Friday, February 29, 2008

Finally some good news!

Biopsies on Sons of Chucky are negative for cancer! Just clean, healthy breast tissue with a little bit of healthy lymph node along for the ride. Great news! (note this doesn't mean I don't have cancer, it's still confirmed in Chucky, but at least it may not be spreading) Must run, will post again soon.

Wednesday, February 27, 2008

New treatment plan coming together

Biopsies of 2 Sons of Chucky successfully completed yesterday, one on each side. These were deeper lesions than the biopsy of Chucky (main lump), which is right at the surface, so were somewhat more of an ordeal. Imagine someone poking a needle the size of a mechanical pencil into your fleshy parts. On second thought, don’t imagine it because it’s not very fun, but at least I was well numbed up for it. The sampling of each mass basically removed them due to their small size. Of course this was not a surgical removal so some cells still remain. Biggest problem was my iPod running out of battery just on the way to the appointment, so my plan to listen to a Harry Potter e-book and zone out during the procedure was thwarted. (I blame Steve Jobs. Any of my lawyer friends want to sue him for me?) Felt quite worn out afterwards, and freaked out when one of the wounds started bleeding a few hours later, but that stopped with some pressure and it’s okay now, though bruised. Results due in a few days.

Significant news is that today when I was in the oncologist’s office getting blood drawn for some tests she asked to talk to me. She spoke with my surgeon yesterday and they concur on a new treatment plan, which is to do chemo first and when that’s finished, have the surgery. The advantages of doing chemo first are:
- Quickly start systemic treatment to eradicate any cancer throughout the body, regardless of what we find through various biopsies and scans.
- Keeping Chucky in actually provides a feedback mechanism to see if the chemo is working. If Chucky gets smaller from session to session, we keep going. If it doesn’t shrink, then we know that particular type of chemo isn’t working on me so I don’t have to go through the whole course of it unnecessarily. If Chucky was removed, we’d have to hope / assume the chemo was working and do all 8 sessions no matter what.
- This will give us plenty of time to get the results of all possible tests, including the 6 weeks needed for genetic results, which may impact the decision of lumpectomy vs. mastectomy – single or double. The surgery decision can then be made without rushing into things.
- If mastectomy is required, allows plenty of time to identify a plastic surgeon I would prefer to do the reconstructive surgery at the same time as the mastectomy. Obviously this requires a bit of coordination of schedules at the very least.
- If lumpectomy is still the plan in the end, it will be much easier for the surgeon to remove the small lump and leaves more tissue behind for me.
- And they only had a limited time offer on the cherry flavored chemo drugs.

Since this was new news, we didn’t make the final decision today so I would have a chance to talk to Colin and let it sink in. However my oncologist is recommending I start the chemo the week of March 10th so things are moving quickly. Now I’m feeling really sad about losing my hair in the imminent future and looking at ugly wig and hair wrap catalogs that in no way resemble my own copper tresses. But knowing a plan is in place at least provides us a future around which to plan.

Coming soon: what you can do to help

Monday, February 25, 2008

Stop this bus, I want to get off! Caution: depressing visit synopsis ahead.

First visit with the oncologist today. When is one of these visits going to yield good news?!?! She said due to the size of Chucky and my triple negative hormone receptor status, she is 99% sure I need chemo. And if it turns out that at least one of those additional suspicious masses is cancerous too, you can round that up to about 1000% sure I need the “most aggressive” chemo, plus am buying a one-way ticket to loosing a boob or two. Good gravy, I am too young for this shit. Aarghh!

OK, cussing in a blog doesn’t cure cancer. Let’s move on. The chemo would be 8 sessions, each 2 weeks apart, so about 4 months of it all up. There’s a 30% chance I’ll go into menopause after, maybe permanently. I said I want to do as much as possible to learn whether is has spread or whether I am more susceptible for this to spread in the future. So I get to do blood work plus CT scan and bone scan to look for cancer elsewhere in the body. I’ll also give more blood for genetic testing to determine if I carry the BRCA1 or BRCA2 genes. This test will take 4-6 weeks. If I do have those genes, not only is the risk of recurrence higher, but the women in my family can act on this information as well.

Meanwhile, we keep moving ahead with the series of biopsies and MRIs so we know what we’re dealing with in those little masses.

The silver lining to today’s appointment was the oncologist, herself. She was very patient and down-to-earth, and explained things to Colin and me quite well. She went through a myriad of options based on the outcomes of tests, the order of treatments and the surgery schedule. (Still up in the air is whether to do surgery or chemo first.) She said that from now on she will take the role of coordinating all the various tests and treatments, which is a relief for me as I really wanted to feel like there was one person who was looking after both the big and little picture.

Friday, February 22, 2008

Another Day, Another Tumor

Alas, dear reader, I wish I had good news out of today’s ultrasound, but I don’t. From the MRI, they had identified 4 small masses that they wanted examined further. The first step of this plan was to look for them via ultrasound, to see if they can be biopsied this way, as this is easier on the patient. They believe they found 2 of the masses on ultrasound, one on each breast. Neither appears to be a cyst (boo!), and both are now scheduled to be biopsied with the assistance of ultrasound (to help them locate the mass) on Tuesday. From eyeballing it, the radiologist is thinking the one on the left, about 3 cm away from the known large tumor, also looks cancerous. She thinks the one on the right may be benign. But we won’t know this for sure until the biopsy results come in later next week. They also found a 3rd mass on the left side which they think is a “satellite” of the main tumor, but this didn’t concern them particularly because it will be removed with the surgery, so doesn’t require biopsy.

