Monday, January 18, 2016

A Plan. Of sorts.

I find myself wondering what to share here.  Do I share all?  Do I stay a bit vague on the details and only cover the main events?  Surgery, etc.?  There are benefits to both but, in the end, if someone stumbles upon this blog who is just beginning to fight breast cancer, I guess I'd rather them have my whole experience instead of a diluted version. 

So, here we are then.

After my initial diagnosis of breast cancer last week, I was referred to the Breast Cancer Multispecialty Team (MST) for treatment.  Frankly, I knew going into the appointments that my cancer is aggressive.  The pathology report for my biopsies finally posted early this morning and, so, I read it before going to the MST session.  If you're going through this right now, you'll have to decide for yourself whether or not you want to read reports before meeting with your doctors.  You know better than anyone else whether you'll benefit from it or be harmed. 

Don't listen to anyone else; make your own decision.

For me, if there is a chance it will be bad news, I'd like to read it, digest it, and perhaps get sick from it in private than sitting in front of another human being.  But that's me.

So I knew that my cancer is aggressive.  I joke that since I excel at so many things (Ha!), I should have expected my cancer to excel as well.  Now, I know my joking is a coping mechanism.  And I'll continue to joke for as long as possible.  Forgive me if it offends you.  But I really don't give a damn.

Because my cancer is aggressive, I'm on a priority list for surgery.  So my surgery will likely be within the next 2-3 weeks.  The grading of my cancer is a 3 on a scale of 1 to 3 with 1 being slightly abnormal and 3 being  ... really fucked up.  The pathology also tests whether the cancer is responsive to estrogen or progesterone.  If it is positive for that, then there are medications that have proven effective for helping fight against any reoccurrence.  Mine is negative for both.  Mine is also negative for a protein called HER2.  So my cancer is a triple negative invasive ductal carcinoma. 

Alas - this apparently is quite different than being a triple crown winner.  But, in a way, it is just another tool for the doctors to use to determine the best treatment. 

Which brings me to the plan:

This week, I'll be getting a chest x-ray, which is a fairly standard pre-operative test.  I'll also see my regular primary care doctor for pre-operative approval. 

Next week, I'll be getting at least two more biopsies.  I mentioned my pathology report above.  I also got the results of the lovely hang-loose breast MRI.  Along with measuring my tumor - it is anywhere between 11 and 15 mm depending on the test you read: the MRI has it at 13 mm - the MRI showed a questionable area immediately above my tumor that may be DCIS - ductal carcinoma in situs - basically, cells that would be invasive cancer IF they broke out of the duct.  It is sometimes called Stage 0 cancer.  The MRI also showed two small questionable areas on the bottom outside of both breasts. 

So, next Monday, I will be getting each of those two small areas biopsied.  If they come back negative for cancer - remember that MRIs can show things that look like cancer but are not - then I will be receiving a lumpectomy of my left breast, i.e., the surgeon will remove the tumor and a few lymph nodes (to double check those).  Before that surgery, the doctor wants a biopsy of that area above my tumor in order to determine exactly how much tissue needs to be removed.

If, however, those first two biopsies next week come back positive for cancer, I will be having a double mastectomy, the removal of both of my breasts.  Again, this would be due to the aggressiveness of my cancer so please, if you're just beginning to deal with your own, remember that everyone is different and many things go into the decision of how best to treat breast cancer.  All I can really say about this possibility is this: 

        If I'm to lose the ones I have, I expect the new ones to be SPECTACULAR. 

The actual surgery will likely be sometime during the first two weeks of February.  Up to two weeks of recovery is expected for a lumpectomy - and it would be outpatient surgery.  I'm not sure right now about the mastectomy recovery - I'll cross that bridge if it comes.

Roughly four weeks after the surgery, I'll be starting chemotherapy.  I'll have a port installed so that the drugs can be put directly into a larger artery and I'll receive it every other week.  The good news is that my oncologist strongly urges women getting this chemo to continue to work.  She does not expect me to have nausea or other issues that would impede me from doing so.  The bad news, or at least odd and surreal news, is that I WILL be bald.  Early on in the chemotherapy, my hair will fall out over a day or two - it happens quickly apparently - and I will then struggle not to call myself Gollum. 

Seriously.  Short, bald creature with large eyes.  Just call me Sméagol. 


 My chemotherapy will last four to five months. 

And about two weeks after the last dose, I'll likely begin up to six weeks of radiation.  The radiation would take place at daily 15 minute appointments.  It is meant to make sure no stray cells of cancer remain and greatly lessens the chance of reoccurrence.

Regardless of what type of surgery I receive, the end result after chemotherapy and radiation will be this: 

My chance of reoccurrence will be between 4-6%.  When you consider that the chance of any woman in the U.S. developing breast cancer in her life is 12%, those odds sound pretty good. 

So, that's the plan.  I might be forgetting some specifics but, hey, it's been quite a day. 

Do me a favor if you've read this far.  Trust that I am strong.  Trust that I'll be fine.

I really am quite a bitch when I need to be.   

Make me laugh if you can.  It really is the best medicine.  Cause, hey, I'll be a hot mess of bald and boob jokes for most of 2016. 

In short, trust that I've got this.

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