A beautiful giftbox with a shiny silver bow

When he finished with all the preliminaries and reviewed all the reports in my file, he explained that in order to decide on a suitable treatment plan there were two major things we needed to do: 1) A "Metastatic Workup" - this looks at all the tests I had on other areas of the body to find out whether the cancer has spread; and 2) Come up with a "Risk of Recurrence" (risk of the disease coming back) based on the pathology reports and my overall health.

Because Dr. MacCormick is very thorough he drew all this out on little cards for me, which he had about 30 of in his pocket (like little recipe cards). He was very organized and made sure I was clear about everything. We first did the Metastatic Workup. He wrote the following on the card:
"Metastatic Workup"
1) Chest Xray- today
2) Liver Ultrasound- normal
3) Bone Scan- normal
4) Blood Test (tumor markers)- today

He told me he would do the xray and blood test immediately following our appointment, but he didn't suspect anything based on the various other tests I had done.

Next, we came up with a risk of recurrence. In order to do this, we needed to review 6 things and then, based on these 6 things, the doctor would use a mathematical model to formulate the risk of the disease coming back. Here are the 6 things we reviewed:

1) Size of tumor: It was mostly 1 cm but 1.3 cms at its largest side. Anything under 1 cm poses no risk of recurrence, but where mine was .3cms over this limit, it posed a little one: 1/2 risk

2) Lymph node involvement: 0 of 12 lymph nodes were involoved, so this gave me 0 risk.

3) Surgical Margins: In other words, were they sure they removed everything during surgery? In my case they were sure because I had a mastectomy, so they were able to examine all the tissue in the removed breast to see whether there was any lingering cancer in the surrounding tissues of the tumor. So this gave me 0 risk.

4) Hormone Receptors: If the tumor is Estrogen (ER) and/or Progesteron (PR) positive, it poses less of a risk. These can be controlled through hormone therapy. My tumor was ER and PR positive (70%), so this gave me 0 risk.

5) Her-2 neu: This tells whether a gene on the tumor was overexpressed and poses a higher risk of recurrence (i.e. those who are her-2 positive have a greater risk of the cancer coming back). Mine was negative for Her-2 neu, so this posed 0 risk.

6) Grade: This tells how aggressive the tumor is (see previous posts). Mine was grade 1, which means it is a slowly growing, less aggressive cancer. So, this posed 0 risk.

I cannot begin to describe the wave of relief that came over my body as the doctor reviewed these details. I felt a weight that seemed 1000lbs lifted from my body and a smile overcame my face. Dr. MacCormick looked up at me from the papers his face was buried in. He said:

"Melanie, looking at these reports and your otherwise perfect health, I really think that the risk of this disease coming back is VERY low. For this reason, at this time I cannot recommend chemotherapy. I think the best route for you would be five years of Tamoxifen (hormone therapy) and nothing else."

I was SHOCKED. I could not believe what I was hearing. I felt that all this was surreal and that I was dreaming. I almost thought that an outcome as such was impossible. My grandmother was right afterall. I looked at my mom and Mike, my smile growing even larger, and I could see the look of relief and excitement in their faces. Suddenly, hope was restored. All the things I thought could be jeopardized seemed to be given back to me in a beautiful giftbox with a shiny silver bow: fertility, my natural hair, good health, red and white blood cells (yay!) ... and so on.

However, you must keep reading because NOTHING happens this easily (especially in the world of Melanie Roach) ... some bumps quickly appeared.