My First Meeting with Andrea
This past Tuesday, I had my first meeting with Andrea. Andrea is an adorable, perky, petite redhead and also my cancer nurse and care coordinator. She is there to coordinate all the aspects of my care from scheduling appointments to getting information shared with all the members of my cancer care team as well as answer questions and go over options.
Her first question was to ask if I understood my diagnosis and what I knew so far. She was thumbing through a pathology report which I, to date, have not seen or been given a copy of (I believe this is because it is incomplete). She confirmed that it is considered a stage 1 and as such, I would have options available and some choices to make. That is indeed a blessing; some cancer patients don't really have choices.
She explained the first treatment for the cancer would be a surgery to remove it. Because my tumor is less than 2 centimeters, I could choose a BCS (Breast Conserving Surgery), also known as a lumpectomy or partial masectomy. This would excise all the cancer growth and a "clear margin" of regular tissue border around it. They would also remove the papilloma growth as it sometimes is pre-cancerous and is what is causing my leakage as well as remove some lymph nodes for pathology testing. I will therefore have three distinct scars but hopefully none will be too big or cause much disfigurement. This surgery will be followed up by six weeks of radiation therapy about a month later.
I could also choose to have a masectomy (one that will involve removal of the entire breast but not the chest wall or any muscle) and that might be enough to never need the radiation. She also said that some lumpectomies have intense scarring and can cause indentation and other issues that will result in a poor cosmetic outcome and that sometimes, women achieve a better cosmetic result from having the masectomy and then having a reconstructive surgery. Andrea just wanted me to have all the information on the table before I made my decision.
I have made the decision to save what I can, live with a few scars and do the radiation treatments to start with.
Apparently, with the all the advances made in breast cancer research in the past 10 years, they now know that one size does not fit all when it comes to breast cancer. There are four different sub-types under the IBC category. Each of these has to do with receptors on the cancer cells that fuel its growth. Those basic types are ER positve, PR positive, HER2 positive and triple negative. You can also be ER/PR/HER2 positive which gives you the most options. These types determine if hormone-based medications in pill form (or injections) can be used to stop or slow any cancer growth. Triple negative cancers are the worst. They do not respond to the kinder, more gentle cancer drugs and require the use of hard core systematic chemotherapy. They are also the most aggressive. Fortunately, less than 20% of breast cancers are triple negative. As I stated before, my pathology report was incomplete and did not have this information. It should be available soon. If I do not have triple negative, I will most likely not need the chemo and will be able to take the medication for a period of five years.
There is basically one other concern that might put the chemo back on the table again and that will not be known until after my surgery. Although the mammogram/sonogram shows my lymph nodes to not be enlarged, the only way to know for sure if the cancer has spread to the lymph nodes is to biopsy a few closest to the cancer. That will be the third incision done during my surgery. If my lymph nodes all come back clear of cancer cells, and my cancer is anything but triple negative, it looks like I might only need a lumpectomy surgery and radiation treatments along with whatever hormone drug is most effective for my type. Oh, and a hell of a lot of monitoring such as mammograms every three months for a few years.
Perhaps the most disturbing bit of information that came from Andrea is that there is a scoring system for how aggressive (and different from normal cells) your particular cancer is. She said mine had a high score and it was "a very angry cancer." I don't know what this really means in terms of treatment; but I can assume the sooner we start the battle, the better.
My next meeting is with the breast surgeon. It looks like my surgery will take place in early December but I am not on the schedule yet. That meeting will probably happen next week where I should also be given my complete pathology report to see what we're up against. Wish me luck and any prayers are welcomed.
There are always risks and unknowns. For example, if the cancer comes back in the same breast they do another surgery and that time it will be a masectomy. If they don't get the whole cancer with clear margins during the surgery, they may have to go in and excise more tissue. At any time, if anything changes or lymph nodes become involved, I could need chemo. Cancer is sneaky and often unpredictable.
For right now, I choose to hope for the best and believe I can be in remission as early as March 2018. I believe I can do the treatments they are recommending and that I will do just fine. I realize I may struggle with some pain and other recovery issues from the surgery and that the radiation treatments may make me very tired and sore as if I had a bad sunburn. I realize my breast may look different and be somewhat misshapen and discolored with scars that may be very visible. But they say your life is never the same after you've had cancer. It changes you; it changes your body. But you know what? It's a small price to pay for many extra years of life.
