“But what does that mean?”

It seems that doctors just aren’t prone to being forthcoming with information with their patients regarding their diseases.  I realize they walk a fine line between giving information and overloading patients with too much information.  Unfortunately for my oncological team, I am not one of those patients who will be satisfied with being minimally informed.  I ask questions, lots of them.  And when I ask questions, I get lots of answers and then I share them with you.  I suppose I could just share the highlights to keep your eyes from glazing over.  But part of the purpose of sharing my journey here on the blog is to help me sort things out in my brain.  To that end, I’ll be writing the unabridged version.  😉

Friday was first appointment with the medical oncologist, who is going to be the head of my team.  The team will be made up of the following:  the medical oncologist, the surgical oncologist, the radiation oncologist, the geneticist and the social worker.  I’m quite sure the doctor I met with on Friday was quite taken aback by my barrage of questions.  Every time I heard something that was unfamiliar, I would interrup.  “What does that mean?”  “What is that?”  “How is that going to impact treatment.”  To his credit, he did answer my questions, taking them all in stride,  and by the end of the appointment, he had already modified his delivery style to include explanations without me having to ask for them.

I learned four things at my appointment:  the type of cancer, they characteristics of the cancer, the treatment plan, and a prognosis.

Since some have been asking if I know the stage and type of cancer, I’ll start there.  I won’t know the stage until later in the process.  It’s kinda like making banana bread.  You bake it in the oven and then poke it deep in the center with a toothpick to make sure it’s finished.  You remove it from the oven knowing that it is cooked.  You won’t, however, know how it tastes until you cut it open.  And now that I’ve ruined banana bread for you . . . ..

The types of cancer I have are very similar and don’t really affect the overall treatment plan.  Both cancers are invasive.  This means that they don’t stay localized in one area and if left to grow, they will go throughout the body invading different organs and systems.  We won’t know whether or not it has moved further afield until the lymph nodes in my armpit are checked during surgery.  I believe there are 5 lymph nodes there.  The likelihood that the cancer has moved on to other locations increases with an increase in affected nodes.

The names of the two cancers are:

1)  invasive pleomorphic lobular carcinoma  – this is the mass they found

2)  invasive carcinoma with ductal and lobular features – this is the 2^nd mass and the location where I felt both the pain and the lump

The lobular aspect means that there is an increased chance that the other breast could also have malignant cells.  In order to get a better picture of what is taking place, I’ll be getting an MRI sometime early this week.  The challenge with dense breast tissue is being able to see what is going on.  A mammogram is really insufficient to the task.  The MRI isn’t going to be perfect either, but as the doctor put it, “It’s the best we have.”

Next up are the characteristics of the cancers.  The tumors are both estrogen receptive and are, well, receptive to the hormone estrogen.  A simple way to limit the growth will eventually involve being placed on an anti-estrogen therapy regimen.  They are also both her2 negative, meaning that they are not receptive to treatment by a particular drug that is very caustic to the body, not to mention expensive.  Both of these are positive pieces of information.  The one cause for concern was that I got the cancer while lactating, which is not typical.  Talking with the geneticist about the very strong family history of breast cancer will, I’m sure, show that genetics played a very prominent role in the genesis of the cancer.  This is speculation, but it would seem that genetics doesn’t care whether or not one is lactating.  If you’re gonna get it, you’re gonna get it!

At this point, I should interject that I was VERY glad to have my pathologist father-in-law along at the appointment.  When I got the pathology report I just handed it to him and said “Here, what does this mean?”  He did a phenomenal job of explaining what everything meant, how cancers work, and clarifying anything that the doctor didn’t quite get to.

The treatment plan could change after getting the information from the MRI, but at this point it would be a surgery (either a lumpectomy or mastectomy) and then 3-4 weeks of recovery.  Six months of chemotherapy would be next, followed by 6 weeks of radiation.  Finally, the anti-estrogen therapy would be started.

And now comes the most important part:  the prognosis.  It’s good.  The doctor said we are on a good trajectory for treatment and headed towards a complete cure.  Now, I’m not naïve enough to think that cancer is completely curable by modern medicine.  I do, however, think that modern medicine, coupled with the great God of the universe CAN completely cure cancer.  So, I am greatly encouraged at this point.

I’ll end with a funny little anecdote.  As the nurse was checking me in, she did all of the usual, taking vitals, etc.  Then she asked what I assume are routine questions for cancer patients.

1)  “On a scale from 0-10, rate your pain today”.  Well, I feel pretty good, so I said a one.

2)  “On a scale from 0-5, how tired are you today?”  I busted up laughing.  “Uh, I have 4 young children . . . I’m ALWAYS tired!”  At this point, my tiredness is not at all indicative of how the cancer is affecting me.  I’m sure that will change and there will come a time when I won’t laugh at that question.  But on Friday, it was highly amusing!