Results of Second Opinion


Our second opinion on Tuesday (1/14/03) with Dr. Monica Morrow, Director of the Lynn Sage Breast Center of Northwestern Memorial Hospital (NMH) in Chicago resulted in a somewhat different diagnosis but Ann's lumpectomy is still scheduled for about 2:30 PM tomorrow, Friday (1/17/03), at Evanston Hospital in Evanston, Illinois. The operation will include an additional procedure and will be done under general anesthetic. The prognosis remains excellent.

Second Opinion at NMH

The radiologists at NMH did an ultrasound exam which showed nothing new. However, the NMH pathologists had a surprise for us. They agreed that the second biopsy was benign. They agreed that the first biopsy indicated ductal carcinoma in situ (DCIS). But, they say that the first biopsy was also micro-invasive with a tumor size of less 1 mm in size. This means that some of the cancer cells have broken through the lining of the breast ducts. And this changes the cancer from stage 0 (pre-cancer) to stage 1.

During our consultation with Dr. Morrow, she said that the tumor size was so small that it did not impact survival rates as opposed to DCIS alone. Her recommended treatment plan is a lumpectomy followed by six weeks of radiation; this is the same recommendation as Dr. Winchester's.

Information about lumpectomies is available online

  http://www.breastcancer.org/tre_surg_lumpexpect.html
  http://imaginis.com/breasthealth/lumpectomy.asp


However, she also recommends a sentinel (lymph) node biopsy to determine whether the cancer had spread to the lymph nodes which she says is unlikely. This biopsy means that the lumpectomy will have to be under a general anesthesia rather than local.

Information about sentinel node biopsies is available online

  http://www.vh.org/adult/patient/cancercenter/sentinelnodebiopsy/
  http://www.breastcanceralliance.org/publications/fall1999-2.asp
  http://www.bcsaf.com/articles/snb.html
  http://www.cancernews.com/category.asp?Cat=3&AID=202
  http://www.breastsurgeons.org/officialstmts/sentinel.shtml


Another Review at ENH

We faxed a copy of the NMH pathology report to Dr. David P. Winchester's office on Tuesday to get his perspective on this discovery. On Wednesday (1/15/03) Dr. Winchester had Ann's slides re-examined by Evanston Northwestern Healthcare's (ENH) pathologists. Independently, I reviewed Ann's case with Dr. Thomas Victor, Chairman of Pathology and Laboratory Medicine at ENH. On Wednesday evening Dr. Winchester indicated that the we should accept the diagnosis of DCIS with micro invasion and modify the treatment plan as indicated by Dr. Morrow.


Going Forward

We were quite taken aback by NMH's finding of micro invasive cancer. But now that we've had time to adjust to it we are just glad that we followed thorough on getting a second opinion. I feel renewed confidence in ENH as a result of my consultation with Dr. Victor and we are going forward with Dr. Winchester performing a lumpectomy and sentinel node biopsy tomorrow.

We are focused on the fact that the survival rates haven't changed as a result of this new pathology report. And, now that we've had a second opinion we can put more confidence into the prognosis: the breast will be saved and the patient will live. We are focused on these outcomes.


Timing of Next Steps

This afternoon (1/16/03) Ann will go to Evanston Hospital for preoperative procedures. She will have a wire placed in her breast which will guide Dr. Winchester's surgery tomorrow. She will also have radioactive dye injected to identify the sentinel lymph node. She will come home for the night.

Tomorrow morning she will go to Evanston Hospital for preoperative procedures including a mammogram to verify that the wire hasn't moved. Her surgery is scheduled for 2:30 in the afternoon. She will come home tomorrow night.

In several days we will have complete pathology reports for both the tissue removed during the lumpectomy as well as the lymph node(s). These reports will used by a medical oncologist regarding recommended chemotherapy, if any.

After 1-2 weeks Ann will begin daily radiation treatments for six weeks.


Your Support

Thank you for all your support. The emails. The notes. They mean a lot to Ann.

I don't plan to send another note out until tomorrow evening after Ann is home so don't be concerned if there is no news until late.


Love

Ann and Nello

Posted: Thu - January 16, 2003 at 12:00 AM        

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