On Making the Breast Cancer Treatment Decision: a Personal Story

MEMORIAL HERMANN WINTER 2017 On Making the Breast Cancer Treatment Decision: A Personal Story Leigh Rozelle found the lump purely by accident, just three days before Christmas. As she crossed her arms, she felt a golf ball- size knot on the outer side of her left breast. “My family practitioner was able to squeeze me into her schedule the very next day,” says Rozelle, who is 38. “When she examined my breast, she was concerned and asked me if I had time to see a breast surgeon the following morning if she could get me in.” The breast surgeon was Liz Lee, M.D., who is affiliated with Memorial Hermann Memorial City Medical Center. “Dr. Lee did an ultrasound and told me the lump was slightly larger than 3 centimeters in diameter,” Rozelle says. “She wanted to move quickly and sent me to the breast center for a mammogram and biopsy the following day. And that’s how I spent my Christmas Eve.” Four days later on Dec. 28, 2015, she heard her diagnosis: stage 1A, grade 3 ductal carcinoma in situ with some invasive components. Grade 3 and 4 tumors tend to grow rapidly – much faster than Leigh Rozelle on her first and last day of chemotherapy treatment at Memorial Hermann Memorial City lower grade tumors. She also learned Medical Center. Leigh was diagnosed with breast cancer in December 2015, and received all of her that her particular cancer was triple treatment at Memorial Hermann. negative – characterized by the absence of three receptors known to fuel most aggressive, they typically respond to mastectomy – and had a scare in the breast cancers: estrogen receptors (ER), chemotherapy. The diagnosis gave her a process,” Rozelle says. “On the MRI they progesterone receptors (PR) and human glimpse into the future. found patches in my right breast, which epidermal growth factor receptor 2 The multidisciplinary Breast Cancer were biopsied and identified as dense (HER2). Although triple-negative breast Tumor Board at Memorial Hermann tissue, not tumors. Then I had lots cancers do not respond to receptor- Memorial City met to discuss Rozelle’s of questions: If I do a mastectomy and targeted treatment and tend to be more case and agreed that surgery was the Treatment Decision continues on page 2 best first course of action, followed by chemotherapy. In January, she met DIGITAL VERSION Frankie Ann Holmes, M.D., a medical To receive the Memorial Hermann Cancer oncologist affiliated with the hospital. Journal via email, please sign up online at “I was struggling with what type of memorialhermann.org/cancerjournal. surgery to have – lumpectomy or SURVIVORSHIP Treatment Decision continued from page 1 these challenges before treatment.” then need radiation, will that delay Prior to surgery, Rozelle saw Emilia reconstruction? How will I know if I Dewi, OTR, O.T.D., CLT, an occupational need radiation? I learned that they could therapist and certified lymphedema remove a few lymph nodes to make sure therapist at TIRR Memorial Hermann that the cancer hadn’t spread. We did that Outpatient Rehabilitation-Memorial on Feb. 1, 2016, in the left arm. Luckily City. Dewi evaluated her and took all five lymph nodes were negative and I measurements for a compression sleeve, would not need radiation. But the tumor which encourages the movement of was growing, and because of the size, I Leigh and her support system on her last day lymph through the body and discourages felt that a lumpectomy would leave my of chemotherapy. pooling of lymph in the arm. breast lopsided. I was dealing with “After the mastectomy, I had four something aggressive and I wanted to prehabilitation,” Dr. Holmes says. “When drains and couldn’t do a whole lot of take aggressive action. I had faith in we see cancer patients, we’re very aware exercising but I could do some light Dr. Lee. In the end I decided to move that they have lives beyond diagnosis and stretching,” Rozelle says. “Once the forward with a mastectomy, and then treatment. Patients who have mastectomy drains were out, I went back to continue decided on a double mastectomy because and lymph node dissection, as Leigh did, therapy before I started chemotherapy.” I’m young and want peace of mind.” will lose some range of motion in the arm She saw Emilia twice a week for about a Dr. Holmes referred Rozelle for and shoulder on the affected side and also month, working primarily on improving prehabilitation – occupational therapy in be at risk for lymphedema. If a patient is range of motion in her shoulder. advance of mastectomy to optimize the deconditioned before chemotherapy, an “As it turns out, I didn’t have a lot of outcome and help improve quality of life exercise program can help with fatigue swelling,” she says. “I was aware of it, but after treatment. “I’m a