The cancer is gone, my medical team is in agreement on that. Today is the day for decision, and frankly, I am a bit apprehensive. I am now at the brink of choosing a treatment that will assure the best outcome—that cancer (the tiny group of ne'er-do-well cells that ambushed me) will not return.
I have a medical oncologist and a radiation oncologist vying for my attention. But, science will determine who I'll be seeing on a regular basis, I'm just along for the ride. Ms. Badass takes a back seat, and waits.
Friday, November 30, 2007
Wednesday, November 28, 2007
Setting the record straight.
There is a rumor going around that I am “fighting cancer.” No way, not so. No fight, skirmish or brawl here. No rumble or roughhousing. Not even a pillow fight. For me, this is not a battle, and the vocabulary implying this is, like war, a win or lose situation simply doesn’t work for me. I have heard from, and read about, too many people that were thankful for what [surviving] cancer brought to their lives—that their lives and relationships were elevated and redirected as a result of this abrupt, unpredicted, and life-altering “gift”. Did anyone ever say that about a war?
Thursday, November 22, 2007
Giving thanks.
There is something quite wonderful that has come out of this experience. I have recently heard from four college girlfriends that I have not been in touch with for over two decades. The news of the c-word has traveled fast and they have contacted me to share their concern for my health. Though our lives have taken us in diverse directions, the thread of love and respect remained intact.
As some have come to find out, I do not take friendship lightly. I may cling (with crab-like claws) to people I have connected with and retreat when perceived expectations of loyalty and integrity are not met—my shortcoming. I offer a blanket apology to all who have stumbled blindly into that frailty.
I know I am strong, independent, and able to survive anything. AND, I am learning not to brush off lightly the loving support offered to me every day in actions and words. Today, I am exceedingly grateful for my many friends and family, past and present, distant and near. You all enrich my life.
I love you.
As some have come to find out, I do not take friendship lightly. I may cling (with crab-like claws) to people I have connected with and retreat when perceived expectations of loyalty and integrity are not met—my shortcoming. I offer a blanket apology to all who have stumbled blindly into that frailty.
I know I am strong, independent, and able to survive anything. AND, I am learning not to brush off lightly the loving support offered to me every day in actions and words. Today, I am exceedingly grateful for my many friends and family, past and present, distant and near. You all enrich my life.
I love you.
Wednesday, November 7, 2007
The saga continues…
Saw Dr. Lisa today. Negative nodes* and clear margins, no more surgery needed—all good. Terrific news…but why aren’t we celebrating yet?
Just when I thought I would have all the information needed, I learn there is another BIG piece missing. Oh yea, my recurrence score.
Frustrated with the low accuracy of the previous (and still used) risk analysis, a more conclusive lab test has become available that uses the unique gene expression profile of a person’s tumor. This is targeted for recently diagnosed, stage I or II, node-negative, and estrogen receptor-positive patients. That rings a bell. Oncotype DX is a diagnostic test performed on the tumor tissue that quantifies the likelihood that early stage invasive breast cancer will return, or recur, and assesses the benefit from chemotherapy. This test may, or may not, be covered by insurance. Bottom line is whether my tumor expresses the genes, which will put me at risk for recurrence. High risk=chemotherapy. Low risk=radiation alone. I have chosen to proceed with this test and will wait another two weeks for the results. Since radiation follows chemo, nothing else to be done at present. Needless to say, I can relax a bit knowing the cancer is out of my body and have postponed my next haircut until I meet with a medical oncologist to discuss results. Positive affirmation: low recurrence score.
*I thought of another point regarding the lymph node evaluation. Positive lymph nodes (showing cancer cells) doesn't necessarily mean there are microscopic cancer cells elsewhere in the body. And, if the lymph nodes are negative, it doesn't mean the cancer hasn't spread elsewhere, 20-30 percent have spread even with negative nodes. Sounds like a crap shoot to me. This is why we rely on examining the characteristics of the tumor (the biomarkers), and the gene expression profile of the tumor. This is all making sense, right?
Just when I thought I would have all the information needed, I learn there is another BIG piece missing. Oh yea, my recurrence score.
Frustrated with the low accuracy of the previous (and still used) risk analysis, a more conclusive lab test has become available that uses the unique gene expression profile of a person’s tumor. This is targeted for recently diagnosed, stage I or II, node-negative, and estrogen receptor-positive patients. That rings a bell. Oncotype DX is a diagnostic test performed on the tumor tissue that quantifies the likelihood that early stage invasive breast cancer will return, or recur, and assesses the benefit from chemotherapy. This test may, or may not, be covered by insurance. Bottom line is whether my tumor expresses the genes, which will put me at risk for recurrence. High risk=chemotherapy. Low risk=radiation alone. I have chosen to proceed with this test and will wait another two weeks for the results. Since radiation follows chemo, nothing else to be done at present. Needless to say, I can relax a bit knowing the cancer is out of my body and have postponed my next haircut until I meet with a medical oncologist to discuss results. Positive affirmation: low recurrence score.
