Next Steps...

Hello All, I finally have a few quiet minutes to type out a few updates. Kari's parents went home last night to catch up on things on their own for the weekend. Kari had a sample sale in Elmhurst this morning and her friend Alex took her out there to help. It was a long day for her but it was an excuse to get out of the house that didn't involve a trip to Loyola. Katie and I went on a walk this morning to the health club. I dropped her off at the kids' center and got in a good run followed by a nice walk home in a light rain. James came home this afternoon. We really missed him and it is good to have the whole family together. It seems like he grew a foot since he left last week. He has been very careful and cautious with Kari. He is hugging her gently. Kari had her follow up appointments this week. In general, she is healing well. Unfortunately, the news that we were given yesterday wasn't what we had hoped. We met with Dr. Godellas first. He told us two things that we didn't expect. First, they found DCIS in Kari's left breast tissue. This is ductal carcinoma, in-situ. It is similar to what she had on the right. The main difference is that the tumors that she had on the right side was invasive and had to spread to her sentinel lymph node. What they found in the left was in-situ, which means that it isn't spreading, but it is still cancer. This was unexpected because they told us that the left breast was clear based on the results from the mammograms and the ultrasounds. Kari certainly made a good decision by having a bi-lateral mastectomy. The second piece of information is that they found cancer in 9 of the 18 lymph nodes that they removed during her surgery. Both of these came as a shock to all of us. I think that we were all expecting to get a confirmation that the cancer was contained in the right breast and that the left was clear. I also think that we had all convinced ourselves that the pathology would show a few affected lymph nodes. Nine was far more than I would have expected. After Dr. Godellas, we met with Dr. Albain, Kari’s oncologist to talk about treatment. She has to recover from surgery before anything happens, which should be 4 to 6 weeks. From there, she will have 4 to 6 months of chemotherapy. We have a few options of different clinical trials that we may want to participate in. There is a stack of papers sitting here on my desk that we need to review. Because of the new findings, radiation is almost certainly in the treatment regimen. We were hoping that Kari would be able to avoid this. Dr. Albain said that we would talk about the details of radiation therapy at a later date. We need to focus on getting Kari healed and healthy for the next round. There are a few additional things that they are going to try to bolt on to Kari’s therapy. First, all of the tumors have shown to be highly receptive to estrogen. They are going to do everything that they can to get her body to stop producing estrogen. Secondly, the US FDA is close to approving biphosphonate as an additional treatment for breast cancer. This is an osteoporosis drug that has been approved in Europe and has shown to increase her chances of beating this. Kari has another appointment with the oncologist next Friday. Before then, she needs to get a heart scan to make sure that she is eligible to participate in one of the clinical trials. Also, they have scheduled her for a PET scan. They did bone scans, MRI’s and CT scans in early May to see if the cancer had spread anywhere else in her body. The results from these tests were all clear, including her left breast. In light of the pathology after surgery, they want to take another look just to make sure. The PET scan (positron emission tomography) looks at how cells absorb sugar in the body. They will give Kari a sugar solution with a radioactive tracer in it. The scan picks up parts of the body where cells are aggressively consuming the sugar. Cancer cells are the greediest ones out there and they show up clearly on this scan. I think what upset us the most after the appointment on Friday was the odds that Dr. Albain laid out for us. You can take a glass is half-full or half-empty approach to this. Either way, they are scary and I know that Kari is really bothered by this. I am very optimistic about this and I think that Kari has a lot of things going in her favor. She made the right choice with the bi-lateral mastectomy. They are going to aggressively treat this. The potential supplemental treatments including hormone suppression and biphosphonate improve her odds. She also has the advantage of being treated by some of the global experts on breast cancer and its treatment. We are very fortunate to have the resources of Loyola so close. Most importantly, she knows that she has the love and support of a big group of people. This will make all of the difference for her. That is what we know for now. Thank you again for all of the cheering, support, thoughts and prayers. We’ll let you know what happens next week.