The Pathology Report
Yesterday (August 26, 2020) I sat down with the surgeon who will be doing the lumpectomy on my left breast. She went over everything we have for information at this point and talked about what the next steps are. Then I met with a nurse who gave me a bunch of reading materials and a beautiful hand-made handbag that a woman who had a daughter with cancer makes for the patients at Elliot Breast Health Center. It was so amazing and made me feel really special that somehow me having cancer makes me worthy of so much love from strangers. I definitely didn’t try to have cancer, and I don’t know why having this diagnosis means I am worthy of love and kindness. As much as having cancer sucks, it has shown me how many amazing people are in this world. It has given me some hope that there are still good people out there, in fact, there are a lot of them, and I am so grateful for each and every one of them.
The Pathology Report
I have been diagnosed (as of right now) with Invasive Ductal Carcinoma. Because the largest tumor (there are two, possibly three), is over 2cm, my cancer is stage 2. The pathology report showed that the cancer is Estrogen and Progesterone Receptor positive. This is a good thing, because it means that they have a target for treatment (hormone blocker pill). The pathology came back for the HER2 protein (which impacts how fast the cancer grows), HER2 negative for one of the tumors and HER2 equivocal for the second one. This means that they had to send for additional testing to determine if the tumor that was HER2 equivocal is negative or positive. It is highly likely that it will be negative. This is very important information, because if it was positive, I would need chemotherapy. I won’t get these results until the end of this week or next week. The cancer is following a usual path of progression, which is good because this means it’s not showing signs of a fast-growing cancer.
Further Tests
I still have more tests to be done before a definitive treatment plan can be created. What I am learning through this whole process is patience. No matter how much I want to know NOW, I won’t have all of the information until after the pathology of the actual tumors is done, which is after surgery.
For now, I have a general idea of what treatment will look like, given the facts that we have right now. Things that will impact treatment are:
Pathology of the second tumor (HER2 pos/neg)
If found positive, I will need chemotherapy
If negative, no change in treatment
The findings of the MRI
If there is a third tumor, I will need another biopsy before surgery
Whether I have a genetic predisposition to cancer
If the geneticist determines that I have a predisposition to cancer, then I could get a mastectomy but I don’t see this happening
Next Steps
The next steps for my treatment are still somewhat up in the air because there are factors that impact treatment (listed above). The plan going forward as well as the steps, in order are as follows:
MRI (to get a clearer picture of the cancer, rule out cancer in other places)
Potential biopsy if there is a 3rd area of cancer found on the MRI
Follow up conversation about the HER2 results of the second tumor
Genetic testing (rule it out or do it)
What I know is that I will have a lumpectomy, probably on September 10 or 11. Recovery is 2-3 weeks, and I can’t do any heavy lifting (over 10lbs) for the first 2 weeks, which means no hiking for two weeks. The next steps following the surgery depend on the pathology of the tumors, which will be determined post-op. In all likelihood, after the 3-week recovery time, I will have 6 weeks of radiation, 5 days a week. After that, I will be taking a hormone blocker pill for 10 years as an insurance policy of sorts.
There are possible additional things that may happen depending on the results of the pathology taken post-surgery. They will also be doing a sentinel node biopsy to make sure the cancer cells aren’t spreading to my lymph nodes. This will be done at the time of surgery. If the cancer has spread to my lymph nodes, they may have to do an axillary dissection, and remove all my lymph nodes. Then I would potentially also need chemotherapy to make sure the cancer doesn’t grow somewhere else in my body. They aren’t seeing anything that would indicate me needing chemotherapy, but if the pathology of the tumor comes back as a more aggressive form post-surgery, then chemotherapy would be the next course of action.
Final Thoughts
I had to get off of my birth control because it has hormones in it and could be feeding the cancer. I am really nervous about this because I haven’t been off birth control in over 18 years. I don’t even know what it’s like to get a monthly cycle, because I have been on a quarterly cycle for years. I remember how awful having my period was as a teenager, which is why I went on birth control and I’m not looking forward to this. I don’t want my period to impact my hiking. To be honest, when talking to the nurse about my concerns regarding treatment, the #1 concern is how will all of this impact my hiking. I want to be strong, I want to stay strong, and I don’t want to lose all the strength I gained this past summer.
I can’t carry my cell phone next to my breast anymore when I hike either because they don’t believe that is what has caused my cancer, but it’s not worth taking that risk. I don’t know where to keep my phone in the winter now because I keep it in my bra so it doesn’t die in the cold when I’m hiking. I’ll have to think of some ideas about where to keep it. The women at the hospital are all wicked nice and they are so easy to talk to. They think that it’s crazy that I have lost toenails from hiking, and I showed them the bruise I got this past summer when I fell on the talus going up Castle Ravine and they were blown away.
I am not worried about the post-op pain, because I think I can handle pain pretty well after all of this hiking. It’s hard to explain just how serious I take hiking to them, because this community that I’m in is sort of “fringe” and not many people understand that when I say I go hiking, I don’t mean I go for a walk in a local park. For now, I am just getting ready to start graduate school next week, and hiking as much as I can (per doctor’s orders actually) between now and when I will be having surgery. I’m also not planning on having breast reconstructive surgery, because I don’t see a need for it, and that would just be one more surgery. Most importantly, the surgeon said that given my current diagnosis, they are looking to cure my cancer. I like that word: cure.
