Pathology Results with the Oncologist

Today has been my lowest since the first few days of this process.  I am still sore from the lumpectomy, but it's not too much worse than the biopsy pain.  My arm hurts more, and there is more bruising, but otherwise it is very similar.  Yesterday we began setting up appointments with a Piedmont oncologist, and with an Emory oncologist.  At first, neither could see us until after our Yellowstone trip, but then late yesterday afternoon we had a call back from Dr. Mininberg's office at Piedmont, and he agreed to see me today.

Luckily, my final pathology came back as we were in the waiting room, so we had that data to sift through together.  Basically, everything I heard during our appointment was pretty terrifying.  My mind has yet to really wrap around the whole, big picture.  I am clinging onto a couple of things:  (1) when I asked him for reassurance that this was still a treatable case, he said absolutely it is, without hesitation, it is curable, and (2) I know I don't have to do this alone.

So, for the results.....well first off, the 6 mm tumor turned out to be 9 mm.  That sounded like a big deal to me, but the doctor said that change doesn't affect the classification.  More concerning....the cancer that was found in my node turned out to be a separate 9 mm mass.  The second node remained clean.  They had no good explanation as to why the ultra sound or the MRI failed to show that mass, other than to say something needs to be about 1 cm to show up and also my nodes weren't swollen.  Finally, the goal was to remove the original tumor from my breast, and then take out a safe amount of healthy tissue surrounding it.  These are called margins and they want at minimum 5 mm of healthy tissue as a margin around the mass.  Again a disappointment - there were at least two sides where my margins were only 2 mm, then even more concerning was a new, tiny mass discovered that was DCIS (Ductal Carcinoma In Situ, meaning it is contained and a grade 0, but in a new location nonetheless that would over time want to become Invasive) and finally, the surgeon reported being concerned with finding a "skip", which means there was cancer, then next to it healthy tissue, then cancer again (trace amounts, but regardless, this shows the capacity to spread and hide within the breast). 

For all of these reasons, I will need either an excision (redo the lumpectomy) or a mastectomy.  At least this is one decision that I do not have to think twice about.  I will get the mastectomy since this cancer has me scared to death, and I want to treat it as aggressively as we can.  The only "up" side to this is that radiation now becomes a question mark.  Apparently, when they do the mastectomy they will also remove some additional nodes, and if two or more have cancer, then I will also have radiation.  All of this comes after the chemo.

Which leads me to that pleasant topic.  This doctor laid out his protocol for me, and I understood it and it seems to make sense.  However, we really want to have the Emory doctors go over everything as a second opinion, if nothing else.  This doctor advised 20 weeks of chemo, to be administered via a port placed in my upper chest.  There would be two drugs initially, and I will research them and write about their details later.  They would be given once every two weeks, for a total of four treatments.  Then a different chemo drug would be given once a week for 12 weeks.  Alongside this is a bunch of medication to help with side effects, mainly to help with nausea and my white blood count.  I would need to return the day after the chemo for a big shot of some side effect medication.  I forgot to ask whether this is the type of thing I can drive myself to receive, or how long each treatment takes.  The only up side to being Her 2 positive is that there is a drug (Herceptin) that targets that protein specifically, and it has been really successful over the last few years.  Even ten years ago, the prognosis for Her 2 positive was not nearly as good as it is now.  

After all of that, then there would be a one month break, then the mastectomy, hopefully NOT followed by radiation, but that is unknown right now.

My biggest fear with all of this is that this cancer has shown itself to be aggressive, and it has infiltrated my lymphatic system to get into the node in the first place, so how do we know if there is cancer elsewhere in my body?  I talked with the oncologist about this, and reminded him that we have been told several different times that "chances are" that xx won't happen, or "it is very unlikely that you have it in your nodes" but as I said, the odds have not been in my favor (I keep hearing Effie's voice from The Hunger Games in my head).  I asked about getting a PET scan, and would that show any other cancer.  He said yes, but that it is a very expensive test and given my prognosis he doesn't think insurance would cover it.  However, he suggested getting a CT scan and a bone scan, which are two separate tests that together will reveal the same information.  Chris and I plan to do our own research to see whether we can confirm that. 

For now, we are moving forward with scheduling these new tests, and I cannot emphasize how much I would love everyone to pray with me that nothing else is found.  I keep telling my mind not to go there, because that would be Stage IV (if there is cancer in another organ) and the options begin to run thin.  The oncologist assured me that people with this type of cancer are symptomatic, which I am not, but I am sorry...it is difficult to fully reign in your mind sometimes.  I know I cannot let this define me.  I know I cannot succumb to the fear and lay in bed all day.  I know I have to trust the doctors (while diligently using all of my resources to confirm that trust).  But I also know that I am not in charge here.  I know I am part of a much bigger picture.  I do not know the exact role that I am meant to play.  I thought I was supposed to be the best mom and wife that I could be, a productive member of society, but how can I do that right now?  I will get it together, but for tonight, I am overwhelmed.  I am devastated.  I am scared. 

Tomorrow I will readjust and try to focus more outwardly than inwardly.  For now I am reminded of several points in Scripture that helped me with the pain of Shingles.....Romans 8:28 was a key phrase that so many different people either sent me via text, or wrote in cards, etc.  "...in all things God works for the good of those who love him, who have been called according to his purpose."  I will cling to the lesson that was so clear in our Bible Study's work through the book of James....that we are to "consider it ALL joy when (not if) we encounter various trials, knowing that the testing of our faith produces endurance."  And finally, Hebrews 12:1...such a good reminder..."Therefore, since we are surrounded by such a great cloud of witnesses, let us throw off everything that hinders and the sin that so easily entangles. And let us run with perseverance the race marked out for us...."  Apparently this race has been marked out for me, and I am going to have to run it, whether I want to or not.