*I thought of another point regarding the lymph node evaluation. Positive lymph nodes (showing cancer cells) doesn't necessarily mean there are microscopic cancer cells elsewhere in the body. And, if the lymph nodes are negative, it doesn't mean the cancer hasn't spread elsewhere, 20-30 percent have spread even with negative nodes. Sounds like a crap shoot to me. This is why we rely on examining the characteristics of the tumor (the biomarkers), and the gene expression profile of the tumor. This is all making sense, right?
The wah in wahoo
Surgery, is behind me. The week following is uncomfortable, not painful. I want to exercise. My mind and lower back would be happier (not to mention my aging butt) if I could move my body. Until I am cleared for take off though, I’ll try not to screw this up while my body heals.
Come on, you are wondering what I’m facing in the shower, right? Ok, read on…the girls are still here and looking surprisingly familiar. My sister on the left is swollen, think breast feeding without the sore nipples. No bruising, stitches or loss of, well, tissue. The tumor was deep, so there is plenty of breast above to cover the area removed. Stitches are internal and will dissolve. I have two small incisions neatly steri-stripped, one under the arm and one off to the side where they nabbed the culprit. Again, I have no complaints and remain optimistic about what I’ll hear on Wednesday.
Come on, you are wondering what I’m facing in the shower, right? Ok, read on…the girls are still here and looking surprisingly familiar. My sister on the left is swollen, think breast feeding without the sore nipples. No bruising, stitches or loss of, well, tissue. The tumor was deep, so there is plenty of breast above to cover the area removed. Stitches are internal and will dissolve. I have two small incisions neatly steri-stripped, one under the arm and one off to the side where they nabbed the culprit. Again, I have no complaints and remain optimistic about what I’ll hear on Wednesday.
Thursday, November 1, 2007
It's Halloween and I'm not a bit scared.
It was NOT a bad day. Kim picked me up at the crack of 7…I had packed her a cancer-crew bag with snacks, a newspaper and magazines. We snapped a photo of me with my shirt lifted and jumped in her car where she had the seat preheated for me (note to self: butt warmer in the next car). Our first stop was the Breast Imaging Center for a wire localization. This delightful procedure involves numbing (oh yea?) the breast and inserting, make that, FORCING through dense tissue, a needle that will guide a wire into the center of the enemy cells. This is a ultrasound guided procedure and I am watching this horror flick on the monitor. I am the topless star.
The end of the wire is sticking out of my breast when they are done and it is carefully taped in gauze for the trip to the hospital. But first, I wait patiently in a room with a plate of just baked chocolate chip cookies that I cannot touch as I’m being starved for surgery. This is an evil test and it doesn't please me. Several mammograms later to record the wire’s position, I am handed my films and sent on my way. Kim is waiting and smiling (well, she did get coffee) and keeps that smile in place all day.
Cut to the hospital. Discussions of directives, emergency numbers, signing and dating and we are escorted to the outpatient area by a woman in a Mrs. Santa outfit. She dryly tells us, “I’m very confused”…we think she just got more interesting.
Nurse June comes to retrieve me asking for Mrs. Hughes. I inform her that was my mother and if she wants me, she’ll need to use another handle. June wins me over later as she maintains my dignity by holding the back of my gown as I make several trips to the restroom (the IV must be full of beer). Nurse Angie brings me warm blankets and rubs my feet as an apologetic tech struggles to stick the needle in, yeeouch, I’d be a lousy junkie. Kim comes to sit by my side and we flirt mercilessly with the adorable nuclear medicine tech that has come to roll me (there will be no more walking at this point) to my next new experience. Radiation isn’t supposed to be a good thing, right? Wrong. One of the benefits of getting breast cancer today is the Sentinel Node Biopsy. A few shots of radioactive fluid (again, needle in the breast) will find it’s way to the sentinel node. While in surgery, with the help of a tiny Geiger counter, Dr. Lisa will track the fluid. That node and a couple others (not the entire flock) will be singled out removed and tested for those pesky cells that have escaped the breast. The procedure, like the others thus far today, is mildly uncomfortable for a brief time. Doable.
We giggle our way back with Mr. Adorable through the halls to our waiting stall. Dr. Lisa comes in to chat. She is a cool as a cucumber, honest, approachable, positively positive. I trust her completely. Our next visitor is Mary the breast cancer advocate. Again, another woman I am proud to have on my side. She gives, in laywoman’s terms, complete explanations on every question or point I need clarity on and I want to know excruciating details on everything. I have no anxiety or trepidation; this is actually feeling like a good experience.
Being the shameless women we are, we tease, cajole and flirt (again!) with the stunning anesthesiologist. Come on, who doesn’t want to talk about drugs? He promises me a good ride, and no nausea. It just keeps getting better. After a little IV cocktail to relax me prior to the big sleep, I say “see you later” to Kim and head to the waiting hands of my surgeon.
Recovery room. Eyes open, and I am miraculously wide-awake. Dr. Lisa is telling me my nodes look clear (final pathology report will be here next week). I feel like dancing, all is right with the world. I gaze under the blanket at my now throbbing boob—she says to me, “it's still there.”