And I give thanks every day for people like Andrea who have made it their mission to help breast cancer patients become breast cancer survivors.
Her first question was to ask if I understood my diagnosis and what I knew so far. She was thumbing through a pathology report which I, to date, have not seen or been given a copy of (I believe this is because it is incomplete). She confirmed that it is considered a stage 1 and as such, I would have options available and some choices to make. That is indeed a blessing; some cancer patients don't really have choices.
She explained the first treatment for the cancer would be a surgery to remove it. Because my tumor is less than 2 centimeters, I could choose a BCS (Breast Conserving Surgery), also known as a lumpectomy or partial masectomy. This would excise all the cancer growth and a "clear margin" of regular tissue border around it. They would also remove the papilloma growth as it sometimes is pre-cancerous and is what is causing my leakage as well as remove some lymph nodes for pathology testing. I will therefore have three distinct scars but hopefully none will be too big or cause much disfigurement. This surgery will be followed up by six weeks of radiation therapy about a month later.
I could also choose to have a masectomy (one that will involve removal of the entire breast but not the chest wall or any muscle) and that might be enough to never need the radiation. She also said that some lumpectomies have intense scarring and can cause indentation and other issues that will result in a poor cosmetic outcome and that sometimes, women achieve a better cosmetic result from having the masectomy and then having a reconstructive surgery. Andrea just wanted me to have all the information on the table before I made my decision.
I have made the decision to save what I can, live with a few scars and do the radiation treatments to start with.
Apparently, with the all the advances made in breast cancer research in the past 10 years, they now know that one size does not fit all when it comes to breast cancer. There are four different sub-types under the IBC category. Each of these has to do with receptors on the cancer cells that fuel its growth. Those basic types are ER positve, PR positive, HER2 positive and triple negative. You can also be ER/PR/HER2 positive which gives you the most options. These types determine if hormone-based medications in pill form (or injections) can be used to stop or slow any cancer growth. Triple negative cancers are the worst. They do not respond to the kinder, more gentle cancer drugs and require the use of hard core systematic chemotherapy. They are also the most aggressive. Fortunately, less than 20% of breast cancers are triple negative. As I stated before, my pathology report was incomplete and did not have this information. It should be available soon. If I do not have triple negative, I will most likely not need the chemo and will be able to take the medication for a period of five years.
There is basically one other concern that might put the chemo back on the table again and that will not be known until after my surgery. Although the mammogram/sonogram shows my lymph nodes to not be enlarged, the only way to know for sure if the cancer has spread to the lymph nodes is to biopsy a few closest to the cancer. That will be the third incision done during my surgery. If my lymph nodes all come back clear of cancer cells, and my cancer is anything but triple negative, it looks like I might only need a lumpectomy surgery and radiation treatments along with whatever hormone drug is most effective for my type. Oh, and a hell of a lot of monitoring such as mammograms every three months for a few years.
Perhaps the most disturbing bit of information that came from Andrea is that there is a scoring system for how aggressive (and different from normal cells) your particular cancer is. She said mine had a high score and it was "a very angry cancer." I don't know what this really means in terms of treatment; but I can assume the sooner we start the battle, the better.
My next meeting is with the breast surgeon. It looks like my surgery will take place in early December but I am not on the schedule yet. That meeting will probably happen next week where I should also be given my complete pathology report to see what we're up against. Wish me luck and any prayers are welcomed.
There are always risks and unknowns. For example, if the cancer comes back in the same breast they do another surgery and that time it will be a masectomy. If they don't get the whole cancer with clear margins during the surgery, they may have to go in and excise more tissue. At any time, if anything changes or lymph nodes become involved, I could need chemo. Cancer is sneaky and often unpredictable.
For right now, I choose to hope for the best and believe I can be in remission as early as March 2018. I believe I can do the treatments they are recommending and that I will do just fine. I realize I may struggle with some pain and other recovery issues from the surgery and that the radiation treatments may make me very tired and sore as if I had a bad sunburn. I realize my breast may look different and be somewhat misshapen and discolored with scars that may be very visible. But they say your life is never the same after you've had cancer. It changes you; it changes your body. But you know what? It's a small price to pay for many extra years of life.
And I give thanks every day for people like Andrea who have made it their mission to help breast cancer patients become breast cancer survivors.
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