A journal of my experiences with breast cancer to inform those who are interested and to help any one else who might have just been diagnosed.

“[She] will have no fear of bad news; [her] heart is steadfast, trusting in the Lord.” Psalm 112:7

Friday, February 8, 2013

Michael J. Guarino, M.D; The Oncologist at the Helen F. Graham Cancer Center, Christiana, Delaware

“Peace I leave with you; my peace I give you. I do not give to you as the world gives. Do not let your hearts be troubled and do not be afraid.” ~John 14:26

It was a rainy morning when we set out to my appointment with my oncologist, Michael J. Guarino, M.D  at the Helen F. Graham Cancer Center , which is normally an hour from our house. In the rainy weather, it took a bit longer and we were a few minutes late to our appointment, which was on the third floor. Steven let me off at the door and he parked the car. I was still checking in when Steven met me at the doctor's office. We waited a few minute in the waiting room, which was a very depressing experience. There was a very heavy atmosphere of sadness, of a sense of desperation in the air. It was unnaturally quiet, reserved, a feeling that fear was everywhere. I was very glad to get out of that waiting room. Steven said he did not notice it, so perhaps I was projecting or perhaps I am overly sensitive to such things. I am not sure. I do know, however, that while we waited in the examination room for the doctor, I became very agitated, very nervous. Scared. Perhaps that was only because we waited for a very long time, and I began to think about all the things that I had put aside during the move and all that entailed. 

Dr. Guarino finally bustled in and had a wonderfully charming bedside manner. Later, over lunch, I likened him to Columbo, and Steven agreed that he seemed very much like the TV detective. He was a wonderful combination of "telling it like it is" kind of doctor and yet kind, reassuring and I felt he met us where we were. He was very reassuring, gave us a sense that he was in this with us and that he would get us through it.  He went over all the material that was sent to him from Tennessee and then he explained what it all meant, some of which I already knew, but some I didn't. The good news is that I may not have to go through the regular chemotherapy after all. He said that he has ordered a test to be done on the tumor that was taken out in TN called Oncotype DX. This is a diagnostic test that helps identify which women with early-stage, estrogen receptor-positive, lymph node-negative breast cancer are more likely to benefit from adding chemotherapy to the hormonal chemotherapy. It looks at the activity of 21 different genes in the tumor tissue that was removed and measures the chances of the woman, whose tumor it was, chances of returning and the likelihood of that woman from benefiting from chemotherapy treatment. How amazing is that? (If you are curious about it, you can find out more about it here.)

I will get the results of this test in about two weeks and it will have a recurrence score result, which is a number between 0 and 100, with the lower the score means the lower the risk that the cancer will return. If the score is low, it also means that it is a cancer that is less likely to respond to chemotherapy, so doctors will recommend treatment with hormone therapy alone. (For those of you that are praying for us, please say a special prayer that this score will come back low.)

The order of treatment will be:
  1. Maybe Regular Chemotherapy, we will know more when the test gets back.
  2. Perhaps Surgery. When a tumor is removed, some tissue surrounding it is also removed. The tumor with surrounding tissue is rolled in a special ink so that the outer edges, or margins, are clearly visible under a microscope. A pathologist checks the tissue under a microscope to see if the margins are free of cancer cells. Margins, then, refer to the distance between a tumor and the edge of the surrounding tissue that's removed along with it. Mine, although were clear of cancerous cells, were close, by 2 mm. The radiation therapist has to determine whether they are too close and I will have to have additional surgery to get more of the tissue or not. 
  3. Radiation Therapy. This will be five days a week for six weeks. Some skin burn and fatigue are the most common side effects.
  4. Hormonal Chemotherapy This will be a drug, Tamoxifen, which is a pill and is used to reduce the risk of getting a breast cancer again. It often causes menopause onset. The use of this medicine is used based on the observation that receptors for specific hormones that are needed for cell growth are on the surface of some tumor cells. Tamoxifen is an anti-estrogen and it binds to estrogen receptor site on cancer cells, blocking estrogen from going into the cancer cell, which interferes with cell growth and eventually leads to the cell dying. I will be taking this for five years.
So, now while we are waiting for the results from the Oncotype DX. test, I will see the Oncology Radiologist, Dr Danavanik on Thursday to see what he says about whether or not I need the surgery.

Please keep us in your prayers.


  1. We continue to lift you and your family in prayer. Remember God is in control, He has placed the exact medical team on your case who know the exact path to proceed.

    As to your feeling in that waiting room, that is exactly the way I felt too. Once that initial appointment was done, though that feeling did subside, and I discovered that actually there is so much love, laughter, and hope in that same room.

  2. He's got the rumply but pleasant Columbo look, for sure. I'm glad he's a good fit.

  3. He does look like Columbo :) Continuing to think of and pray for you, Phyllis!

  4. Crossing all digits very tightly and sending positive thoughts your way for a low score.

    The Tamoxifen causes wicked hot flashes, so you might want to buy a hand-held battery powered fan before you start taking it.

  5. I had to scroll back up and look at his picture again, he really does look like Columbo!

    I keep praying for you my friend.

  6. What a lot of information to process! Praying for a low score and peace and strength. Your verse is on my fridge. I know that waiting room feeling...I've had it in many a waiting rooms.