Boob is a Weekend Word

Meet Dr. Splichal, my favorite Oncologist

May 13th, 2011

About Dr. Splichal

Ok first of all, this man is CRAZY! I say this with the utmost respect for him and mostly for his wife, but Dr. Splichal has 8 kids! And he just took all 8 of them to Disney in the last few weeks. He does have an Au Pair which makes it possible to manage all 8. I am convinced he is the right oncologist for me because anyone that crazy is alright in my book.

He is a very gentle man, wonderful temperament, patient as can be, and he let me record the whole session so I could let my nurse practitioner sister-in-law, Beth McLear, hear the recommendations since she absolutely could not get out of a prior engagement to come with me today and insisted she be able to hear EVERYTHING. If she had an iPhone worth a crap we could have face-timed and she could have talked directly to him….*hint hint*.  I have to also thank my  husband for keeping our appointment on track because I tend to try more to “kin” too much with new people and learn about their lives than I do focusing on hearing the details of what i’m there for. But we got down to business so here you go:

So I will try to summarize what I learned to day. And bear with me because I have to admit my mind did tend to wander a bit because I also had a corrective surgical procedure for the necrosis mentioned in this blog post that was being done right after this appointment which I will write about separately.

Additional Studies

Dr. Splichal is recommending we do some additional studies just to make sure we all know exactly what we are dealing with. Its definitely breast cancer, but they just want to make absolutely sure there aren’t any obvious signs of metastatic activity going on. Dr. Splichal referred back to the breast MRI and agreed that it was troubling. There was an extended conversation with the radiation doctors around what was seen in my MRI. So I think there is consensus that I should have radiation. There will be about 3-4 weeks between the end of chemotherapy and the radiation therapy.

The additional studies that I will have done prior to chemotherapy and radiation will include:

• PET Scan –  The PET scan is determine if there are other detectible cancer cells throughout my body. The PET scan works on glucose metabolism and is picked up by higher metabolic cells, cancer cells, but the brain utilizes glucose exclusively for energy and so the PET scan is not as sensitive there which is why they also want to do a brain MRI
• Brain MRI -The brain is much more sensitive for baseline staging of any cancer cells in the brain
• Echocardiogram – The echocardiogram is to evaluate baseline heart function because some of the chemotherapy can be cardiotoxic.

After all the results of these studies are done I will start chemotherapy. I get my port inserted on May 16. I will also have my brain MRI that day. I will get the Echocardiogram and PET Scan that same week as well. My first chemotherapy session will be May 26, then we are off to the races. I don’t know what I’m going to do about the second chemo because it will happen while I am on vacation at the beach and I am definitely not missing my beach trip in exchange for poisoning. This is where my bargaining skills will be useful. Who would have thought a beach trip I planned 6 months ago would get screwed up by the big C! Rats.

My Chemotherapy

So how will the chemotherapy work?
The chemotherapy will be every two weeks for 16 weeks (8 sessions). Each session will take 3-4 hours including prep time, the actual IV injection of the chemotherapy chemicals, and checking out.  The first 4 treatments will be a combination of two drugs Adriamycin and Cytoxin. The day immediately proceeding each of the first four chemotherapy treatment I will go back and get a shot of  Neulasta. Neulasta grows white cells which helps fight infection because chemotherapy reduces your ability to fight infections. The last 4 treatments will be with a drug called Taxol.

The chemotherapy drugs will be injected through a port. I have to wait a couple more weeks before I get the first chemotherapy treatment because of my surgery today for the necrosis.  The port will go in my left arm. EMLA cream will be applied to the skin covering my port to numb it for the injection. I wished I could find a good photo of a port under skin in the inner arm but there are some god awful photographers floating around on flickr and google. My hubby will take a really good one once I get mine that other people can use to see what they are getting into!

During chemotherapy, menstruation can stop and I may go into menopause. There is a chance that I will not come out of menopause.  If I do stop menstruating during chemo then there is a 50/50 chance that I will remain in menopause but that will be good because estrogen production will go down. It might be possible that we remove the ovaries to prevent estrogen production instead of tamoxifen or we may use tamoxifen and then later remove my ovaries – we will make this call later. He wants me to get genetic testing to find out if I carry the BRCA1 or BRCA2 gene just for my children’s sake – this can wait for another 6 months or so.

My Radiation Therapy

After about a three or four week break Radiation therapy will begin. Radiation therapy is done with a machine that is a lot like an x-ray machine. You lie in the same position every time and they use a physics plan to find the exact place to beam these rays  to make sure they only radiate the areas that are affected.

Doing radiology and chemotherapy cuts your chances of recurrence down by 50%. So you have a 70% chance of it coming back without doing anything besides mastectomy so doing both of them cuts it down to about 30%. If it does come back it can come back locally or metastatically. I will just have to put faith in the doctors, medicine, and maybe I might have to resort to the good ole fashioned way of praying which is definitely something totally foreign to me, but I believe you can teach an old dog new tricks. Now don’t any of my religious friends expect me to suddenly find God or anything. I’m gonna try to beat this with my natural born talents first! If you are all right, then God will only give me what I can handle on my own.

My Cancer Staging

There are two different ways to talk about staging. One of the ways is staging is based on an acronym known as TNM

• T describes the size of the tumor and whether it has invaded nearby tissue,
• N describes regional lymph nodes that are involved,
• M describes distant metastasis (spread of cancer from one body part to another).

Dr. Splichal calls this a:
T3 – because there were three identifiable tumors
N2 – because there were two lymph nodes involved
M0 – He does not think there is any metastatic disease but we want to be sure which is why we are going to do the additional studies mentioned above

The other staging that most people are familiar with is Stage 1, Stage IIA, Stage IIB, Stage IIIA, Stage IIIB, Stage IIIC, and Stage IV. Based on that staging terminology he approximates my stage at Stage IIB until anything different is indicated in the further studies. The largest tumor I had was 2.1 cm but I did have a tumor in one of my lymph nodes that was 1 cm. Then I had two other smaller tumors and then a plethora of cancer cells that had not yet formed tumors. Here is a definition of Stage IIB from the Cancer Institute

In stage IIB, the tumor is either:

• larger than 2 centimeters but not larger than 5 centimeters and has spread to the axillary lymph nodes (mine falls mostly within this category however if you add up the size of all my tumors it may actually be larger than 5 cm so its kind of a gray area) ; or
• larger than 5 centimeters but has not spread to the axillary lymph nodes.

My Cancer Grade

Hmmm….I failed out this one…feels like calculus all over again. He did make mention that that the microscopic inspections of the cells indicated they were Grade III tumor (high grade). This means it is pretty aggressive and fast growing – not surprising considering my personality. I did it to myself!

Clinical Trial Possibility

Dr. Splichal also offered to let me speak with one of his clinical trial staff to talk about a treatment they are testing on premenopausal women with high risk breast cancer – XGEVA™

The study originated with a drug called Zometa in Austria. They found that women who got two injections of Zometa had dramatic reduction of chance of recurrence of breast cancer. XGEVA is similar to Zometa with lower risk of kidney damage.

We will talk more about this later but thought it was an interesting option to consider.

That’s about all tonite. Restoril and lortab kicking in. Gonna zone out in front of the idiot box for a few before I get my beauty sleep!