Consultation with Dr. David P. Winchester, a surgical oncologist.
Dr. David P. Winchester considers Ann's prognosis
excellent but orders a second biopsy to determine whether cancer is more
widespread.
As most of you know, this morning Ann had a
consultation with Dr. David P. Winchester, a surgical
oncologist.
The outcome of this
consultation is that Ann is scheduled for an additional stereotactic core needle
biopsy on Monday (12/30) morning at Glenbrook Hospital, the same facility that
she had her previous biopsy.
The rest of
this email relays some of Dr. Winchester's comments as a result of a physical
exam and review of Ann's mammograms and pathology
report.
His
findings/recommendations:
- The
pathologist's diagnosis of ductal carcinoma in situ (DCIS) is bad/good news. It
is bad news because it is cancer; it is good news because it is Stage 0 cancer,
the most curable form. The 20-year survival rate for DCIS is
98%.
- Dr. Winchester expressed high
confidence in the team of pathologists who did the diagnosis but he was open to
pursuing whatever additional opinions Ann wants. Regardless, he will review the
slides himself once the additional biopsy is
performed.
- Axillary (under arm) lymph
nodes are not inflamed and need not be
removed/biopsied.
- Additional
calcifications in mammograms warrant another breast biopsy. Calcifications of
this type are almost always benign.
-
Treatment will depend on the result of the upcoming
biopsy.
- If the other calcifications are
benign then the treatment would probably consist of a lumpectomy followed by
radiation treatment for six weeks. Technically, there is no lump to be removed,
but the procedure is the same to remove the duct and some surrounding tissue.
The lumpectomy would be 20-30 minutes of surgery handled on an out-patient
procedure so that Ann would not spend a night in the hospital. Anesthesia might
consist of only local anesthetic with sedation; general anesthesia is also a
possibility. Ann would be able to resume normal activities the next day.
Radiation treatment would not result in loss of hair or reduced energy levels.
No chemotherapy would be expected for the affected breast; tamoxifen therapy
might be considered to prevent cancer in the other breast. It is important to
cut out a margin of healthy tissue surrounding the malignancy. Unfortunately it
is not possible for the surgeon to see where the malignancy stops and the
healthy tissue starts; a pathologist must examine the the removed tissue to see
whether the edge is malignant or healthy. If the margin of healthy tissue
around the malignancy is not thick enough then the surgeon will have to operate
a second time to remove more tissue. A second operation is necessary about half
the time.
- If one or more of the other
calcifications is malignant then the treatment would consist of removing the
entire breast, a mastectomy, because the amount of tissue that would be removed
for multiple lumpectomies would leave the breast cosmetically in poor shape with
multiple scars. Various options exist for breast reconstruction and these would
be reviewed prior to a mastectomy; the chosen reconstruction procedures would be
preformed during the same operation as the mastectomy. The surgery would
involve general anesthesia and a hospital stay of 1-2 days with several days of
recovery. No radiation or chemotherapy would be
necessary.
- The surgery would be
performed at Evanston Hospital. Dr. Winchester indicated that more oncology
surgeries are done at this hospital than any other in the Chicago
area.
Regarding Dr. Winchester's
qualifications, he indicated that he's specialized in breast cancer surgery for
the last 10 years. He said that he would do the surgery personally (as opposed
to a surgical resident).
The consultation
was very pleasant and professional; Ann was very pleased with Dr. Winchester's
"bedside manner" and found his nurse very friendly. When asked who would be
responsible for coordinating Ann's case, he said that he'd be the "captain" of a
team of specialists. Coincidentally, he just moved to Glencoe about three weeks
ago and lives about 3-4 blocks from us and recalled our house, having seen it on
his morning constitutionals; he likes the
color!
We don't expect to have any
additional information for you until early next week when the pathologist's
report regarding the new biopsy is available. We will let you know the results
at that time.
For now there is nothing to
do other that enjoy a merry Christmas...we will and hope you will
too.
Love,
Ann and Nello
Posted: Mon - December
23, 2002 at 12:00 AM