Surgical Consult Today

Rather than sending mass emails, as this is going to be an ongoing journey/battle/stage/insert cheesy phrase here, I decided that a blog might be the best way to keep those who care about me informed.  Feel free to subscribe to stay up-to-date, or not.  But, as I've already learned just in the past few weeks, this is a step-wise process and plan that every time I get another "answer" another question is waiting around the corner. My patience (and that of my friends and family) will definitely be tried.  I'll post the story to this point later on.

We (my mom and I) met with the surgical oncologist today.  This was a follow-up appointment to the biopsy performed last week.  I received most of the biopsy results last Friday via phone.  I was hopeful, as the skin punch (taken because inflammatory cancer, the most aggressive, was suspected) came back negative for cancer.  The lymph node sample came back as "atypical" (not positive, not negative), and the core sample from the mass in the breast (affectionately called Big Bertha) was positive for cancer.

The cancer is invasive ductal carcinoma.  Invasive meaning it had spread out of the milk duct, ductal for that being the site of origin.  The tumor itself is a grade 2 (out of 3).  The sample is positive for estrogen and progesterone receptors, meaning it feeds off of estrogen and progesterone hormones.  This is typically "good" as these can then be targets for treatment.  Also, the Ki-67 rate of proliferation, or growth, is very high, so not as good.  Clinically, the mass is quite large.  Taken together, while it isn't inflammatory cancer, per se, it is an aggressive cancer and therefore will need agressive treatment.  The surgeon stated that despite the atypical lymph node result, given the imaging and the fact they are palpable, she thinks that it should be treated as the cancer is already there.  The surgical oncologist staged it as stage 3B (on a range of 0-4).

The recommendation is neoadjuvant (fancy word meaning "before surgery") chemotherapy.  I will meet with a medical oncologist to plan and discuss this out.  This should happen within next week or so after we get the pathology results of the HER2 protein test from the biopsy sample.  If it is positive for this, it is more aggressive, but then again, treatment will be specifically targeted.  Chemo could start within a week of this appointment.  The chemo is needed 1) to shrink the tumor as it is too large to remove with good margins in the current state; 2) the kill any cancer cells that may be spreading/ready to spread; 3) to hopefully prevent reoccurance/relapse.  Chemo will last 3-4 months and then I'll have surgery.  We won't know what the surgery exactly entails (lumpectomy vs mastectomy) until my response to the chemo is seen.  I'm also getting some genetic testing done to determine overall risk.  Surgery will occur 3-4 weeks after chemo.  Radiation will need to follow the surgery.

In the meantime, I'll get an MRI to better image the breasts and a full-body PET scan to see if there are any other places where it may have already spread.  As of right now, my mom will stay here until this next appointment.  

Think that's about it for now.  Another wait for results, more appointments, etc.  Something that I'll have to get used to.   Classes start next week.  I meet with my chair tomorrow but will plan on trying to keep life as "normal" as possible throughout chemo.  Hopefully surgery may be able to fall over winter break to allow for some recovery (maybe in Arizona!?!) before the new year.

Overall, I'm doing ok.  As you can probably see, trying to focus on the concrete (test results, etc).  It's all quite a shock, but yes, it could be worse, and there are things that I have going for me (age, overall health, etc).  Thank you all SO much for your continued love and support!