I had my consultation with the Dana Farber Radiation Oncologist (RO) today, Dr. Jay Harris, and we were very impressed. First, a resident and a medical student came in and took my history and examined me. Then they went off and shared their findings with Dr. Harris. Dr. Katz (my first RO) had sent some information, also. So Dr. Harris was fully armed with enough information to make the right recommendations.
His first request is that I have the left tissue expander removed. It is covering my heart, and he is concerned that if it remains, he will not be able to radiate my chest wall without doing collateral damage. With the TE out of there, he will use electron beam technology which can be pointed at the proper angles to avoid heart and lung damage. I agreed that I would have BOTH of them removed. I hate them; if one has to go, they can both go. He was pleased with that decision. I have a tentative surgery date of October 26th with Dr. Hergrueter at Brigham & Women's.
Dr. Harris will then radiate the internal mammary nodes that showed up as cancerous on the earlier PET/CT scan. And he will radiate the supra-clavical nodes (in the area of the neck). And the mastectomy scar line will get an extra blast.
With all this, I will have a 30-50% risk of spontaneous broken ribs. My left rib cage took about 50% of the radiation from last year's Mammosite, so it's going to get a really big radiation dose, which weakens the bones. They don't see this as life-threatening, although if it happens it will be quite painful as there is no treatment. He doesn't think that my heart, lungs, or thyroid will be impacted. Also, he is not going to radiate the axilla area (armpit) so that should cut the risk of developing lymphadema.
Radiation reduces my risk of recurrence from 30% to 10%. And oh, it appears that this cancer was not a recurrence but rather what was missed from the first round of surgery and radiation. It showed up in the area of the biopsy scar, and as I have suspected all along, cancer cells were trapped in the hematomas then released as the hematomas dissolved. The radiologist at the Breast Center at Menorah was the only one who was suspicious, back in December, and it turns out she was probably right on. She wanted to do a biopsy and both the medical oncologist and the breast surgeon thought it was nothing.
Having radiation at Dana Farber will involve about a 3-4 hour round trip each and every weekday for seven weeks. We will check out public transportation options to see if there is a way to minimize the commute. This will get very interesting with traffic and winter weather on the horizon.
I am very much looking forward to our Florida beach vacation next week!!!