Second Opinion

Went to Stanford today for a second opinion. The oncologist was Dr. Jennifer Caswell. I found out two things:

1. My tumor is Grade 3 (poorly differentiated), not Grade 2 (moderately differentiated).
2. My MRI shows a tumor in my other breast that was not caught by the radiologist at PAMF (my current provider).

My right breast has a fibroadenoma diagnosed in 2015 in the 1:00 position. Stanford says there's a second tumor in the 10:00 position. It's possible it's related to the fibroadenoma, or it could be another fibroadenoma, or it could be malignant. They want to do another diagnostic mammogram of my right breast and also an ultrasound. My previous ultrasound was for the left breast only, something that did not make sense to me. A biopsy might also be necessary. These tests will be done at Stanford, possibly next week.

I mentioned before that 6 cycles of TCHP was the treatment recommended to me. There is a study that Stanford wants me to consider that's 4 cycles of THP (no C for carboplatin). 

While I like the idea of having fewer drugs and fewer cycles with THP, it may not be as effective as TCHP. This study shows that the pCR for TCHP is 63% compared to only 55% for THP. pCR is pathologic complete response, the lack of all signs of cancer in tissue samples removed during surgery after treatment.

Another reason I don't want carboplatin is that it can cause leukemia. Dr. Caswell said it's less than 1 in 100, but that sounds too risky to me.

I could join the study, and if my tumor doesn't disappear completely, I can drop out of the study and get additional cycles of THP with or without carboplatin. I would still need a mastectomy, and if the pathology still shows cancer cells, I will need additional chemo. T-DM1 (Kadcyla) was the drug mentioned.

I have to decide if I should:

1. Transfer my care to Stanford, and
2. Join the study.

Due to miscellaneous problems I've had with PAMF (e.g., the missed tumor), I'm pretty sure I want to transfer to Stanford. I just have to decide about the study.