Stage III

The tests came out clear -- brain MRI, bone scan, CT scan. So it's official -- Ma is Stage III, not Stage IV. More specifically, she's Stage IIIB.

We met with the tumor board at the hospital Wednesday. I was expecting only about six people there. But no, there must have been about 20 -- surgeons, oncologists, radiologists, pathologists, two medical residents, a dietitian, a social worker, the director of the cancer center, and who knows who else. They basically agreed with the chemo treatment recommended by Stanford and that no further surgery is needed at this point. They also said that the liver doesn't look cancerous in the PET scan. This contradicts what Dr. Guardino at Stanford said. The radiologist said that "a liver with cancer doesn't look like that." So I was pretty confident going into Friday that Ma would be "only" Stage III.

Chemo will start on Wednesday.

Port

Ma had her port inserted on Tuesday. Her appointment with the surgeon was canceled the day before, but we had a hurried consultation with her the next day before the surgery. It took less than an hour. Ma had a MAC, somewhere between general anesthesia and conscious sedation. She was given three different anti-nausea medications when surgery ended, but she still got nausea. The nurse gave her another drug, and that seemed to help, but all those drugs made her very drowsy. We had to wait several hours before taking her home. The good news is she had no pain at all the next day.

Full Week This Week

Ma has a full week this week.

Mon - Consult with a surgeon about inserting a port in her chest for receiving IV chemo.
Tue - Have the port installed. It's an outpatient procedure.
Wed - Tumor board and brain MRI.
Thu - Bone scan and CT scan.
Fri - Follow-up with the oncologist. Pa is also having a growth removed from his underarm.

The Background

Ma felt a lump in her left breast a few days before Easter. (Easter was March 21st this year). She immediately had a mammogram, but the lump was hard to see because she has dense breasts. It was clearer in the ultrasound that followed. A biopsy showed that it was cancer. The surgeon ordered an MRI which showed more suspicious areas in the same breast. Another biopsy was done on one of the areas, but it turned out to be negative. So the surgeon recommended a lumpectomy and an axilla dissection. That was done on April 29. The results:

2.2 cm tumor
Invasive ductal carcinoma
Poorly differentiated
Grade 3
Triple negative (ER-, PR-, HER2-)
16 out of 16 lymph nodes positive for cancer

That means it's aggressive and advanced. In addition, Ma had a pleural effusion in her right lung. That was drained on
May 2nd. Tests results showed it was negative for cancer. But see the previous post. At the moment she's considered stage IIIB. Further tests will determine if she's stage IV.

Update 05/23/08: Ma is officially stage IIIB.

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.