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.