I met with Dr. Kristine Rinn, a medical oncologist. “Aren’t they all oncologists?” you ask. (At least that was my question.) A medical oncologist deals with the systemic, medication treatments for cancer. Surgery and radiation are local treatments because they only focus on one body part or region rather than the whole body. Medications, since they travel through your blood stream are systemic in that they impact one’s entire body. The most commonly known type of systemic cancer treatment is chemotherapy. However, there are a number of systemic treatments for breast cancer, including hormone blocking medication, which is called endocrine therapy.

So Dr. Rinn went over the pathology report with me because she was the first doctor I saw since it became available earlier today. I will be meeting with my surgeon soon, as well.

The good news follows:

1) The cancer I have is not an aggressive type. It is also very small. Younger women tend to have larger and more aggressive tumors. However, that is not the case for me. I have a small, old lady type tumor. In the breast cancer world, this is a good thing. Dr. Rinn told me that she thought I was going to be “just fine” in terms of long term health.

2) There was no cancer found in my lymph nodes.

3) There was no evidence of lymph vascular invasion. This basically means that they looked for the bus station that leads to the lymph system and there was no cancer waiting for a ride to other parts of my body.

4) All of the margins for the tumor detected on mammogram and biopsy were good.

5) Dr. Rinn seems awesome!

The unclear and/or negative news:

1) There was a second, smaller tumor found right next to the main one. The second tumor is 3mm. This is not so unusual. However, two tumors is worse than just one.

2) They couldn’t tell if those cells that looked like they might be stage 0 cancer, were stage 0 cancer or not. Whatever they are, there are two spots where they are too close to the margin of the tissue that was removed during surgery. There is also concern that this area, which comprised 2.5 cm, over half of the removed tissue, was not detected through the mammogram or MRI imaging.

3) Although my chances of needing chemotherapy are low, more testing of my tumor is needed to assess this and it’s done in one lab in the country. The testing is called oncotype testing. It is done for women with no evidence of breast cancer in the lymph node who also have a hormone responsive tumor. Swedish is sending off a sample of my tumor to be evaluated by the lab. They will look at 21 genes, which are correlated with long-term cancer recurrence. They are able to use the information to assess 1) the chances that my cancer will recur and 2) whether my cancer would likely benefit from chemotherapy treatment. The results will be available in 2-4 weeks and at that time, Dr. Rinn, John, and I will go over her treatment recommendations.

The long and short of it is that I am going to need to have another surgery. I am at peace with this. The approach now is to preserve as much breast tissue as possible and one possible negative for this is that another surgery might be needed. I will have more information about this after I meet with Dr. Beatty.