Each doctor visit seems to lead to multiple additional tests required, and this was no exception. When the 2 new masses are biopsied, they will place a small metal pin in them to mark the location. Later, I will have another MRI to check the location of the 2 pins. This will be compared to the original MRI image to see if the masses found and sampled are indeed the ones identified as questionable on the first MRI. Then, assuming the masses found on the first MRI but not by ultrasound are still looking suspicious, I will probably have to have those biopsied while in the MRI machine for a 3rd time. Fun!

Updates to surgical plan are pending results of all this fun and games.

Thursday, February 21, 2008

Diagnosis summary

As the diagnosis is ongoing I'll use this space to give a summary of known diagnostics.

Diagnosis (from original 2/12 biopsy):
"Invasive poorly differentiated ductal carninoma with extensive necrosis"
Medical to English translation of this, as best as I know it, is:
Invasive = it's cancer
Poorly differentiated = cells are very different from normal cells (this is bad)
Ductal = in the ducts
Carcinoma = a tumor
Extensive necrosis = it's big

Stage 2, due to tumor size. Dimensions, based on ultrasound, is 3.3 cm x 2.5 cm x 1.8 cm. No spread to elsewhere in the body. (No lymph node involvement, no metastasis)

Hormone receptors:
All negative. (ER negative, PR negative, HER-2/neu negative)

Here are some explanatory comments on this stuff helpfully emailed by my friend Kathleen, M.D.:
"If the biopsy were HER-2/neu positive, the cancer cells would carry a gene that makes it faster growing with more resistance to chemotherapy and more likely to recur. That's great that it's negative. If the tumor were positive for being hormone-receptive, you might be able to take medicines to help stop it, but you also might have to go into premature menopause to decrease estrogen production. I think hot flashes at our age would irritating.
"Also I was reading up more on the grade - poorly-differentiated, and while that is not great in some ways, it does mean that the tumor might be more affected by radiation or chemo because it is growing quickly. The reason some people get mouth sores or lose hair with chemo is because those are fast-growing cells, so they are the first to go. This can be true with poorly-differentiated tumors too."

Background Info:
I am 36 years old and there is no history of breast cancer in my family.

Wednesday, February 20, 2008

Help fill my Netflix Queue! What are your favorite funny movies?

Laughter is the best medicine... so speed my post-surgery recovery by telling me what are your all-time favorite comedies. This will give me something to look forward to while I lie around the house on painkillers.

Tuesday, February 19, 2008

MRI results (originally emailed 2/19)

Overall, I'm still reeling from the cancer news. It's awful, but I'm trying to keep up a good attitude, and still be there for the people who need me, my family. The kids don't know, of course, so they still expect as much from their mommy as ever. Meanwhile I'm finding myself especially tired and needing lots of extra sleep, though I don't know if I can attribute that to the disease, the mental exhaustion of dealing with the news, the fact that I have 3 little needy and energetic kids, or what. Having now had umpteen "I've got cancer" conversations with people, I've already become numb to describing the situation, and can do it without tears. Everyone I've spoken to both at work and in my home life has been amazingly supportive, so that is very nice. I've even had two wonderful neighbors show up on my doorstep with dinner (two different days, luckily!), great to have one less thing to worry about when I get home in the evening.

A few updates:
- I had an MRI of both breasts on Sunday morning. Colin went with me. I got a sedative for claustrophobia and got to go feet first (and face down) into the machine. Being face down, similar to being on a massage table with a hole for the face, I could see a mirror placed below the face pad which allowed me to see the technicians in their room, and a digital clock which timed down how long each image took, usually 3 to 8 minutes. Then I returned home and slept for 6 more hours.
- This evening I received a call from my surgeon with the MRI results. It wasn't terrific news. They found a few lesions / nodules / masses / spots / somethings on both sides that they want to look at further. They are small, 5mm or less each, so would not have been easy to see on a mammogram. The next step is to look at them in an ultrasound to determine if they appear to be more tumors, or something harmless like cysts. During the ultrasound, they may decide to take more biopsies for testing.
- The surgery (lumpectomy) is currently scheduled for Monday, March 10 at the Faulkner hospital. It will be outpatient surgery, and I expect it to last several hours. However if we do the additional biopsies and get bad news from that, it could change the surgery plan to push out the schedule and potentially change from lumpectomy to something bigger. I told my surgeon that I really wanted to get the big lump out quickly, but she cautioned me that it's better to get the right information up front so they can do an accurate job getting it all out the first time.
- One piece of good news today, is that test results from my first biopsy show it is (or possibly I am?) HER-2/neu negative. Those that are positive for that particular element tend to have more recurrence. The tumor also tested negative for being hormone reactive, so I believe this means I will not be taking pharmaceuticals as a long-term treatment following the surgery and other procedures.

I'm continuing to read up as I learn each new piece of information and plan how to attack this. I'll keep you updated as I know more.

Thursday, February 14, 2008

First Surgical Consult (originally emailed 2/14)

I had my surgical consult this morning. The surgeon's initial recommendation is to have a lumpectomy (i.e. just remove the lump but not the whole breast) followed by 6 weeks of radiation. My lump is 3.4 cm, which categorizes me for Stage 2 cancer. I'm still awaiting more tests for additional information. Also, during the surgery itself there will be further testing to see if the cancer has spread to the lymph nodes (if it has, this will very likely require chemo); while this came back negative in the test I had Tuesday, that was of a small tissue sample so it's still possible that it's there.

Current next steps:

1) Get MRI of both breasts. This is scheduled for 6:40 a.m. (geez!!) on Sunday, Feb. 17 at the Brigham & Womens hospital.
2) Schedule surgery for removal of the lump. This is expected in the next few weeks.
3) Appointment with a genetic counselor / oncologist to get blood test for breast cancer genes.

Thank you for all your best wishes and prayers.
Love, Martha