Monday, August 31, 2009

PSA - Oncotype DX Test for Breast Cancer


Living with breast cancer is challenging for millions of women today. Some new ways of evaluating the likelihood that breast cancer will recur may allow doctors to determine who might benefit most from chemotherapy and other treatments.

With any cancer, the tumor cells divide uncontrollably. Cancer cells can then invade nearby tissues and spread through the bloodstream and lymphatic system to other parts of the body (called metastasizing). To kill cancer cells, doctors have routinely given patients with breast cancer the standard prescription: tumor removal via mastectomy or sometimes lumpectomy, usually followed by radiation and chemotherapy.

Until now, doctors have not been able to tell which women are at higher risk for breast cancer recurrence. Rather than take chances, every patient received the standard course of chemotherapy, which often has toxic side effects for many patients.

As we've learned more about cancer, researchers now realize that not all women with early breast cancer, including stage I and II, lymph node-negative breast cancer, actually benefit from adjuvant systemic therapy, which refers to chemotherapy, hormone therapy, and/or the drug trastuzumab (Herceptin).

Not All Breast Cancer Is the Same

More researchers are now thinking that not all breast cancers should be treated the same. Through findings from breast cancer clinical trials, scientists are discovering they can do a risk analysis of each woman's particular cancer and then base the outcome of breast cancer therapy (and specific type of therapy) upon the estimated risk of breast cancer recurrence.

Using a tool called the Recurrence Score, scientists are learning to quantify the likelihood of breast cancer recurrence in women with node-negative, estrogen receptor-positive (ER+) breast cancer and also predict the extent of chemotherapy benefit. While chemotherapy is necessary for some types of breast cancer, it may not be necessary for other types. And that's where the Oncotype DX test comes into play.

Breast Cancer and Oncotype DX

Oncotype DX is a diagnostic test that assesses the tumor tissue and estimates the likelihood that invasive breast cancer will return, or recur after treatment. By analyzing the expression pattern of certain genes in breast tumors, the Oncotype DX test can more precisely estimate a woman's risk of cancer recurrence when compared with the standard assessments doctors normally use to evaluate the risk of cancer returning.

The Oncotype DX screening test is performed on each tumor sample to get the Recurrence Score. The Oncotype DX test scores the breast tumor on 21 different genes involved in breast cancer and gives a Recurrence Score, or a number between 0 and 100 that shows a the chance of the breast cancer returning within 10 years of the original diagnosis.

The Recurrence Score is then categorized into one of three groups: low, intermediate, or high risk. For example, if a tumor has a Recurrence Score over 31, a high-risk score, this means there's a greater chance that the breast cancer will return. If a tumor gets a Recurrence Score of 18 or less, a low-risk score, this signals a lower chance that the breast cancer will return.
Using the Recurrence Score as a measure of risk, researchers now acknowledge a correlation between the score and the type of cancer treatment that is required. For example, with a low Recurrence Score, hormone therapy alone may successfully treat the woman's cancer. Alternately, a high Recurrence Score indicates a greater chance of the breast cancer returning, so the patient may benefit from adjuvant systemic therapy, including chemotherapy.

Who Might Benefit From the Oncotype DX Test?

The Oncotype DX test is recommended for breast cancer patients who are newly diagnosed, node-negative, estrogen receptor-positive, stage I or II, and who will be treated with tamoxifen, a selective estrogen-receptor modulator (SERM). Early findings from prospective trials indicate that a low Recurrence Score may determine which patients with ER+, node-negative breast cancer do not need chemotherapy.

The TAILORx TRIAL for Breast Cancer

More clinical trials are ongoing testing the Oncotype DX test. A groundbreaking clinical trial known as TAILORx is using the Oncotype DX test to see if some of the genes involved in breast cancer recurrence can also determine the need for chemotherapy -- and, more importantly, who will do better without it.The eventual results will help doctors recommend therapy that's based on the unique characteristics of each breast cancer tumor so they can maximize both effectiveness and safety in breast cancer treatment.

Use of the Oncotype DX test is limited to women with estrogen receptor-positive, node-negative breast cancer to help doctors determine if they can avoid the toxicity of chemotherapy if they have a low Recurrence Score. If women still want to undergo chemotherapy, that's a choice they can make with their oncologists.

