Second Opinion

Ma, Pa & I went to Stanford today to get a second opinion on Ma's chemo treatment. We had to wait a few hours before we got to see Dr. Guardino. She did consult with other oncologists at the cancer center before seeing us, so it's almost like getting the benefit of a tumor board. The news was not good.

First of all, she finds the pleural effusion "worrisome." She thinks we got a false negative on Ma's PE. If the PE comes back, it should be tapped again. Her guess is if the fluid is processed without delay, cancer cells will be found.

Second, she feels there are suspicious areas in the left breast (the same breast that had the tumor). I believe she was talking about the areas that lit up in the MRI. One of them was biopsied and was negative. Another is described in the MRI report as this: It is possible this represents an intramammary lymph node. Dr. Guardino thinks it's a cancerous lymph node in the chest wall. There is also a very high risk of recurrence of the cancer in the same breast or the remaining lymph nodes. Now I'm regretting not pushing for a second opinion on the surgery. I really felt that Ma would have had a difficult time recovering from a mastectomy vs. a lumpectomy, so I was relieved when the surgeon recommended a lumpectomy. It doesn't matter now. Dr. Guardino said at this point, additional surgery would do more harm than good.

Third, if I heard correctly, the PET scan showed that the liver has "a nodular border consistent with cirrhosis." This is the first I've heard of it. Dr. Guardino thinks it's suspicious and may be cancerous.

What's the next step? Additional tests to determine staging -- a CAT scan with IV contrast and a bone scan.

If Ma is Stage III, Dr. G recommends 4 cycles of TC (Taxotere & Cytoxan) every 3 weeks followed by radiation.

If Ma is Stage IV, she recommends 4 cycles of Taxotere & Xeloda, followed by radiation, then low dose Xeloda as maintenance therapy for the rest of her life. Xeloda is an oral chemo taken twice a day for two weeks, then one week off. It's well-tolerated by the elderly and doesn't cause hair loss.

This is in contrast to what Ma's oncologist recommended - Taxol weekly for 12 weeks and 4 cycles of Avastin every 3 weeks. Dr. Guardino thinks Avastin is too high-risk for Ma because of its side effects.

Also, because of Ma's numerous health issues (diabetes, hypertension, etc.), she needs to be monitored very closely.