In came the doctor, in came the nurse, in came the lady with …

Isn’t it odd that after more than 60 years of never hearing or thinking about it, a child’s jump rope rhyme should suddenly pop into my head. But I suppose these days are destined to be full of surprises and my mind doing odd things (like that’s never happened before).

So there I was, finally, in the surgeon’s office on April 27. After seeing several doctors and enduring all sorts of tests in the preceding two or three weeks, I was finally going to see the results of it all, get everything explained, and hear a proposed treatment regimen.

What I didn’t fully appreciate at the time is how much information can be crammed into two hours (something akin to a 2-hr med school lecture on breast cancer), how much of it would be totally new to me (most of it), and how much of it would fly right by me because of my anxiety level. My son was there taking notes and asking questions too, so some of what I missed, he caught.

The pathology report said the tumor is a grade III invasive ductal carcinoma (grade III cells look abnormal and may grow or spread more aggressively). Invasive ductal carcinoma is the most common form of breast cancer. For those who understand the terminology, the tumor is strongly estrogen receptor positive (ER+), moderately progesterone receptor positive (PR+), and the Ki67, at 39.2%, is designated “high proliferation” and unfavorable. I won’t try to explain all that but basically it means hormonal/chemotherapy should work well and it tells the doctors which drugs are likely to be most effective (there are a lot of different ones). Based on its size (fairly large) and the fact that it does not appear to have entered the lymph system, it was designated Stage IIA (that’s on the familiar scale of stages I through IV that you hear about so often). The doctor translated all that to roughly “chemo should work well” and “a 98% chance of no metastases.”

How big is the tumor? Well, the doctor started speaking in millimeters, and I don’t speak metric. At all. But I wrote down what he said — 27 mm × 32 mm × 6 mm — as he drew a rough circle on a piece of paper. It looked big, but what do I know; I’ve never had my very own tumor before. My son, who does speak metric, noted immediately, “It’s flat.” Which was obvious to me much later, when I could again think straight. (Interestingly, for his explanations, the doctor just unrolled a fresh strip of the paper that covers the examining table and did all his scribbles and drawings on that.)  For those as metrically challenged as I am, the size in good ol’ American inches is 1.1″ × 1.2″ × .2″. I always thought of tumors as roundish irregular lumps; this one is more like a flat chip sitting up on edge on my ribs.

The doctors seem to think the location is interesting; they’re used to breast tumors being lumps somewhere in the fatty part of the breast. It works to my advantage though, because almost the entire breast drains to the lymph nodes in the armpit, which puts my tumor a long way from those nodes.

Before I forget, the chest x-ray showed no other abnormalities. I’ve also neglected to mention two different blood tests, a metabolic panel and a CBC. Nothing notable from those.

There was one pathology report still outstanding — the HER2 report. I have absolutely no idea what that is other than another characteristic of the cancer cells that helps determine which chemo drugs are used.

Based on all this, the surgeon proposed “neoadjuvant hormonal therapy,” aka chemo prior to a lumpectomy. That would/could/might give him a better chance of getting a clear margin around the tumor, since it’s right on top of the underlying muscle and bone. Radiation would follow as the last step in the treatment. I think he said it could take the better part of a year to finish all treatment.

Before I left he ordered an MRI to get the best possible images of the tumor. And when I asked about getting a second opinion, he gave me the name of a breast cancer specialist down at the CU cancer center in Aurora.

And all that was just the first conversation with the first doctor.

When we got home my son’s first comment was, “Well, you’re looking a lot better.” When I gave him a quizzical look, he explained, “When I got here to pick you up, you looked the worst I’ve ever seen you look.” The worst I’ve looked in his 47 years!? But thinking back on how I felt after three days of knowing I had cancer but not knowing how serious it might be, that’s probably a pretty accurate description.


15 thoughts on “In came the doctor, in came the nurse, in came the lady with …

  1. IzaakMak Thursday, May 07, 2015 / 3:22 pm MDT

    Wow PT. As frightening as that no doubt was, it still sounds as if the news could have been a lot worse. Still, I admire how well you seem to have come through it. I think I’d have been shaking like a leaf the whole time…

    • PiedType Thursday, May 07, 2015 / 5:52 pm MDT

      Trust me, there has been a whole lot of shakin’ goin’ on! And there are some unpleasantries farther down the road that I don’t even want to think about yet. I gain some calm as appointments get made, call backs come in, dates are set. It gives at least some semblance of control and restoring order. If only new things wouldn’t keep popping up every day!

  2. Jim Wheeler Thursday, May 07, 2015 / 4:01 pm MDT

    Soooo, there is light at the end of the tunnel. I’m glad. 🙂

    • PiedType Thursday, May 07, 2015 / 5:44 pm MDT

      Haven’t even entered the tunnel yet. Still checking on the different routes for getting there. But everyone sounds convinced the light is definitely there. Just a lot of speed bumps and lane changes along the way. That will become clearer if I ever get caught up to current events.

