The Details... So Far

I had a breast exam less than 3 months ago. I had a small infection in a hair follicle on my right breast which, by the time of the exam, had all but resolved itself. The breast exam was normal, but I was still advised to continue self breast exams and to return for a follow up in October.

This has been the busiest Fall of my life. Doug and I got married October 5th. I've been teaching an overload. We just moved this weekend. Charlotte's schedule is increasingly busy with preschool, play dates, dance class. Our life is full of joy.

Tuesday, November 5th was a particularly busy day for no particular reason. I'd been catching up on grading papers all day, prepping to start the literature unit in my evening class, forgetting to plan dinner. When I got home from that night class, I was exhausted, just wanting to take a long, hot shower and breathe. I remembered, in the shower, that I hadn't made my follow up appointment and I hadn't even done a self breast exam since I had last been at the doctor, so I checked. There it was; a golf-ball size lump in my left breast. My stomach sank, but just as quickly, I remembered that women often get lumps in their breasts as a result of hormonal fluctuations. I decided to give it a week to see if anything changed.

In the meantime, I did some checking with family members about our medical history. I knew that several family members had died from cancer, but I didn't know the details. There's colon cancer on my mom's side, brain, lung, breast and ovarian cancer on dad's side. I read that only 7% of breast cancer occurs in women under the age of 40 and I already knew that my dad's cousin, Susie, was diagnosed with breast cancer at 38 and died the following year. I'm 35.

By Friday, I was too worked up to wait the full week.  I called and made an appointment at Glen Meade Women's Health for the following Tuesday morning. I went in at 9am. After a complete annual exam, I was referred to Delaney Radiology for a diagnostic mammogram and ultrasound. Because of the "extensive family history," my nurse practitioner said she would've sent me for a baseline at that point anyway, but since I presented with a sizeable lump that had appeared within a couple of months from my last breast exam, a diagnostic mammogram was in order. As I left her office, one of the receptionist's said "you know, Delaney is pretty 'Johnny-on-the-spot'. If you go there now to make your appointment, they'll probably squeeze you in today."  So I did. And they did.

By 10:30, I was already having the mammogram. The baseline part wasn't bad at all. I'd heard nightmarish tales about how much mammograms hurt. It's awkward, a little uncomfortable, but not painful. That is, not until the diagnostic part of the imaging. There's a smaller paddle used for diagnostic mammogram imaging. Mary, the radiology tech, took lots of diagnostic images, moving quickly to spare me the discomfort. The ultrasound that followed was pretty standard. I was asked to wait until the radiologist had put his stamp of approval on the images before they let me leave. Mary came back. More diagnostic mammogram images. Ugh!

I was home by noon. Everything seemed to be moving at warp speed. The next afternoon I got the call. The radiologist had identified micro-calcifications and a "tiny" mass, both "likely benign." He advised I follow up with another round of imaging in 6 months. My nurse practitioner said that she'd prefer I follow up with a breast surgeon, just to get a second opinion on the images. She referred me to Dr. Elizabeth Weinberg.

I went to Dr. Weinberg's office thinking she'd recommend I follow up with additional imaging in 2 or 3 months, instead of waiting 6 months like the radiologist had suggested. She said that what they were seeing in the images was small (like grains of sand), but what she felt was much bigger. She suggested a core needle biopsy and we did it right there in her office. She injected my breast with a good dose of Lidocaine, and took approximately 15 samples. She told me they look like small pieces of spaghetti. Gross, right?! The worst part about the biopsy was the seeing that needle for the first time. It took my breath away, and I cried. It makes an awful sound, like a plastic gun shot, every time a sample is taken. Dr. Weinberg said she'd have a preliminary report the next day.

Wednesday at noon. I was trying to distract myself from the neurotic thoughts running through my mind. It was highly likely the results would show fibrocystic tissue, a non-issue as compared to the other possibilities, but I couldn't get those "other possibilities" out of my head. The phone rang. "It's cancer," she said. "Wow," I said. Wow. She needed more time to get the details about what kind of cancer it was, so we set an appointment for Thursday at 2:15.

Doug, Mom and Bob joined me. It's so important to have support and extra ears. Dr. Weinberg gave us the details, and explained I would need to have a sentinel node biopsy to check whether or not I have lymph node involvement. Ultimately, that will help them (the team of doctors and surgeons that will be helping me) better determine the staging of my cancer (if it has spread beyond my breast tissue) and the plan for my treatment. My sentinel node biopsy is scheduled for Wednesday, the day before Thanksgiving (my FAVORITE holiday). Dr. Weinberg explained that they will inject radioactive material into my breast, followed by dye, an incision in my arm pit. She'll remove a couple of lymph nodes for microscopic evaluation, and the dye, which will have been taken up by the lymph channels, will show them if there are cancer cells in my lymph nodes.  The lymph nodes act like gatekeepers, preventing cancer cells from moving to other parts of the body. The status of the lymph nodes will dictate some of my treatment plan.

To highlight my frame of mind at this point, you should know that when Dr. Weinberg said "radioactive material," the Imagine Dragons song "Radioactive" started playing in my head. When I realized what I was doing during such an important conversation, I laughed out loud. Everyone looked at me. Probably not the best time to laugh. I'm finding, though, that after the initial shock, I'm finding more reasons to laugh than cry.

Anyway, here's the rest of the details. The stuff everyone seems to ask about:

I have Invasive Ductal Carcinoma. This means that my cancer started in the milk ducts, but has broken through, invading the breast tissue around the duct. This is the most common kind of breast cancer.

My cancer is Grade 2. This refers to the speed at which the cancer cells are replicating. On a scale of 0-100, mine is replicating at a 44. This is considered "intermediate." Not slow, but not particularly aggressive either.

We think my cancer is Stage 2. This part is based solely on size at this point, but there are a lot of other factors that will influence accurate staging. The sentinel node biopsy, this Wednesday, will influence the staging of my cancer.

My IDC is estrogen sensitive. There are receptors on the outside of my cancer cells that are basically feeding on estrogen. And let's face it, folks; I ooze estrogen.  That was a joke. Haha. This is important to know. Blocking the estrogen receptors, with drugs like Tamoxifin, can help reduce my chance of reoccurrence. I'll likely have to take Tamoxifin for 5-10 years.

I'm HER2neu negative. I can't explain this, but it's good news. Yay!

I had a lot of options in terms of surgery. I'm having a double mastectomy.

Though I haven't been tested, my doctor seems fairly confident that I have the BRCA genetic mutation (which means I'm likely BRCA 1 or BRCA 2 positive). My dad's cousin Susie ( I mentioned her earlier in this post) had two daughters. They tested positive for BRCA2. We know the gene is in my family, but again, we don't know if I am positive for it and I haven't made a decision about getting tested for it yet. The potential for reoccurrence seems too much of a risk. If I have to go through this, I'd rather do it once. No double-dipping for me! My family is entirely supportive of my decision.

I will likely need chemo, but that isn't certain yet. I still need to find out about lymph node involvement and meet with my oncologist.

I shouldn't need radiation, but that could change. I don't think it will.

We just moved this weekend. My home office isn't set up yet. When it is, I'll try to scan and post interesting tidbits from my labs so far. I actually have a picture of my cancer cells. They record digital images of the slides when the samples go under the microscope. Cool, right?!