What the tumor board said

The tumor board met on Monday and talked about my case. If you are unfamiliar with a tumor board, it is a meeting of oncological medical professionals (surgeons, medical oncs, radiation oncs, nurses, etc.) who discuss especially more complicated cases to determine with a multi-disciplinary approach the right course of action. So I get input on my care not just from my primary doctor, but from all kinds of doctors with different specialties. Pretty cool, I think!

So yesterday I called to find out what they'd come up with. I spoke with Dr. Skinner's nurse, which was great because now I can mull over their thoughts and be prepared to talk with Dr. Skinner about them next week when I see her.

We were actually somewhat surprised by the report. The tumor board is strongly recommending I have the other breast removed before I get pregnant (like, after wedding, but within the next year or so), and they are softly recommending Tamoxifen. Here's the rationale:

We know that my breast tissue has responded to radiation three times now by making hormone receptive breast cancer (two times in situ, one time invasive). They asked the radiation oncologist if my right breast is at significantly lower risk of this. She said it is at lower risk, but not lower enough risk to make her feel comfortable with me keeping the breast through a pregnancy. Again, the invasive cancer has made this more of a concern. Flooding my body with pregnancy and post-pregnancy hormones will only exacerbate that concern. The best defense is to make sure I have as little breast tissue as possible before I try to get pregnant. The Tamoxifen would be a stronger recommendation, I suspect, if I were post-childbearing. But taking it for five years adds a new set of risks by putting me in the high-risk pregnancy age bracket. It also adds a slew of undesirable side effects that I would love to avoid if possible.

I feel strangely okay with this recommendation. I am definitely bidding farewell to the possibility of breast feeding, but I'm okay with that. I have mourned that several times before, so that work is done; this is just how the dice landed, after all that shaking around. (As a side note, just as Jim and Pam in The Office upset me by getting pregnant right before I went on birth control, they made me feel better in a later episode when Pam gave birth and could not get the baby to latch. Watching how frustrating this was for them made me feel a little better - I guess I won't have to deal with that, I thought!) I am certainly sad to see my other breast go, and do have fears about another mastectomy even though I've done it once successfully and know what to expect. But what really makes me feel better is that at least with the option of just having a mastectomy and no Tamoxifen, I feel like we have been given back some choice in the matter of family planning. I mean, of course God has the final say in that, but I'd much rather leave it to God than have cancer or a drug protocol dictate it. But with a mastectomy, it moves back to, "When I'm healed, and when we feel ready, we can start trying." And that feels like such a gift to me.

Sometimes I go further down the road. What if we try and fail? What if this turns into another disaster? I have some answers to those questions (adoption is a very real option that we have considered seriously).  But today at my appointment with my spiritual director, I got a small ceramic heart that has the word "joy" etched into it. There were several to choose from, with different words. Last month, I would have taken the one that said, "Peace." But I found some peace, and now I am searching for joy. I've felt a lot of sadness in this thing, and a lot of grief, and a lot of anger, but despite my apparent positive attitude and good humor, I have not felt much joy about my situation, especially in the last week. So I have been thinking today about how I will find joy. And one way is to look only at the thing right in front of me, and give thanks for that. So today, I will find joy in the possibility that Michael and I might have some say in when we want to start a family. I'll take it!