Background (TMI for some…):
In early November-ish, I noticed a firmer-than-normal lump in my left breast. I had mastitis on the left side back in 2005 and that breast had been a full cup size larger than the other since. Plus, I was naturally somewhat lumpy due to the type and amount of breast tissue in the old double Ds… I waited a couple weeks to make an appointment because my breast lumpiness waxes and wanes substantially with my menstrual cycle (see what I mean about TMI…?) and I wanted to make sure it was something. I was due for my annual physical, so I got the first appointment with my doc, which was 4 weeks out. It’s been a whirlwind of medical appointments since then…
I was scheduled for a diagnostic mammogram on Monday, Dec. 21, which turned into a diagnostic ultrasound, which was followed by a core needle biopsy to determine what the hell this mass was. It was large (7cm, I know how to grow ’em big!). I was told I wouldn’t get results from pathology until the following Monday due to the holiday, but they called on Wednesday, Dec. 23 to give me the results (Happy Festivus…talk about airing grievances!). The official diagnosis was invasive metaplastic carcinoma, squamous cell sub-type. Leave it to me to have something so unique (less than 1% of breast cancers are metaplastic). It’s aggressive, fast-growing, and not very well-researched. It also isn’t generally as responsive to many of the typical BC treatments. I will write up something with some MBC facts in a different post (I discourage people from going to the interwebs for info…not much good can come from it!). Not knowing much more than that basic info, and not wanting to Google MBC and get crappy/scary intel, I wanted to at least wait until we got more info from the docs before talking to people (and also didn’t want to ruin anyone’s Xmas…). That left 4-5 days for Kevin and I to grapple with the info, cry, think about worst case scenarios, laugh a little when we could, and come up with lots of what-ifs while we waited to meet with the surgical oncologist.
Meeting with the surgical oncologist, Dr. Jennifer Steiman:
We met with the surgical oncologist on Monday, Dec 28. It was very valuable both in terms of getting more information and being a tremendous mood booster…we had the beginnings of a plan to kick cancer’s ass, and that’s no small thing when you’ve been hit over the head with this diagnosis. The appointment was three hours and we packed a lot in, discussing general breast cancer facts, surgical options, chemo, radiation, breast reconstruction, genetic considerations, and oh so much more. The full pathology wasn’t back at this point, so there were still some holes in the diagnosis that we would have to wait to find out. Still, I felt a lot better with the knowledge we gained even if it was a mixed bag of good and bad. We’d still have to meet with other specialists and have some more tests performed, but had a tentative plan to do a mastectomy (likely bilateral, verdict is still out), chemo, and radiation, followed by delayed reconstruction. The plan is to hit this bitch hard and fast since it’s aggressive and big, kind of like the school bully of cancers (grrrrr….).
What we don’t know yet:
I had genetics testing done last week and should get results next week. It’s a standard recommendation for any BC that develops before age 45. There is no history of breast cancer on either side of my family, so there may be no genetic component or I could have a gene with a more recent mutation. If I have one of the known BC genes, or even if it’s just an abnormality on a different gene (the panel tests 25 typical locations), it would cement the decision to remove the right breast as well as yank my ovaries (good thing I had a perfect kid the first time around!). It will shed some light on things either way and, if there is something there, give the ladies in my family a potential early warning to think about enhanced screening down the road.
The big question now is whether or not the cancer has hitched a ride outside my boob. This would most likely happen through the lymph system, so they need to rule that out by looking at the lymph nodes in my underarm area to see if there is ‘axillary involvement’ with the sentinel node (the primary node that removes fluid from within the breast, kind of like a plumbing drain trap…if there’s cancer in the lymph system, it will be seen here first). They did not suspect nodal involvement (so many new vocabulary words!) after initial palpation, mammogram, and ultrasound, but there was one little bugger that seemed a bit off when the surgical oncologist felt me up (the ladies are getting lots of action these days!). It was a week after the breast biopsy, though, and that boob was still super angry and swollen (two large hematomas will do that…), so there’s a good chance that particular lymph node was just responding to all that inflammatory business. I had a contrast MRI yesterday (Jan. 5) that showed some additional areas of abnormality in both breasts, including the lymph nodes on the left side, but not necessarily of concern. It will give them a jumping off point when they do the ultrasound and lymph node biopsy today (Jan. 6).
The treatment schedule is still up in the air. No matter what, they are likely going to hit me with everything they have in their arsenal (surgery, chemo, radiation) and hope for the best. I am not a candidate for hormone therapy because my cancer is triple-negative (meaning it does not have receptors for estrogen, progesterone, or HER-2, which can be blocked by anti-hormone drugs if present to slow/stop/prevent tumor growth following other types of treatment). If there ends up being nodal involvement, a couple rounds of chemo will likely come before the mastectomy to see if the tumor and other cancer sites will respond and shrink. Otherwise, there will likely be a mastectomy first, followed by a few months of chemo, then a few weeks of daily radiation treatment to round out the trifecta.
Breast reconstruction will be delayed, mostly due to the radiation treatment. Reconstruction is a bit more limited with a full mastectomy, but I’ll meet with a plastic surgeon next week to discuss options (implants, muscle flap, or fat tissue). The surgical oncologist asked if I wanted to try and regain the same cup size I have currently and I’m like OH HELL NO…this is my one shot at a free breast reduction and I’m taking it. Honestly, not thinking about this aspect too much right now, just concentrating on getting the cancer OUT!
That’s the basic low-down. I’ll update as we know more, and I figure out how the heck this blogging thing works (holler if you can help me with this, I’m a little lost out here in WordPress land…). We’re starting to come down from the initial shock and it’s not on my mind every minute like it was in the beginning (man, this shit can be all consuming if you let it get in and fester…trying very hard not to!). Also pretty positive and optimistic at this point (don’t really have a choice…gotta keep living and can’t do that if I’m feeling sorry for myself all the damn time!). I’m gonna fight, smile and laugh as often as I can, and enjoy life no matter what comes at me. Some days are going to be easier and some harder, and I’ll need support of all kinds, but feeling so very fortunate in many ways. I’ve got lots of family and friends to help me out on this journey, I’m stubborn as hell and this cancer is going to find that shit out right quick, I have a supportive and flexible work environment (with sick leave and health insurance…Jesus, I can’t imagine going through this and having to worry about the financial side of things on top of everything else!), plus the love of a good man and an amazing daughter. I’m a lucky gal 🙂
Peace and love,