I did not want to go to my meeting with an oncologist. It is standard procedure after a diagnosis of DCIS to visit with an oncologist to talk about hormone blocking therapy. To make sure that the other breast - which had been hiding at least 1.8mm DCIS - did not grow any (more) DCIS. At this point, it seemed moot, but it was important to cross all the Ts and dot all the Is.
First off, the reception room of the oncology department was dismal. I thought to myself, "I am never coming back to sit in this room again." I was the youngest sitting there. There were about equal numbers of men and women. There was a man with an inflamed red, puffy leg. There was another woman who just looked ill. And there were the obvious chemotherapy patients wearing scarves around their heads. It just was not the place I wanted to be. Still, I felt lucky that I was only there for a consult.
The doctor spent over an hour with us. She drew pictures of what a hormone blocker does to a cell (this was a revisit to basic biology from college, so that was pretty easy to understand). It was also pretty clear that she does this to everyone she speaks with. Tamoxifen is a hormone blocker that buffers the estrogen receptor to cells. Estrogen changes the cells so much they may turn into cancer. Tamoxifen blocks the estrogen from affecting the cell. Tamoxifen can also cause: fatigue, hot flashes (which can be alleviated with a pill), mood swings (which can be alleviated with a pill), increased clotting issues, and uterine cancer. Basically it comes down to taking this pill (with the possibility of two additional pills to decrease side affects) for five years, then once you are off it, you actually go through menopause. As my husband put it, "um thats like 10 years of menopausal symptoms. Do I get a vote?" Of course I had to laugh at that - only because I am not really considering it.
The doctor ran all the numbers for us. Here is the breakdown of recurrence of DCIS given the following scenarios:
Watching and waiting (mammograms/MRI every six months) - 20% chance of recurrence in 5 years; 31% chance of recurrence in 10 years
Radiation only: 8% chance of recurrence in 5 years; 13% chance of recurrence in 10 years
Tamoxifen only: 10% chance of recurrence in 5 years; 16% chance of recurrence in 10 years
Radiation and Tamoxifen: 4% chance of recurrence in 5 years; 6% chance of recurrence in 10 years
Mastectomy - "cure" or 1% chance of recurrence in a lifetime. There won't be enough breast tissue left to measure cells.
The doctor said that I was extremely lucky to have the surgery team that I had working with me, and that she understood why I would have a mastectomy and implant, but that everyone's journey was their own.
One day later, I had my second drain taken out. Yeah, it was awful. Not painful, just yucky. But its gone. I spoke to my nurse about whether I needed to come back again and she said that my healing was going really well and that I won't need to be seen again unless I have a concern. She actually sent my reconstruction surgeon in to chat- she was in that day and had a few minutes. We spoke about how disappointed we were to find the DCIS in the reduced breast. She presented all options for the next surgery (mastectomy with direct to implant) and we made a plan. She and my surgeon will discuss dates and get back to me.
4 more weeks of no laundry; no dishwashing; no lifting ten pounds. The implant has to stay in place so the scar tissue forms in the right place and it stays in place. That is a lot of "places" to worry about. I am going to follow the instructions so that I can heal best and get the best result. Because I am seriously falling down a dark path with the next steps. Not because I am scared. Just because I am done. D.O.N.E.
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