Future Trends in Breast Cancer Treatment

In the near future, scientists predict the Recurrence Score may be used on other types of cancer, thus aiding doctors in prescribing individualized treatment that is safe and effective for cancer patients. A web-based tool called Adjuvant! Online allows doctors to incorporate the Recurrence Score from an Oncotype DX test to determine the benefit of chemotherapy in women with node-negative, ER-positive breast cancer. Using data from the Surveillance, Epidemiology and End Results (SEER) program of the National Cancer Institute, and from the year 2000 analysis of the Early Breast Cancer Trialists Collaborative Group (EBCTCG) findings, along with a proprietary formula, Adjuvant! Online can assist doctors in estimating each patient's prognosis and the benefit of adjuvant systemic treatment.

Reprinted from Web

Friday, August 28, 2009

"Cookie Cutter" Thinking Down the Rabbit-Hole

Today, I need to take a few detours. Full warning & I RANT! Beware of flying "d-bombs."

Sprinkled in between preparation and belligerently peppy is SURREAL. The journey that started on July 8, 2009, and the place I find myself at today can only be summed up as SURREAL.

The med-pros told me from the start that I am dealing with a 4 to 5.5 cm tumor. Each time I was diagnostically measured 5+ cm (and I had 4 levels of diagnostics) I got the qualification that, "its hard to tell with ILC ("invasive lobular carcinoma") BUT (and here is the kicker)...MRIs exaggerate the measurements of ILC tumors."  So, the expectation is that the malignancy will be closer, if not indeed smaller than, 4 cm.

So, when it comes back ... SURPRISE ... its a bouncing 6.2 cm. (NEARLY 2/3 OF THE SIZE OF MY LEFT BREAST!) (And for those in the studio-audience that have not gleaned the obvious, ample bosoms is...oops, I did it again...was not one of my physical attributes.)

Okay, that's cool. They took the whole SHATZBAT (thanks Kuwie!) and here I sit with my play-dough boobee (that is a tad bigger--certainly perkier--than the "lonely lady" next door - but that too will change with reconstruct round #2).

All of the above has been dealt with in a head-on fashion. Done! Fini!

Today, I had a sit-down with the med-oncologist (part of the med-pro squad) whom I chose because he at least admitted to being part of the industrial b.c* complex (plus, he has this really cool name: KATO - and I was just so enraptured with the Green Hornet's sidekick, Kato (aka Bruce Lee) as a kid). Oh, and he laughs at my jokes, REALLY! Someone truly does!

Sigh...but I digress...

So, we are having what I think is going to be this "team strategizing" meeting as to what should be my next treatment steps in this journey of "survival." I had the expectation that we would be discussing an individualized "treatment plan" specifically tailored to ME, moi, ya know... one of the (in)distinct individual "cogs" that keeps the industrial b.c. complex churning. Otherwise known as the individual patient!  Instead, I get "standard of care" party line! I get the perfunctory chemo, radiation, hormone therapy (replete with heavy-duty dosages of the "red devil" and Tamoxifen!).

I ask this Kato (who is so not looking like my childhood Kato anymore) and say...yeah, but that is the "cookie cutter" plan. What about me? The vacuous stare I received in response confirmed my worst preconceptions. He did recover quickly and replied defensively, no its not, it is based on the size of your tumor...(as he pulls out the cardboard stand-up that is used for "show n'tell" (??) and points to the 5 cm measurement scale)...see your tumor is off the display! Ahhh...I replied, I'm feeling the personalization now, I just needed the visual cut-outs!

This is advanced U.S. medicine (at least in the southwest) at its....? SURREAL Thank g-d I am one of the lucky medically insured in this country?!

It gets even stranger the further down the rabbit-hole I go. What the med-pros are offering is "adjuvant" therapy on a toxic-platter. (Meaning: the "just in case" treatment) The med-pros cannot tell me with any assurance that the lobbing-off of one of the ladies is definitive of my survival; they cannot tell me with any assurance that the toxic-buffet will be definitive of my survival; but they can tell me with a modicum of assurance that I will experience many, if not all, of the horrific side-effects if I partake in the meal-plan being offered; and my insurance will pay for it! Surreal

IF I choose not to dine at their buffet... well, then the med-pros can assure me that. . . .(????)


b.c. = "breast cancer"
industrial complex = that very lucrative niche industry that turns a greater profit in the name of the CAUSE than the CURE

Thursday, August 27, 2009

Belligerently "Peppy" . . .?

