Wednesday, August 16, 2006

Today's oncology appointment

The medical oncologist is indeed nice. She's nice in a slightly saccharine and ever-so-slightly patronizing way. I guess there are people out there that like that sort of thing... I just happen to be not one of those people. One thing I did like about her was that she paused so that I could write down the names of the medications we discussed, and she made sure that I could spell them. However, I felt that the discussion was led less by her and more by me and Ian's mom (who came with me because Ian is away). I'm sure the doctor did that so that we would only get as much information as we can handle. She just doesn't yet know that I want to know EVERYTHING :)

We started off by talking about the CT scan results. She said that we couldn't be sure that it was cancer, although if it was breast cancer it wouldn't matter because the treatment would be exactly the same, and that we could do additional tests if we wanted, and would I be comfortable doing an MRI? What?!? I got her round to the idea that yes, I firmly believe that the thing in my sternum is cancer, based on the gradually increasing pain and the CT report that I've read. And that it was my understanding that the question was whether or not the cancer in my sternum was breast cancer or a radiation induced cancer.

She did say that it's highly unlikely that it's a radiation induced cancer, which I know to be true. I'll feel a lot more comfortable knowing that we have as much knowledge as possible before we start treatment, though. She agreed that we could go that route, and so we are going to do a biopsy. She said it would be up to a couple of weeks to get in and then they'd have the results within 10 days of the biopsy date. There is about a 15% chance that the results from the biopsy will be inconclusive, and of course there is some risk associated with the biopsy. Let's hope that the biopsy goes smoothly and that it gives conclusive results. Ummm, we're not doing an MRI :)

If the thing in my sternum is breast cancer, then we'll remove my ovaries. It might take a while to get in to surgery, as my surgeon apparently doesn't do this surgery and so I'll need a referral to someone else. If it does take too long to get in to surgery, we'll start me on the injections to prevent my ovaries from functioning. That way, they can start me on aromatase inhibitors 4 weeks after the first injection. She said that I would be able to take some herbal supplements (black cohosh, evening primrose oil, and vitamin E) and they have some prescription medications (clonidine and effexor) that will help to minimize the menopausal symptoms that I will experience in this case. We would also start me right away on some bone-building stuff (clodronate or pamidronate if I don't tolerate the clodronate) in addition to calcium and vitamin D, because the aromatase inhibitors and menopause will weaken my bones. We will not do a mastectomy.

If the thing in my sternum is bone cancer, then we won't do any of the stuff above, but will only treat the bone cancer. She said that the reason that we would do this is that there is no point in giving a treatment designed to prolong my life by years and years and years if the new cancer would catch up to me in a few years. This makes some sense.

We did a baseline blood test including some tumour markers; these markers can be used to determine whether cancer is actively growing. They're not perfect, these markers, but they're better than nothing. She also said that at the moment, there are no clinical trials that would apply to me, so I'm just going to get standard treatment.

And that's it. I hope I remembered to ask her everything.

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