  3. Jim Wheeler Friday, May 08, 2015 / 7:38 am MDT

    PT, I want to recommend a New Yorker article on healthcare to you. I found it on AFrankAngle’s list of “interesting reads”, so you might have already seen it. But if not, I can assure you that it will be interesting in your situation and may help to get your mind right. Here’s the link:

    • PiedType Friday, May 08, 2015 / 8:21 am MDT

      Good article! It must sound already that I’m being overtreated, but trust me, I’m familiar with all the tests to date and know why they were necessary. I’m seeing lots of different doctors (more than I’ve written about so far) because any treatment in my case will require a team of three different specialists — and I’m getting opinions from two different teams of breast cancer specialists (in each case, a breast cancer surgeon, a medical oncologist, and a radiology oncologist). I’ll gather the reasoning and plans from all before choosing one of the groups and proceeding with their recommended treatment. And I will be very skeptical of any testing suggested beyond what I’ve already had. There appear to be two different ways to proceed, and whether the teams agree or disagree on which is best, the choice will be mine. Daunting, but I’m a doctor’s kid and so are my four siblings; we make a pretty formidable team ourselves.

      (I learned years ago that a lot of doctors are like hammers that see everything as nails. Saved my ex from knee surgery recommended by a surgeon by suggesting he first see a physical therapist — and the problem was solved with a month or two of targeted exercise.)

      One must always be an informed patient, an activist on one’s own behalf.

      • Jim Wheeler Friday, May 08, 2015 / 8:49 am MDT

        You are an exceptionally good patient. I suspected I might be preaching to the choir on this. I was pleased to see by the article that a positive trend seems to be developing with corporate plans, although that is less than a third of adults.

  4. zenzalei Saturday, May 09, 2015 / 11:35 am MDT

    ER+ means that the cancer cells have receptors for estrogen, and that the cells may receive signals from estrogen that promote growth. So the hormone therapy will be geared either toward lowering estrogen or blocking estrogen from promoting growth. If you’re taking hormone replacement therapy, the doctors may discourage it at this juncture, and a dietitian may tell you to cut back on foods high in phytoestrogens, like soy, but that’s just my thinking aloud. I’m not well-versed in oncology beyond what I’ve written about prostate cancer and multiple myeloma.

    • PiedType Saturday, May 09, 2015 / 12:29 pm MDT

      Yep, I knew the ER+ and PR+ mean the tumor is a good target for hormone/chemo therapy. I was still on a tiny amount of estrogen, .150 mg (half the smallest dose they make) a day, which I dropped it like a hot rock when I got the diagnosis. However, the ever-so-helpful adrenal glands continue to produce androgens, which the body converts to small amounts of estrogen. So I’ll be counting on the medical oncologist (the chemo dude) to devise the best combination of drugs. Nobody’s mentioned nutrition yet, but I’ve no doubt if it’s relevant, it will come up at some point.

      • philosophermouseofthehedge Monday, May 11, 2015 / 5:23 pm MDT

        (I think Zenzalei is right about soy. I remember several friends/relatives talking about what they avoided after diagnosis and treatment. Your team should cover that at some point)
        You’ll probably get a lot of attention from young docs-in-training as you have an unusual tumor. (Oh, joy. Well, you always wanted to be a celeb)
        Hugs to your son. He sounds like a keeper!

        • PiedType Monday, May 11, 2015 / 7:35 pm MDT

          I can live with soy restrictions. But if they ban french fries … I’m sunk!

          As for the young docs, I haven’t gotten caught up with my posts yet, but I’ve already met a few.

          Yep, the son’s a keeper. And if he’s shaken by all this (he’d better be!!), he’s never let it show.

        • philosophermouseofthehedge Tuesday, May 12, 2015 / 7:44 am MDT

          I can even limit my Dr Peppers, but not the fries and a good hamburger. Told one doc that at some point you get into a quality of life thing. He laughed and said it was a deal if I keep the dog and the walking.
          Strawberries and blueberries. All the ones defeating breast cancer I know say those are part of the recommendations.
          (Now there’s research that ADHD people do better and have better focus at higher elevations – like mts… that’s my newest prod to pry outta here. Not holding my breath…once you have doc/med teams established, it’s hard to get geared up to move.)

        • PiedType Tuesday, May 12, 2015 / 8:40 am MDT

          Hey, strawberries work for me. I’ve eaten more than my share since they started appearing in the store. I hope the Haagen Dazs Vanilla Bean I always put on top of them is part of the program.

          Don’t know about the stats on altitude. High level of fitness here, but is it because of the altitude or because fit people move to the mountains? And then you have all the folks who can’t live here (like some of my relatives) because the air’s too thin. That ADHD thing is interesting, though …

"You don’t have to say everything to say something." ~Beth Moore

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