I have done some personal re-labelling of the tried and true "emotional stages" of breast cancer. The current template:

* Denial and Shock
* Anger, Rage
* Stress and Depression
* Grief and Fear
* Acceptance, Adjustment
* Fight and Hope ... blah, blah, blah...oops! I mean, etc. etc, etc....

I cannot speak to the standard emotional/psychological appellations (above), but for me personally, I have had the pleasure of working through:

* DENIAL, and

Preparation has been my favorite so far because it really allowed me to show off my strengths: the researching; the cross-examinations of medical professionals; the organizing of the data; and the strategizing of the course of action. I love that kind of stuff. Especially when it includes tabs, annotations, indices and spreadsheets.

Over the last two days, however, I believe I have now entered a stage that I am fondly calling:


There are external factors over the last two days that launched this new stage, i.e.: the myopia of certain unnamed curmudgeons I find myself embroiled in battle with (professionally); the idiocracy of the current health care debate that only punctuates that the human species, or at least the American strain, values profit over decency; as well as the ambiguity of the practice of medicine -- I got the preliminary pathology results yesterday and among other things it appears that the tumor was much larger than anyone expected. Let's put it this way, if I had had no tumor in my left boobee I WOULD NOT HAVE HAD A LEFT BOOBEE!

This new stage is confusing, however.

On the one hand, the immediate and general response has been...Oh! TC must be feeling better, she is "ripping people new ones" again! And, I do feel strangely energized by the present fury and frustration I am feeling.

Conversely, I feel extremely drained by that same energy it takes to keep these fires stoked. And that fact alone pisses me off.

For now, I suppose I will just accept on face-value that the former "energizing" fury is the PEPPY; that the latter composes the BELLIGERENT; and just see where this takes me. And, if I am feeling more peppy than belligerent, just hope that I might feel enough momentary compassion to forewarn!

Wednesday, August 26, 2009

The Unveiling & Transition


The torment of the "tube top" is over! I have now transitioned into a "training bra" Yes Alice, it truly is possible to go back and revisit puberty at 47 years of age!

My 19 year old daughter called from college today. She was inquiring about the unveiling from the surgery. She wanted to know what the scars looked like (both from mastectomy and the 1st stage of reconstructive surgery (yes, sigh, there are stages...!) She was oozing unrestrained curiosity. "So...what does IT look like?"

"Hmmm...well sweetie, remember playing with play-dough when you were little and how your rollie balls would always end up a little misshapen? You know, smooth on one side and just a little lumpy on the other? And, then, how they felt after you left it out on the patio too long? Hard, crumbly...well................"

The funny thing is, after all the mental preparation for the dreaded lopsidedness; the culling of the creative fashion juices for the public appearances; the embarrassing fitting - not to mention giddy embracing of the "fluffies" (and you still do not want to know) -- there is absolutely NO apparent size difference between the play-dough ball and the real deal!

I am not sure what I was expecting. In fact, I think I was void of expectations at this early stage of the C-Battle. As such, today indeed brought a "surprise."

I'm sure that in the light of dawn I will find my dough-ball a pleasant some sort of backward, wickedly humorous, mother-naturey kinda way. At a sleepless 1 a.m., however, I'm only feeling the wicked.

Monday, August 24, 2009

Field Trip, Torture and Vitamin C

Yowza! My first field trip outside since the "big whack." Okay, it was to the naturopathic oncologist, but it was highlighted by some great stuff.

First, the purpose of the trip was to offer up my already assaulted veins for an I.V. Vitamin C treatment laced with Traumeel. (Google that one!)

Next, one of the physicians in the practice played "re-wrap the 'mummy'" (ah, an old b'nai mitzah reception game!) several times. (Wearing gauze bandages reminds me of trying to wear tube tops in the '70s...I had nothing to hold the darn things up then, and I now I no longer have anything to hold them up now!)

I also discovered a commonality with the males of our species I never thought possible. My empathy was triggered as I desperately struggled all day to discreetly camouflage my two "drainage bombs." (Recall back to high school gym class and that guy who always wore boxer shorts underneath his too short gym-shorts?)

If the excitement of all of the above was not enough, I had the added pleasure of exposing...I mean sharing...all of this with a dear friend (read: indentured chauffeur-ette). Yes, Steph got to share in the mummy wrap, bombs, needles and the memory of pubescent jewels. Payback...I mean gratitude...can be a bitch, however, and my dear Steph leads the class.