big believer in during treatment. We can address all of it was nothing anyone else would notice. IN THIS ISSUE SURVIVORSHIP 1-3 BRCA1/2 and Other Genes Associated with EXCELLENCE IN CANCER CARE 13-14 Breast and Ovarian Cancer: The Importance On Making the Breast Cancer Treatment of Genetic Testing Memorial Hermann Launches a South Region Decision: A Personal Story Lung Program Focused on Early Detection Early Detection of Gastrointestinal Cancers A NOTE FROM LEADERSHIP 3 With Advanced Endoscopic Techniques and Memorial Hermann Cancer Centers Teamwork Greater Heights Breast Care Center ADVANCES IN CANCER TREATMENT 4-9 Digital Tomosynthesis Improves Early PERSPECTIVES ON RESEARCH 9-12 COMMUNITY OUTREACH 14-17 Detection of Breast Cancer An Adjuvant Therapy, Plerixafor, Shows Memorial Hermann Offers Free Cancer Promise in the Treatment of Glioblastoma Funds Raised at the Memorial Hermann Screenings to Northeast Community Multiforme Foundation’s Annual Razzle Dazzle Luncheon Bringing Cancer Awareness to the Workplace Bring Advanced Biopsy Technology to A Patient Benefits From Participation in a Memorial City Clinical Trial of a New Treatment for Relapsed Community Partner Spotlight: Ovarcome Ovarian Cancer Video-Assisted Thoracic Surgery Gives Memorial Hermann Goes Pink for Breast Patients a Minimally Invasive Option for Lung Ongoing Clinical Trials Cancer Awareness Month Cancer Surgery VOLUNTEER SPOTLIGHT 12-13 EXPERTS ON THE PODIUM 18 Memorial Hermann Breast Care Centers Offer Superior Care Across the City Clara Cook Lambert: From Cancer Patient to BY THE NUMBERS 18 Energetic Volunteer MEMORIAL HERMANN WELCOMES PROFILE IN CARING 13 NEW TEAM MEMBERS 18-19 William Velasquez, M.D.: On the Front Line of Cancer Care 2 MEMORIAL HERMANN CANCER JOURNAL Emilia got me started early with a sleeve that they were going to recommend apy. “No matter how much I prepared to help prevent full-blown lymphedema.” chemotherapy, but that it was my choice and took charge of things, there were Rozelle prepared for chemotherapy as whether to have it,” she says. “I was bad days, so I was happy to be done with diligently as she had prepared her home surprised. I’ve been blessed with good chemotherapy. A lot of friends and family for life after mastectomy. “I read what to doctors, including my reconstructive came to celebrate my last day, and all the expect of chemotherapy but avoided the surgeon, Dr. Rafi Bidros. He’s phenom- nurses came out to wish me well. I have horror stories. I focused on things I could enal. As a team they have it down to a a lot of good support and a lot of people do around the home to make my life easier. really good science.” praying for me at different churches, and The preparations were comforting and Rozelle finished chemotherapy in I know that this is just a season in my gave me a sense of being in control.” mid-August and had her reconstructive life. It will pass.” u Early on, Dr. Lee emphasized Rozelle’s surgery in November after giving herself role in treatment planning. “She told me a chance to bounce back from chemother- A NOTE FROM LEADERSHIP Everyone at some and there was very little treatment for fall Memorial Hermann rallied together point is touched by breast cancer at the time. My grand- as a system to spread the message of cancer. Whether mother was the very example of a loving prevention and early detection, in it’s a loved one or and generous spirit. She always went out particular, regarding breast and lung a personal diagno- of her way to love and serve her family, cancer. It is our hope that by maintaining sis, we will all friends and neighbors. It is my privilege Memorial Hermann’s strong presence in encounter cancer to have been influenced by her and the community, we will continue the at some point in motivated to continue her legacy of caring. fight against cancer through screenings, our lifetime. From our dedicated nurse navigators, prevention, education and outreach, For those of us who help guide patients through every because at Memorial Hermann, you’ll who have spent careers in the fight against step of their journey, to our expert never fight cancer alone. cancer, we feel a deep connection to each affiliated physicians, who are committed and every one of our patients as we help to providing high-quality cancer care, it Sandra Miller, M.H.S.M., RN, NE-BC them along their cancer journey. For me is everyone’s mission to be there when Senior Vice President this connection comes as a result of the our patients need us most. Oncology Service Line inspiration of my grandmother who had As reflected in this edition of the breast cancer. It was in the late 1960s Memorial Hermann Cancer Journal, this According to the Over the past year, our physician screening.

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