Take two

A quick update on where we are…

Based on the final pathology, Jul has been diagnosed with Stage 1a breast cancer. As I mentioned she had three millimeters of invasion. This means DCIS broke through the wall (thus became Invasive Ductal Carcinoma) and grew to the size of three millimeters. This is a small area that we caught early. We consider ourselves lucky because this area eventually grows into a tumor. Millions of women aren’t diagnosed with breast cancer until this area becomes detectable by a breast exam.

Treatment from this diagnosis will be dictated by percentages. If there is a high percentage of recurrence and chemo will help, chemo it is. Same goes for Tamoxifen. Everything we have read suggests that this amount of invasion shouldn’t require chemo but we need to discuss with our oncologist. One open question is whether Jul’s cancer is HER2/neu positive. HER2/neu is a protein that, if found, indicates a particularly aggressive form of cancer. We were supposed to get the results of this test last week.

The other pending test results are Jul’s genetic tests. Genetic tests for women with breast cancer look for two genes - BRCA1 and BRCA2 (cool kids pronounce that Brah-ka one/Brah-ka two). The results of this test will also change how we treat Jul’s cancer. If Jul is BRCA1 positive, her chances of having a recurrence are greater and her chances of getting ovarian cancer are 40-60%.  We would want to remove her ovaries but not until age 40.

I talked about margins in my last post. “Margins” is surgeon for “amount of good tissue between the cancer and the stuff we cut out.” The way the pathologists figure out margins is they coat the tissue in ink when it is removed. Then they examine the tissue and measure the distance between the cancerous tissue and the ink. The gold standard for margins is 1 cm although anything over 2 mm is deemed acceptable. Dr. Dirbas got less than 1 mm in one area. So on May 5th he will remove more skin in order to improve this margin when Dr. Kahn gives Jul her permanent implant.

We are also seeking a second opinion on the pathology from an expert breast pathologist named Dr. Michael Lagios. His specialty is DCIS. He will be able to confirm the size of the DCIS and the amount of invasion. Sometimes with a large area of DCIS, there are multiple areas of microinvasion. We are confident that there is, in fact, only the one 3 mm area of invasion since the Stanford pathologists took three weeks painstaking searching for it but one always feels better after getting a second opinion. If this doctor does find other areas of invasion, chemo will be more likely.

We will update you when the HER2/neu results arrive, when we get our second opinion and after we meet with our oncologist. Keep sending the positive vibes our way; they have been working well so far!

This entry was posted on Friday, March 17th, 2006 at 9:02 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.