For those who are curious, here are the characteristics of my cancer:
ER positive: The tumor has estrogen receptors. This is good news. My cancer will be responsive to tamoxifen, a standard chemotherapeutic regimen for breast cancer that blocks these receptors to halt tumor growth.
PR negative: Neutral news. As long as the tumor is ER positive, it's okay to be progesterone-receptor negative.
HER2 negative: Good news. Herceptin-positive tumors are very aggressive.
BRCA1/2 negative: Certain alternations to the BRCA genes are associated with a high risk of breast cancer and are often seen in younger women diagnosed with breast cancer. These were not found in my biopsy. This is good news for my 4 sisters.
Tumor size 8 mm: This is good news. The small size (less than 1 centimeter) indicates that the cancer was caught early.
Tumor grade 3: This is bad news. The cancer is aggressive.
Tumor stage IA: This is good news. The cancer was caught early.
4 sentinel lymph nodes removed: All were negative for metastasis, indicating that the cancer has not spread. VERY good news!
Oncotype DX: Breast cancer recurrence score of 30, which corresponds to a 20% likelihood of distant recurrence ('distant' means occurring elsewhere in my body). This high risk of recurrence makes me a good candidate for preventative chemotherapy.
Thursday, February 17, 2011
Wednesday, February 16, 2011
Progress to Date
November 4, 2010: At my annual ob/gyn appointment, Dr. Petraske discovers a lump. (Thank you, God, for Dr. Petraske and her vigilance and her kindness!) She asks me to schedule a mammogram.
I am 39 years old. The risk of developing breast cancer at my age is 0.43%, corresponding to 1 in 233 women.
November 5: Mammogram does not visualize the lump; however, it is seen via ultrasound. Radiologist deems it potentially of concern and recommends a biopsy.
November 17: Meet with breast surgeon (I hadn't known there was such a specialty!) to discuss imaging results. Dr. Krisher determines that I will need a biopsy.
November 30: Biopsy performed; cancerous cells found, so a lumpectomy or mastectomy is necessary
December 9: MRI shows no additional areas of concern
December 14-22: Consult with various specialists to help decide between lumpectomy and mastectomy. I chose a lumpectomy to preserve as much tissue as possible.
January 4, 2011: Lumpectomy and sentinel lymph node dissection performed. The cancer has not spread to my lymph nodes. However it is grade 3 and has 'dirty margins' (the tumor was surrounded by extensive pre-cancerous cells called DCIS, or ductal carcinoma in situ) that will require either re-excision or a mastectomy.
January 19: I chose a mastectomy, since it may be necessary anyway and since so much tissue will need to be removed in the re-excision. Mastectomy scheduled for March 3.
Feb 2-11: Consult with two oncologists to determine the need for chemotherapy and chose the best regimen. Both agree that my case necessitates chemotherapy.
I am 39 years old. The risk of developing breast cancer at my age is 0.43%, corresponding to 1 in 233 women.
November 5: Mammogram does not visualize the lump; however, it is seen via ultrasound. Radiologist deems it potentially of concern and recommends a biopsy.
November 17: Meet with breast surgeon (I hadn't known there was such a specialty!) to discuss imaging results. Dr. Krisher determines that I will need a biopsy.
November 30: Biopsy performed; cancerous cells found, so a lumpectomy or mastectomy is necessary
December 9: MRI shows no additional areas of concern
December 14-22: Consult with various specialists to help decide between lumpectomy and mastectomy. I chose a lumpectomy to preserve as much tissue as possible.
January 4, 2011: Lumpectomy and sentinel lymph node dissection performed. The cancer has not spread to my lymph nodes. However it is grade 3 and has 'dirty margins' (the tumor was surrounded by extensive pre-cancerous cells called DCIS, or ductal carcinoma in situ) that will require either re-excision or a mastectomy.
January 19: I chose a mastectomy, since it may be necessary anyway and since so much tissue will need to be removed in the re-excision. Mastectomy scheduled for March 3.
Feb 2-11: Consult with two oncologists to determine the need for chemotherapy and chose the best regimen. Both agree that my case necessitates chemotherapy.
Friday, February 11, 2011
Today's Gratitudes
The Psalms. These ancient poems express raw human emotion -- the whole
range -- before God. From anger and frustration and fear, to joy and
peace and gratitude. It's good to be reminded that God invites us to
pour out our hearts to Him and that all these emotions are acceptable to
Him. He desires this sort of honest dialog.
The Psalms often talk about enemies, praying for protection from enemies or the defeat of enemies. For many years, I skimmed over the enemy parts, thinking that I certainly don't have that problem. Besides, some of it sounds bloodthirsty and 'un-Christian', to desire the bloody defeat of your foes. But I've learned as an adult that enemies do not need to be people who hate you or who follow you around trying to kill you. Anxiety and shame can be enemies, as can any other internal battle that impedes your faith. I think of those who struggle with addiction.
My mom reminds me that 'cancer' can be an enemy too. As she sat through chemotherapy, she meditated on the Psalms with that in mind.
