We were finally able to meet with Stanford on July 1. Dr. T was out of the country the week before, so scheduling had been a debacle, but we finally got fit in. The overall experience was essentially the opposite of UCSF. The drive down 280 and approaching a suburban hospital was incredibly more relaxing. Like at UCSF, we also spent an unexpected 3-4 hours at these appointments. Unlike UCSF where the bulk of that time was waiting, however, at Stanford those hours were efficiently spent meeting with doctors or getting a blood test done. We first met with Dr. W, a recommended breast surgeon. She had amazing bed side manner. Maybe it’s because it’s a teaching institution or maybe it’s just her style, but she very methodically walked us through what’s going on, what the different reports mean, and what the implications are on the treatment options available, as well as patiently responded to my many questions. She confirmed that based on the reports’ indication of the size of my tumor, the negative lymph node FNA results, and the resulting minimal likelihood the cancer had metastasized, we are dealing with a Stage 1 cancer. Score!
The medical oncologist, Dr. T, then joined us and they proceeded with the clinical exam. They did a physical exam of my neck and collarbone area, tapped my vertebraes, and checked my breathing, and confirmed I wasn’t experiencing any symptoms potentially indicating metastasis. They then did a physical exam of my breasts and armpits. This is when the appointment took a turn for the worse. They both had rather serious expressions on their faces. Upon physical exam, the tumor felt more like it was larger than 2cm – was it really that big (note all the ultrasounds and imagery indicated it to be more like 1.5cm) or was it just swollen from the bruising caused by the biopsies? More concerning, the physical exam of the left armpit indicated such a “suspicious” texture and shape of the lymph node that Dr. T was compelled to believe the lymph node FNA biopsy was wrong and that the left node was in fact positive for cancer. WHAT??? Perhaps the FNA didn’t capture enough cells since no cytotechnologist was present at Dr. G’s office at the time of the biopsy. Perhaps the correct lymph node was never sampled. All we know, is that the lymph node continues to be suspicious and she felt it’s better to operate under the presumption that it is positive.
Believing the lymph nodes are positive would mean we would definitely do chemo first since observing and measuring the tumor’s and lymph nodes’ reaction to the chemo would provide a better sense of prognosis. It would also mean there’s a risk that the cancer has already spread and we need to confirm that with a blood draw and PET/CT scan as soon as impossibe. It would not, however, influence her recommended chemo plan. Dr. T’s research focuses on TNBC amongst BRCA carriers and she pitched a treatment plan composing of Carboplatin+Gemcitabine for 6, 21 day cycles. She strongly believed in the effectiveness of this plan and pitched the benefits of its lower toxicity (e.g., no hair loss!). What we found so exciting is the option to start with CarboGem, observe its impact on the tumor, and switch to a more aggressive treatment (e.g., follow the more “standard of care” plans involving ACT) in a month or so if needed. While we were bummed to hear about the Stage 2 news, we were uplifted by this cutting edge treatment plan available. We left Stanford with mixed, roller coaster emotions. Had the cancer actually spread? Could a less toxic treatment plan work for me?
The great efficiency of Stanford demonstrated itself that night. Though we had spoken with Dr. T for hours until 7:30pm, she sent us straight to the lab for the blood draw to assess if there was any impact on the liver, lungs, etc. She emailed later that night with the results – the blood draw looks good overall, but there’s slight elevation of the alkaline phosphatase level and she recommends a PET/CT scan. Whoa. What does “slight elevation” mean? An immediate PET/CT scan – are we seriously concerned the cancer may have metastasized elsewhere? How could I have been told I have Stage 1 cancer earlier that evening, to then be wondering if I have Stage 4 cancer just hours later?
New job. New baby. New cancer. 