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The person has been diagnosed with early-stage breast cancer in their right breast, which is hormone positive but HER2 negative. This means they may not need chemotherapy and could undergo lumpectomy surgery followed by radiation and hormonal blocking therapy. Additional tests and blood work will be done to determine the treatment plan. Surgery timing and type will be discussed with the surgeon, Dr. Wilson, who will guide the decision-making process. Radiation would follow surgery, with the possibility of starting chemotherapy depending on further test results. Tell me what you know is going on, what they've told you. Well, what they've told me so far is that I have cancer in my right breast. Yes. And we believe that it is contained. Yes. No lymph node activity. My best friend is a pharmaceutical rep with AstraZeneca. Okay. So she's got breast cancer knowledge. Yes. She looked over the pathology report from the biopsy, told me that it's hormone positive. Yes. Her positive. It's actually not her positive. I'm going to talk to you about that here in just a minute. Okay. So it's hormone positive, she said. Yes. Her two negative. Her two. Okay. Her two. And she said that that's a good thing. It is a good thing. For treatment. Yes. Yes. So, but you don't have, you've not been set up to see a surgeon yet? No. Okay. You're my first stop. Okay. Okay. Besides my primary. Absolutely. Absolutely. So, yes. So you do have early stage breast cancer. It is localized from what we can see with your imaging studies in the right breast. It does not appear based on the mammogram or the breast MRI that you've had done that you have any lymph node involvement, which is a good thing. Okay. This is a breast cancer that is strongly hormone positive, meaning that it's being driven by your female hormones. Both estrogen receptors and progesterone receptors were found on the breast cancer. Okay. And that means that your female hormones are the main driving force of the growth of this cancer. Okay. Okay? Now, there are other things that can sometimes cause breast cancer to develop. And one of the other more common things is this mutation called the HER2 mutation. Okay. About 15% of breast cancer have the HER2 mutation. All right? And so there's a little bit of semantics that goes along in checking this HER2 mutation because we know that there are different levels of whether or not you're HER2 positive. And some patients have what we call a true positive HER2, and some patients have what we call a HER2 low positive. Okay. Okay? So the initial test that they do... I think it's a pill box. It is. It's a pill box. They're everywhere. Yeah. So the initial testing that we do to look to see if we're seeing any HER2 receptors on the biopsy is this test right here. Okay. It's called an immunohistochemistry stain. Okay? And so what we know about IHC testing is that you're either going to be 1+, 2+, or 3+. Okay. Okay? If you're 1+, that means you're HER2 super low. Okay. Okay? If you're 3+, that means you're definitely HER2 positive. Okay. Okay? But if you're 2+, it could go either way, and that's why we see this word here called equivocal. Okay. All righty? So there's actually additional testing that we do when we have someone that is equivocal or HER2 2+, to determine if you truly are considered to be HER2 positive that would require you to pursue HER2 therapy as part of your treatment plan. Okay. Anti-HER2 therapy, I should say. And that's this test right down here. This is what we call a dual-ish test, or in situ hybridization testing. And your in situ testing is negative, meaning that it is non-amplified. Okay. Okay? So you are not HER2 positive. Okay. So the benefits of not being HER2 positive is that you do not require chemotherapy at this juncture from what we know. Because a lot of times when patients are HER2 positive, that's generally a recommendation that patients get chemotherapy up front. Okay. Okay? Even before they have surgery. So I'm assuming that that's why your primary care doctor sent you to see medical oncology because she thought based on the HER2 of this, and she may not even have these results back, but I'm assuming that she thought maybe because of this that you might be HER2 positive requiring that you would have to do chemotherapy even before you had surgery. Okay. So at this point in time, we do not yet know if you are going to truly require chemotherapy. Okay. Okay? But I would say to you that knowing that you've got early stage hormone positive breast cancer, the likelihood that you are going to require chemotherapy is not that great. Okay. So when we have patients who are hormone positive and HER2 negative, and you have early stage breast cancer, usually the first thing that we do is surgery. Okay. Okay? So I have actually already spoken to one of our breast surgeons. Her name is Dr. Wilson. Okay. And she says that she could probably see you later this week, maybe on Friday. Perfect. Okay? Yeah. So that would then get the ball rolling for us. Wonderful. So how do we ultimately determine if you're going to require chemotherapy or not? There's actually a test that we can do to help us to determine that, and it's called an Oncotype test. Okay. And so I will ask her at the time of your surgery, Dr. Wilson, if she can send off for this Oncotype testing for us. And that will then help us to know once I see you back in the office whether or not there is any role for you to have to do chemotherapy. Okay. Okay? Does that make sense? Yes. Okay. So talking therapy, though, is definitely something that we will plan on. Okay. All right? Are you pre-menopausal or post-menopausal? Pre. Pre. So are you still menstruating on a regular basis? I don't have that, so I don't know. I've had an ablation and another procedure, so I haven't had a period in 16 years. So when you say that you're pre, how do you know that? Is that based on female hormone levels? That was, yes, on a doctor who's done some blood work in the last two years. Okay. So they said that I wasn't in menopause yet. Okay. So one of the things that I would like to do today, if you're okay with that, is to draw some blood work on you to determine what your menopausal status is because that is then going to guide us into what our hormonal blocking therapies choices are going to be because pre-menopausal patients have a different recommendation than post-menopausal patients. Yes. So can we order on her, Chelsea, FSH, LH, and an estradiol level today? Yes. And by the time I see you back after your surgery, we'll know those results as well, and we'll then be able to know what hormonal blocking therapy that we're going to use. Perfect. Okay? Yes. Questions about what I've talked to you all about today? So when you're saying that I would need surgery, I'm assuming that's like a lumpectomy. They would just go in and take out, or we don't know. Yes. So based on