She insisted that we stop for a quick nosh on the way back home. The excitement of the day obviously gave her an appetite. Sitting in the Scottsdale icon, The Sugar Bowl, she sinfully indulged in a four scooper bowl of Turkish Coffee ice cream, slowly licking every caramel droplet from the spoon. Only to then chase this decadence by slurping a diet cherry cola as she smirked in concerned fashion in my direction. I, being lactose-intolerant, watched longingly as I gagged down my 1/2 tuna melt (sans frommage). All the while drooling with envy into my ill-fitting "tube top," wondering if my "d-bombs" were peaking out from my proverbial "boxer shorts!"

All in all, a pretty great day!

Sunday, August 23, 2009

Touch Down

****** Just got home from the hospital a few hours ago. The stories while I was drugged up have begun to be retold to me! OY!

Apparently I got a bit frantic when the surgical team came into pre-op to take me in. (This I do recall.) I wanted to know when I got the meds to start calming me down. The anesthesiologist -- with the most manicured eye-brows I have ever seen on a man (aside from the character "Sandy Cohen" in the O.C.)-- tells me he is injecting sedatives into my I.V. right then. The good news, according to eye brow doc was they were not intending to sedate me too much, as they needed me lucid in the O.R. to ask me questions. The frantic part came into play when he told me I did not have enough time to boot up my blog and share the ride with you all.

Well, I showed Doc Eyebrow! I may not have had time to blog before the drugs hit. BUT, neither did they get their interrogation. HaHa! Reportedly, I announced that I was so feeling the sedative, slipped down into the bed and began to giggle. (Med doctor's have a tendency to overestimate what a 100lb woman's tolerance level is for the "good stuff.")

Hubbie reports that the last he saw of me I was "cracking myself up" en route to the O.R.  Who says breast cancer is not funny!

The last thing I recall is observing all these mint-green clad creatures, looking like they were from Area 51, scurrying about busily. A 51-er extended both of my arms into a spread-eagle position and strapped me down (and we are talking leather). The very last thought I had before slipping into wondrous oblivion, so this is what crucifixion feels like? (Weird thought for a nice Jewish girl, eh?)

Friday, August 21, 2009

Hurry Up and Wait

****** Okay. The process is beginning.

I am sitting in my pre-op bed. Oh is SWEET, you can get WIFI access in pre-op!!! They have me draped in this exaggerated vacuum cleaner bag that comes complete with hose openings for the hot-air tube to keep me warm. "Ground control to Major Tom..."

I was admitted at 8 a.m. (but was required to arrive at 6:30 a.m.) and whisked to radiology for the injections for the sentinel node biopsy that will occur concurrently with the mastectomy. I will admit, it gave me pause that the radiologist injected my breast in four locations with a "matter" that had to be carried in a steel paneled box marked "radioactive." And then, he had to dispose of the gloves he used on me into the same paneled box. Regrettably, at the writing of this entry my super powers have yet to show themselves.

Can anyone remind me how long it took for Spidey's powers to kick-in after he got bit?

Thursday, August 20, 2009

Countdown & Checklist

With my mastectomy looming just hours away, it is time to go over the requisite checklist:

1) Derma-planning followed by an Osagi peel. DONE (It will be bad enough to be the Bride of Frankenstein this time tomorrow, but I cannot handle being the Bride of the Wolfman too!)

2) Pedicure and manicure. ALMOST DONE (With the multitude of down-time in the OR and recovery, g-d forbid someone should glance upon the toes and be given another reason to snicker!)

3) Packed lovely customized post-surgical camis. OY VEY, DONE! (And yes, they come complete with their own little portable "fluffies" & not ask!)

4) Made the kids' school lunches (Because radiology wants me sooooooo early in the a.m. that it makes me wonder what they plan to do with me for 6 hours. So very glad my surgery is not being done at a teaching hospital!)

5) Explained to 8 year-old son's teacher, who called at 9 p.m., that "no" I was not having surgery on the entire left-side of my body from brain to foot. DONE?? (Re-explained to 8 year old too!)

6) Read 8 year-old an extra long bedtime story and danced with him to a Weird Al Yankovic CD. (Yes, it can be DONE.)

7) Watched kids sleeping (even the 17 year old). LET THAT PLEASURE NEVER BE DONE!

