Yesterday, I saw my oncologist for one of my every-three-month follow-up visits. As always, I went armed with my list of questions -- which is really my list of worries -- and one by one, I rattled them off. On a little sticky note, I had written:

• Lymph node
  
• Digital mammogram
  
• Next MRI
  
• Heart
  
• Colonoscopy

And this is what my doctor had to say about my concerns of the day:

Women with hormone receptor-positive breast cancer who have negative lymph nodes can take advantage of a test known as OncotypeDX. This test is used to estimate the risk of cancer recurrence in women diagnosed with early stage breast cancer. Results presented at the 2007 annual meeting of the American Society of Clinical Oncology said that the test results changed the oncologist's treatment decisions in about 31 percent of cases.

The test is useful in determining which patients are likely to benefit from chemotherapy in addition to hormonal therapy. It can predict the risk of a patient experiencing a recurrence up to ten years following diagnosis. The patient receives a Recurrence Score that ranges from 0 to 100, the higher the score -- the greater risk of recurrence.

This a great way for oncologists to be able to give individualized treatment -- instead of one size fits all. It's important to get chemotherapy if needed but physicians don't want to over-treat and have the unnecessary risk of side effects from chemotherapy treatment if it's not warranted.

What is a sentinel lymph node?

www.breastcancer.org explains it well:

The dictionary defines "sentinel" as a guard, watchdog, or protector. Likewise, the sentinel lymph node is the first node "standing guard" for your breast. In sentinel lymph node dissection, the surgeon looks for the very first lymph node that filters fluid draining away from the area of the breast that contained the breast cancer. If cancer cells are breaking away from the tumor and traveling away from your breast via the lymph system, the sentinel lymph node is more likely than other lymph nodes to contain cancer.

When I was diagnosed with breast cancer my head was spinning when my surgeon offered me to participate in a clinical trial. The trial would put women in two groups. One would have just the sentinel node removal and the other group would have a full axillary dissection.

Mantle cell lymphoma is a type of Non-Hodgkins lymphoma. It is a cancer that forms in the cells of the lymph system. Mantle cell lymphoma is considered to be a low-grade and slow growing lymphoma.

The standard of care treatment is usually the chemotherapy combination called MCP, mitoxantrone, chlorambucil, and prednisolone.

The Journal of Clinical Oncology says that the addition of Rituxan (rituximab) to the chemo combination of MCP as initial therapy can improve long term survival rates.

Since Rituxan has proved to have anti-cancer responses in other forms of NHL, researchers continue to evaluate how it can work in the treatment of various types of Non-Hodgkins lymphoma.

Surgeons will normally remove the lymph nodes during surgery when a patient has Stage II or Stage III colon cancer. These stages refer to colon cancer that has penetrated the colon and entered the abdominal cavity. There may be spread of the cancer to local lymph nodes that need to be removed and biopsied.

An article published in the Journal of the National Cancer Institute says that patients have improved survival when a greater number of lymph nodes are removed during surgery. Patients have anywhere from six to forty lymph nodes removed and evaluated. The question is -- What is the optimal number of lymph nodes to remove and evaluate?

A clinical study was conducted that involved nearly 62,000 patients. The researchers concluded that patients with Stage II or III colon cancer had significantly improved survival when more lymph nodes were removed.

The author of the study stated "These results support consideration of the number of lymph nodes evaluated as a measure of quality of colon care."

An analysis of data from SEER, Surveillance, Epidemiology and End Results Program, shows that a common staging procedure given to patients diagnosed with Stage I non-clear cell ovarian cancer will live longer than those not going through the same procedure.

The procedure is called lymphadenectomy, meaning the removal of the lymph nodes during surgery to remove the cancer. Standard therapy is supposed to include lymph node removal but many of the women diagnosed with early stage disease fail to undergo a complete staging procedure.

Information on 6,686 records of women with Stage I invasive ovarian cancer diagnosed between 1988 and 2001 was analyzed. Overall, five year survival was 92.6 percent for those who underwent removal of lymph nodes versus 87 percent for those who did not have the nodes removed during surgery.

Scientists from Harvard University and Massachusetts Institute of Technology (MIT) are developing a tiny implant that will allow doctors to see what's happening with tumors from the inside out.

If all proceeds according to plan, doctors will one day be implanting tiny sensors inside tumors to determine whether or not cancer drugs are shrinking the tumors. The sensors will also determine whether or not tumors are growing.

Cancer specialists have long wished for better methods of measuring the success of drugs. While blood tests can show if a drug has reached the bloodstream, they don't reveal much about the tumor itself. This small silicone cube, no bigger than two millimeters on each side and embedded in a tumor or lymph node, would remain in the body throughout treatment while essentially broadcasting what's going on inside the tumor.

MIT scientists hope to begin animal experiments within months. Their goal is to one day make the implant as thin as the pieces of led used in mechanical pencils.

This research, funded by the National Cancer Institute, is part of a long-term project to make medical technologies that will cure cancer. It's all part of journey toward complete targeted cancer treatment. And this little implant will have the power to communicate whether or not these treatments are working.

Touch imprint cytology (TIC) lymph node assessment during breast cancer surgery could prove to have advantages over the current standard lymph node assessment. TIC can be important to the breast cancer patient because usually the results from the lymph node dissection can take up to a week. It causes a lot of anxiety and stress waiting to find out if the breast cancer has metastasized to the lymph nodes. TIC would provide immediate results during the sentinel node extraction.

An economic assessment that was published in the November 15, 2006 issue of Cancer says TIC is less costly than standard lymph node assessment. They studied the cost effectiveness of the two techniques and found that especially in larger tumors TIC is more effective.