the size of this, I do believe that you would be a candidate for a lumpectomy or partial mastectomy. Okay. Again, that would be something that Dr. Wilson would go into detail with you when you see her about your surgical options. I would not see, based on what I've seen so far, I would not see anything that would tell me that you would need to do anything differently unless you chose to do something differently. If you were like, I don't want to keep my breast, then that's a different story and that's a very personal decision. Right. And that is an option for you if you want to consider it. But if you decided that you wanted to have a partial mastectomy or a lumpectomy, and this is a perfect scenario to consider doing that, then radiation would also be part of your treatment in the postoperative setting. Okay. Radiation is usually Monday through Friday, and it's usually for anywhere between four to six weeks, depending on what the radiation oncologist believes your dosing and everything should be. Pretty easy to do radiation. It only takes about 15 minutes. So even though you're having to come and get radiation every day, it's usually a very short time frame that you're actually having to be here. Now, what part of this area do you all live? We live in Sevierville, but closer to Seymour. Okay. So we're not far. Okay. So we have radiation in Sevierville. So if you have the lumpectomy and you decide you want to do radiation closer to home, then we can always get you set up with our physicians up in Sevierville. I think it's Dr. Townsend. Is that correct? Yes. So Dr. Townsend would be the one that we would set you up with. Okay. So, yes, when we get you set up to see Dr. Wilson, she will talk to you then about your surgical options. I'm going to ask her if she can order this oncotype test for us because I would like to see you back probably about three to four weeks in the post-operative setting because that means that we'll have those results, we'll have your menopausal status, and we'll be able to then talk to you about your systemic treatment plan as to whether or not chemotherapy would be recommended or we can just press on and go into hormonal blocking therapy. Okay. And as far as radiation, that is a for sure thing that's going to happen? If you have a lumpectomy, yes. Okay. And it happens, does it start immediately after surgery? Radiation is about four to six weeks after surgery unless you require chemotherapy. If you require chemotherapy based on your oncotype testing, chemotherapy would come before radiation, and that, again, is usually about four to six weeks after you have your surgery. Okay. So the scenario would be if we do go down the path of chemo, surgery, chemo, radiation, and then hormonal blocking therapy after the radiation. Okay. If you don't require chemotherapy, it's going to be surgery, radiation, and then hormonal blocking therapy after that. Okay. And none of that would start until, like, four to six weeks post-op? Exactly. Okay. So I want to make sure I understand the timeline. Yes. Okay. Yes. Okay. What else can I help you all with today? The surgery time, that would be dependent on Dr. Wilson, not necessarily from you. Her surgery timing and type of surgery? Yes, ma'am. Yes, so the timing will, of course, be dependent on Dr. Wilson, but the type of surgery is going to be a shared discussion between you and Dr. Wilson about what you would like to have done. Okay. You know, based on what she believes your cosmetic outcome would be if you decided to have a partial based on the location of where this is and those types of things. Okay. But, yes, that would be a shared decision for you all to talk with her about what you would like to do as it relates to whether or not you want to try to keep your breast tissue or whether or not you want to have a complete mastectomy, meaning have all of your breast tissue removed. Okay. Okay. But, again, early stage breast cancer, good prognostics, you definitely, from my standpoint, again, I'm not the surgeon, but from my standpoint, would be a great candidate to do a partial. Okay. With radiation. Okay. Okay. All right. It's a lot to process. It is a lot to process. It is a lot to process, but you know what? We are here to help answer any questions, so if you leave here today and you have any questions about what we have talked about so far, please do not hesitate to pick up the phone and call us. Okay. Okay. I am tentatively going to put you on the schedule to come back and see me in about six weeks. Okay. Just so that I can already have an appointment set up and ready for you to go. If Dr. Wilson is able to get you in for surgery, you know, sooner than that, I just need to see you at least in the four-week post-operative setting. Okay. Okay. But I'm going to give her a couple weeks time frame to get everything set up since you're not probably going to see her until, I think she said she could see you on Friday. Okay. So, everything set up for that, and I'm going to go ahead and tentatively put you down for six weeks, but if it changes and she's going to be able to operate on you and you need to come back at a four-week time frame, just please call and let us know and we'll make the adjustment to that. Okay. Now, will she contact me for that appointment or her office contact me for that appointment for Dr. Wilson? Yeah. So, we need to do the referral to Dr. Wilson. Yeah. And I'll make sure that she knows that and that you're good seeing her on Friday. Absolutely. I'll text her. Okay. I'll text her on Friday at 11 o'clock, but we'll go ahead and make the official referral. If, for some reason, you have not heard from her office, what is today, Tuesday? If, for some reason, you've not heard from her office by Thursday, please call us. Okay. Okay. I will. Because, you know, even though this is all computer stuff, I get messed up every now and then. Yeah. Even the referral to you, the same thing happens. Yeah. I understand you've just kind of joined here, right? Okay. Officially? I am officially now here, your patient number seven. Okay. I thought it was the first day. First day. I mean, obviously, I know you have a long standing history. Yeah. I've been at UT for the last 22 years. I'm doing mostly breast is what I do. But I got a great opportunity from Covenant Health to become their medical director for oncology. Wow. I'm honored to be on your first day. Thank you so much. I'm one of those offers that I just couldn't refuse. Yeah. Fantastic. Yeah. Absolutely. Yeah. So, again, I know we haven't talked about everything today, but I think it's going to be a great day. Great. That's what I needed to know. Okay. All righty. And then I do want to draw your blood work today. Okay. And I do want to do a breast exam on you. Okay. Okay. So, what we will do is Chelsea will bring you your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay. And then I do want to draw your blood work today. Okay.