Wednesday, August 19, 2009

Which is the bigger challenge?

There seemed to be a consistent theme in correspondence I received today, as well as in conversations. The common thread had to do with "allowing others to take care of me" while I venture down this route...(or, as I fondly like to think of it...being sucked down the vortex of the industrial complex called breast cancer).

I will confess, I am so the Type A++++ personality! I admit it, I desperately want to grow up to be Miranda Priestly (you know, the b*tch who wore Prada!). As such, it is likely that the challenge of embracing my own vulnerabilities and allowing people to be witness to those vulnerabilities will definitely be the greater of the challenges facing me.

A personal lesson I'm sure I should contemplate seriously.

OH...the hell with it, even the Bride of Frankenstein would have looked good in Prada!

Tuesday, August 18, 2009

The Countdown...

While embarking on this forced-path, I have made an infuriating discovery. Despite the gross and seemingly exploitative merchandising associated with breast cancer in this country...the medical supply industry does not make "post-surgical" garments in my size!!!!

I am not talking about "things that would be nice to have." But rather, those items that are "necessities" for post-surgical healing. Yet, despite the need, the "industry" of cancer does not find it cost-effective to make these garments in XS. So, as I go through the poking, prodding, and blood leeching (and don't get me started on the contradiction of "pre-surgery" exposure to radiation in the name of diagnostic x-rays), I have to also "tailor" my own "lovely" fashion additions.

So tonight I will have the uplifting task of "stitching my own noose."

As Roseanne Roseanneadanna would say: "What is up with that????"

Sunday, August 16, 2009

How I Spent My Summer "Vacation"?


First, I need to come clean. I did not have a summer vacation. And, seeing how the summer played out, I should have. I should have thrown caution and responsibility to the wind and taken myself somewhere fabulous and decadent!

During this summer, I joined the venerable ranks of the 40,000 +/- women who are diagnosed with breast cancer each year in the U.S. A staggering and incomprehensible number. A statistic, it appears, that is indiscriminate in whom it envelopes.

For all intents and purposes I should not be a member of the club. (And believe me, I SCREAM this fact out -- at least inside my head--daily.)

I have no risk factors. I have no family history. I do not, and never have, smoked. I have not taken any synthetic estrogen (e.g. the "pill") since 1985 -- and that was for only 6 years. I am physically active at 47 (young by breast cancer standards). I am fairly fit at 5'1" and 102 lbs (soaking wet), and someone who logs 60+ hours at the office. I run. I weight-lift. I hike. I power walk. I yoga. I Zumba. I maintain my passion for martial arts that I have been working at since 1982. I am the one in the crowd that my junk-food junky BFFs tease in a good-natured way about my "healthy lifestyle."

You've heard a variation on the theme: "it's you fruit & granola types that will be stricken with a horrific disease...just look at Keith Richards and what he has done to his body and he's still rocking!" I always laughed, and still do. Who knew my McD's critics would be prophetic??

Despite the "clean" lifestyle, here I sit. Stage III(+) Invasive Lobular Carcinoma measured at approx. 5.5 cm. looking at a mastectomy in 4 days. The "initiation" into the first stage of this "rite of passage."At this point, you are probably asking why are you telling me this? In short, I don't know.

I will be blunt, however. It is so not about YOU. This blog is my therapy session. And before you click-off, I am not talking about indulging in a maudlin recitation of the "poor meeees." (But do forgive me if I digress once on awhile.)

On the contrary, it is just that I have so many "conversations" going on in my head. So many observations about this path that has been forced upon me. An outlet is needed. The screaming in my head is becoming too loud. And in deference and compassion for those I love and care about, I will not impose these "conversations" upon them. It would not be fair to burden them so.  I would rather foist them upon you, kind stranger.  And, they might add on another diagnosis or two to my list if I did indulge them with my mental musings.

Journaling is good. I have advised many persons on the benefit of doing so. Journaling is a cathartic way of expressing and sorting out our thoughts. But journaling for me at this time is stifling. It keeps the SCREAM isolated inside my own head. And honestly, I am getting a headache!

So, read if you like. Don't if you don't. Add your nuggets of wisdom as you choose. And if you would like to SCREAM along with me, add your voice to the cacophony. After all, if you SCREAM and there is no one to hear you, than how can you be sure that you really made any noise?

Yours truly, TC