The end of the wire is sticking out of my breast when they are done and it is carefully taped in gauze for the trip to the hospital. But first, I wait patiently in a room with a plate of just baked chocolate chip cookies that I cannot touch as I’m being starved for surgery. This is an evil test and it doesn't please me. Several mammograms later to record the wire’s position, I am handed my films and sent on my way. Kim is waiting and smiling (well, she did get coffee) and keeps that smile in place all day.
Cut to the hospital. Discussions of directives, emergency numbers, signing and dating and we are escorted to the outpatient area by a woman in a Mrs. Santa outfit. She dryly tells us, “I’m very confused”…we think she just got more interesting.
Nurse June comes to retrieve me asking for Mrs. Hughes. I inform her that was my mother and if she wants me, she’ll need to use another handle. June wins me over later as she maintains my dignity by holding the back of my gown as I make several trips to the restroom (the IV must be full of beer). Nurse Angie brings me warm blankets and rubs my feet as an apologetic tech struggles to stick the needle in, yeeouch, I’d be a lousy junkie. Kim comes to sit by my side and we flirt mercilessly with the adorable nuclear medicine tech that has come to roll me (there will be no more walking at this point) to my next new experience. Radiation isn’t supposed to be a good thing, right? Wrong. One of the benefits of getting breast cancer today is the Sentinel Node Biopsy. A few shots of radioactive fluid (again, needle in the breast) will find it’s way to the sentinel node. While in surgery, with the help of a tiny Geiger counter, Dr. Lisa will track the fluid. That node and a couple others (not the entire flock) will be singled out removed and tested for those pesky cells that have escaped the breast. The procedure, like the others thus far today, is mildly uncomfortable for a brief time. Doable.
We giggle our way back with Mr. Adorable through the halls to our waiting stall. Dr. Lisa comes in to chat. She is a cool as a cucumber, honest, approachable, positively positive. I trust her completely. Our next visitor is Mary the breast cancer advocate. Again, another woman I am proud to have on my side. She gives, in laywoman’s terms, complete explanations on every question or point I need clarity on and I want to know excruciating details on everything. I have no anxiety or trepidation; this is actually feeling like a good experience.
Being the shameless women we are, we tease, cajole and flirt (again!) with the stunning anesthesiologist. Come on, who doesn’t want to talk about drugs? He promises me a good ride, and no nausea. It just keeps getting better. After a little IV cocktail to relax me prior to the big sleep, I say “see you later” to Kim and head to the waiting hands of my surgeon.
Recovery room. Eyes open, and I am miraculously wide-awake. Dr. Lisa is telling me my nodes look clear (final pathology report will be here next week). I feel like dancing, all is right with the world. I gaze under the blanket at my now throbbing boob—she says to me, “it's still there.”
2nd Appointment with Dr. Lisa Guirguis (Oncology Surgeon) October 16
MRI results—good news. We are only looking at the one tumor, in only one breast. She asks me what I want to do. "I dunno, how about a lumpectomy?" I am scheduled. A golf ball portion of me will be taken out aiming for clean margins around the small tumor. I have it to spare. Party on.
MRI. October 11
Dr. Guirguis orders an MRI to determine if there are any spots of concern in the other breast or overlooked in the one with the known tumor. Incidentally, the size is a Stage 1 (1.2 cm), another good feature, but there are many other factors which can alter that initial clinical staging. It's all about getting as much information as possible. Now, I will wait for a second meeting with the surgeon and then, likely, choose to schedule a lumpectomy. In recent years, the goal is toward breast conservation—lumpectomy plus radiation has proven to be as effective as a mastectomy. Mastectomy is still appropriate for large tumors or several sites of cancer in the breast but the goal is to hang on to what we have.
At the time of surgery there will be a sentinel node biopsy to determine if the cancer is in the lymph nodes. More pieces of the puzzle to find out “what kind of cancer is it?” In between, it's a waiting game. I am going to survive (because I say so) and grow stronger from this.
At the time of surgery there will be a sentinel node biopsy to determine if the cancer is in the lymph nodes. More pieces of the puzzle to find out “what kind of cancer is it?” In between, it's a waiting game. I am going to survive (because I say so) and grow stronger from this.
Ultrasound Guided Biopsy. September 19
I had no idea of what was to come. Having talked to a friend AFTERWARDS with a similar experience, we felt like women should be warned well in advance. Dense breasts, who knew? Although my breast was numb, the pressure from the ice pick, I mean, needle being shoved, with brut force (to get through the dense tissue) became so invasive by the time sample 16 of 20 was being extracted the tears started running down my face. I lay there, eyes darting from the pinched face of the doctor (clearly not liking what she was seeing) to the monitor giving me full view of the ice pick penetrating the black shadow in my breast. One hour, or two? It seemed like an eternity. Next, the metal chips to mark the biopsied locations were inserted (insult to injury) and mammograms recorded my new permanent shrapnel. Last, I was bandaged tightly with ice packs pressed in my bra and sent off to the waiting room where I burst into tears.
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