a marathon not a sprint

Ok, so we got a lot more information Thursday, and not all of it good. This breast surgeon visit was the first time we visited with part of our team since Becca's scan results were presented at a big meeting of radiologists and thoracic surgeons. I should state up front that the end result is that while everything may turn out to be as we thought it was (sternum involvement and nothing else), there are a significant amount of opinions that expressed more concern with the results and emphasized more caution in the planning of the next steps going forward.

Specifically, two more spots on the sternum showed up in the bone scan. They were also sclerotic, which would be consistent with responding to the chemotherapy. Why they were not on the first scan is the big question, the most frustrating but truthful answer being "we don't know". It's possible they spread to there during the treatment. The thoracic surgeon's opinion is that they were there before but not big enough or not affecting the bone enough to show up on the scan. These new spots mean a sternal resection would be ineffective; the entire sternum would have to be removed. More on this later.

The other issue is one that I don't think we have mentioned here before. The first scans we did last year showed what was determined to be a very small and most likely benign "bone island" next to the 8th vertebrae. It's a couple millimeters wide. Nothing changed with it in the second set of scans, but the more cautious members of the big meeting emphasized that we still can't discount it outright.

So, given these two new developments, if you want to call them that, the prevailing opinion seems to be that there is very little reason to hope that sternal surgery and a mastectomy will rid Becca's body of cancer. Statistically speaking, it is not very likely at all that the cancer metastasized to three places on the sternum and nowhere else.

This was a blow. Unreasonable as it may have been to hold out hope for this, I think Becca had pretty much hung her hat on getting through chemo, having the surgery, cleaning up with the radiation and then reconstructing and then DONE. Turns out not so much. We thought it would be a long sprint but a sprint nonetheless. The thoracic surgeon himself said "this is not a sprint, but a marathon."

And by the way, he was just as described by our oncologist. Clearly a huge brain, and though confident to the point of being matter-of-fact about his ability to go to the greatest lengths if that was what was needed, he was also very careful to keep in mind the entire range of medical options available. He emphasized that he is willing to be as agressive as we want to be, but that this is a chess game and we need to make the best move available based on what we know now. He suggested a major surgery like removing the sternum that requires 1-2 months of recovery is perhaps not the best route right now when there are other options open to us. In particular, radiation.

The other question that was raised at the big meeting was whether a masectomy was even necessary at this point, since maybe radiation should be done sooner rather than later, and a mastectomy puts off the radiation due to the recovery time required. Our breast surgeon is still advising that any remaining cells should be removed; they were the source of all this and no matter where the cancer is now, we want to eliminate the root cause.

The next steps would be much more clear if we could find out what the thing on the back is. If we can confirm it is benign, then we go ahead with the mastectomy. Otherwise we consider radiation beforehand. To this end, our oncologist is looking into getting a biopsy done on it next week. It might prove inconclusive but it is fairly non-invasive so it is probably worth a shot.

At any rate, a surgery date of June 24 has been scheduled, for use if we are going forward with it.

So that's as much as we know at this point. Apologies to those of you who knew something was up but didn't get the full rundown from us. This stuff takes a while to digest and worry about and tell Becca's immediate family about, etc.

And many thanks to John & Michelle and Erika and Kara who took over our evening parental duties while we waited an extra TWO HOURS for the thoracic surgeon appointment. Once again, a few calls and our rat-race of a homelife is covered, down to the last tball pick-up.