrogen receptive, HER2 negative, yada, yada, there are still clearly unknown and perhaps highly individual aspects to each person’s particular case of cancer.

Now, if you give chemo before removing the tumors you can literally see if a specific cocktail of drugs actually affects the tumor because it will shrink. So, not only do you know that this exact cancer is responding to the chosen treatment, but afterwards you get to take out less tumor and surrounding tissue. If one were trying to save a breast, the smaller the tumor the better, no? And even if one weren't, knowing a little more for sure that any stray cancer cells floating around your body don't like this set chemo drug would be good.

However, then there is the issue of the lymph nodes. See, if the cancer has spread to the nodes then it might have spread elsewhere. That’s why they remove some of them, called the sentinel nodes, to biopsy them. Traditionally they remove them during the lumpectomy/mastectomy. But what if we do chemo first? Let’s say that my nodes were cancerous but only just barely…and then I did this preoperative chemo and it shrunk my tumors…it might also nuke the barely detectable cancer cells in the nodes meaning I wouldn’t know the cancer had been there.

The solution is to do a sentinel node dissection first – go in, remove them and check for cancer. Then do the preoperative chemo, then the lumpectomy/mastectomy, then...whatever else. This is a newer standard treatement, not some whacko idea, mind you. But I also want to be clear here…this is my understanding from my own research. I want the doctors to disagree with me if I am incorrect, I'm not approaching this with an attitude of knowing anything.

So, when I raised the question of preoperative chemo with Doc #2 he was incredibly dismissive and acted like what I was asking about was useless and a waste of time, yet couldn’t/wouldn’t really explain why. I mean, it does make sense when you read about it and seems to be a prevalent method so why act like I’m being silly? Silly? For crying out loud, I’m the one with the cancer here, I have a right to know this stuff and asking isni't silly!!!

In my opinion what I have experienced are the two opposite ends of the spectrum regarding women’s breasts and cancer according to the typical male physician:

Doc # 1 thinks, lop it off, it’s just a breast and why would you ever want to actually use it for anything, certainly not breastfeeding – how weird a thing is that to do with a breast.

Doc # 2 thinks that to “disfigure” a woman would be so traumatic and de-feminizing that any chick in her right mind would be willing to risk whatever it took, even her life, to keep her precious boob.

Clearly I’m looking for sensible answers here and not getting any. I don’t like that these two men have been so trivializing of my questions and seem unwilling or unable to explain things to my satisfaction. I am a relatively intelligent person, I could understand what they had to tell me if they deemed it worthwhile to explain.

Not for nothing, but how would anyone without my advantages…supportive husband, good insurance and a decent intellect…be able to navigate any of this???

We have our last scheduled surgical appt Tuesday, Doc # 3…she (yes, I said she) will hopefully be better, maybe even “the one”. If not, I’m thinking there will at least be a Doc #4…perhaps even a # 5. In the meantime I also have an appt Friday with a medical oncologist, also a woman.

Still, I decided to have this doctor #2 order some tests. The BRCA test to see if there is a genetic issue, the PET scan was done to help see if the cancer has spread, and I have an MRI script too – unlike Doc #1 this guy thinks it's still worthwhile despite the fact that I’m lactating (oh troublesome me!) Even though I highly doubt this guy will be the doctor for me, I can always get all these results and take them elsewhere. I thought getting started on the tests was time conserving.

So, that’s the doctor portion of my update. I’ll post some more stuff tomorrow. I’m frankly exhausted...and frustrated. But strangely…still hopeful. Or maybe it's just the Xanax ;)

Bye for now, and thanks so much again (and again, and again, and a thousand times again) for being there.