I will visit my oncologist on Monday for my every-three-month check-up. It's the recurring appointment that will appear on my calendar until I hit the five-year-survival milestone. I am three years away.

It's the appointment that consumes at least half of my day due to endless waiting -- waiting for a parking spot, waiting in the lobby, waiting in the exam room, waiting to pay. It's the appointment that officially begins with the drawing of my blood for lab work, continues with a check of my vitals, proceeds with a history review and physical exam with a medical student. It's the appointment that brings me face to face with the man who prescribed my treatment, the man who offers me strategies for living beyond treatment, the man who helps keep me alive. My oncologist.

And so I am preparing for this visit in the same exact way as I always do. I set aside a large chunk of time for this time-consuming extravaganza. I think a lot about the lab work and wonder if something suspicious will surface. I think a lot about the physical exam and wonder if an enlarged lymph node or mass in my breast will be discovered. And I think a lot about what I want to ask -- because this is my only very own allotted time for unraveling the mysteries of cancer with the man who knows the topic like no one else I know.

On Monday, I will ask a few questions. I will ask about tumor markers, about why I am not tested for these indicators of tumor growth, a standard option for my co-writer and co-cancer survivor Kristina Collins. I will ask about Zoloft, about how long I should continue taking this anti-depressant and how to best wean myself from this drug when the time comes. I will ask about the flu shot, about whether or not I can get one during this same appointment.

And that's all. For now. Until three more months pass and my calendar tells me it's time to return for this recurring appointment that takes me closer to the five-year mark.

Just two months after her mother lost her battle with gall bladder cancer, Liane was diagnosed with breast cancer. It all happened earlier this year -- and while Liane is still mourning the loss of her mother, she is also still managing the madness of her own disease. Liane is surviving with courage, with determination, with the same powerful spirit that powered her mother's fight.

Liane lives in a small city -- population 43,000 -- in northern Alberta Canada. She has been happily married for 18 years and has two daughters, ages 13 and 15, and a golden retriever named Sunny. Liane loves to garden, cook, read, and spend time with family. She normally works full-time in a real estate and property management office but has been blessed with six months off for treatment. Liane is already -- without a doubt -- a survivor.

Kim Taylor is a 45-year-old single mother who lives in Suwannee County, Florida and is proud to have successfully raised one daughter -- a graduate of the University of Florida. Kim enjoys outdoor activities like camping as well as sewing, crafting, and carpentry projects. She is most at peace spending time with her family, working as a youth volunteer -- and raising awareness for breast cancer. It's a interest she acquired just two years ago, compliments of a personal encounter with the disease that has taught her to let the little things go, to appreciate every sunrise, to make every moment matter.

Melanoma patients that have a intermediate-thickness, 1.2mm - 3.5mm size tumor, should receive a lymph node dissection and sentinel biopsy at the same time the tumor is removed.

The results of a clinical trial showed that survival was significantly improved in patients that had the nodes removed at initial surgery than those that waited and had lymph node enlargement appear later. Melanoma tumors in the lymph nodes are important to find before they become clinically detectable. The lymph node staging process can help determine the treatment that is needed.

The clinical trial called Multicenter Selective Lymphadenectomy Trial (MSLT) reported the interim results to the New England Journal of Medicine. Patients were put into two groups for the clinical trial. The first group with intermediate-thickness melanoma was given a wide excision and sentinel node biopsy and the second group was given a wide excision and nodal observation. The group with the sentinel node biopsy ended up having smaller metastasis in the nodes than those that only were observed. It showed that those who waited for clinical enlargement of lymph nodes to have them removed and analyzed had further disease progression in the nodes and lesser survival rates.

Dr. Balch, from Johns Hopkins Medical Institutions in Baltimore, and Dr. Cascinelli, from the National Tumor Institute in Milan say that the results of the trial "convincingly show that sentinel node biopsy is a standard of care staging procedure and is justified in patients with melanoma with tumor thickness of 1.2 to 3.5 mm"

Gastric cancer staging by lymph node sampling has a profound effect on patient survival. Survival of patients with gastric cancer can be compromised if the staging is done inadequately. This can happen if too few lymph nodes are removed and analyzed.

A study in an issue of Cancer, a peer-review journal of the American Cancer Society revealed that less than one third of gastric cancer patients had adequate lymph node assessments (ALNA). There was a change in the guidelines of the staging system for gastric cancer in 1997 but since then only minimal improvements have been made.

Compliance with the new guidelines remains poor because the lymph nodes removed and sampled since the change in the guidelines only increased from 9 nodes to 10. The guidelines now say that 15 lymph nodes removed and analyzed should be the standard. The lymph nodes that are tested will show how far the cancer has spread. If you do not have the correct information that the lymph node sampling can provide it can cause the patient to receive incorrect treatments and less survival rates.

Researchers in Spain conducted a study among 1606 women with node-negative breast cancer. The results were published in the Annals of Oncology. What the researchers wanted to find out is whether the number of lymph nodes removed during axillary lymph node dissection influences risk of recurrence. Axillary lymph node sampling is a necessary procedure to stage a patient diagnosed with breast cancer. Women who underwent sentinel lymph node biopsy were not included in the study.

The researchers discovered that there was an increased risk of local breast cancer recurrence if fewer than six lymph nodes were removed. If the surgeon removes less than six lymph nodes there is a risk that other lymph nodes that could contain cancer can be missed. This can result in under staging and the patient not receiving the correct treatment plan.

In order to be confident that the patient does indeed have node negative breast cancer it is important to remove at least six lymph nodes for evaluation.