Psalm 41 particularly struck me today.
In this Psalm, the enemies can so easily be visualized as cancer. I imagine the enemy (cancer) standing beside the sickbed, just waiting for the author to die. The image of the enemy spreading lies "he goes out and spreads it abroad" -- how malignant!
For me, the "close friend" who betrays the speaker represents my body -- something I've trusted and been (literally) attached to me entire life (can't get much closer than this "friend"!). The friend is described as "sharing my bread" and "lifting up his heel against me" -- interesting that the author uses the body-related imagery of eating and the foot. My body, close and trusted friend that it has been over the course of my healthy life, has betrayed me to my enemies. That my physical body cannot be relied upon for support is a shocking lesson but also a lesson valuable to learn as I age. Cancer is a crash course in the untrustworthiness of the body. And, if I weren't learning it now, I would certainly get the same lesson slowly over the (God willing) post-40 decades of my life that start in 2 weeks!
The Psalms often talk about enemies, praying for protection from enemies or the defeat of enemies. For many years, I skimmed over the enemy parts, thinking that I certainly don't have that problem. Besides, some of it sounds bloodthirsty and 'un-Christian', to desire the bloody defeat of your foes. But I've learned as an adult that enemies do not need to be people who hate you or who follow you around trying to kill you. Anxiety and shame can be enemies, as can any other internal battle that impedes your faith. I think of those who struggle with addiction.
My mom reminds me that 'cancer' can be an enemy too. As she sat through chemotherapy, she meditated on the Psalms with that in mind.
Psalm 41 particularly struck me today.
1 Blessed are those who have regard for the weak;
the LORD delivers them in times of trouble.
2 The LORD protects and preserves them—
they are counted among the blessed in the land—
he does not give them over to the desire of their foes.
3 The LORD sustains them on their sickbed
and restores them from their bed of illness.
4 I said, “Have mercy on me, LORD;
heal me, for I have sinned against you.”
5 My enemies say of me in malice,
“When will he die and his name perish?”
6 When one of them comes to see me,
he speaks falsely, while his heart gathers slander;
then he goes out and spreads it around.
7 All my enemies whisper together against me;
they imagine the worst for me, saying,
8 “A vile disease has afflicted him;
he will never get up from the place where he lies.”
9 Even my close friend,
someone I trusted,
one who shared my bread,
has turned[b] against me.
10 But may you have mercy on me, LORD;
raise me up, that I may repay them.
11 I know that you are pleased with me,
for my enemy does not triumph over me.
12 Because of my integrity you uphold me
and set me in your presence forever.
13 Praise be to the LORD, the God of Israel,
from everlasting to everlasting.
Amen and Amen.
In this Psalm, the enemies can so easily be visualized as cancer. I imagine the enemy (cancer) standing beside the sickbed, just waiting for the author to die. The image of the enemy spreading lies "he goes out and spreads it abroad" -- how malignant!
For me, the "close friend" who betrays the speaker represents my body -- something I've trusted and been (literally) attached to me entire life (can't get much closer than this "friend"!). The friend is described as "sharing my bread" and "lifting up his heel against me" -- interesting that the author uses the body-related imagery of eating and the foot. My body, close and trusted friend that it has been over the course of my healthy life, has betrayed me to my enemies. That my physical body cannot be relied upon for support is a shocking lesson but also a lesson valuable to learn as I age. Cancer is a crash course in the untrustworthiness of the body. And, if I weren't learning it now, I would certainly get the same lesson slowly over the (God willing) post-40 decades of my life that start in 2 weeks!
Thursday, February 10, 2011
Today's Gratitudes
1. A family friend who is also an oncologist talked to me today (on his
day off); our discussion convinced me to use his close-by clinic instead
of traveling >1 hour to a big cancer center for my chemotherapy. I
am greatly relieved, since this will save time and will be less
burdensome to friends and family who will take me to my appointments
2. My mother, who will be staying with us for most of the month of March to care for us during/after my mastectomy. She is also planning to give me her head-coverings and make me some new ones. She is a breast cancer survivor so is also an amazing source of information and understanding
3. Husband who is working on our taxes (I'm so grateful that he's willing to do that miserable tas!) and who is watching the kids this weekend while I attend our church women's retreat
4. That there are some decent-looking wigs out there!
2. My mother, who will be staying with us for most of the month of March to care for us during/after my mastectomy. She is also planning to give me her head-coverings and make me some new ones. She is a breast cancer survivor so is also an amazing source of information and understanding
3. Husband who is working on our taxes (I'm so grateful that he's willing to do that miserable tas!) and who is watching the kids this weekend while I attend our church women's retreat
4. That there are some decent-looking wigs out there!
Wednesday, February 9, 2011
A Vacation in Denial -- I Mean Mexico
We just returned from a 6-day vacation in the Mayan Riviera, the eastern
coast of Mexico. It was beautiful -- sunny and warm and perfect.
Husband and I snorkeled and read and soaked up vitamin D. Huckle and
Sally swam in the pool and "snorkeled" off an innertube and built
sandcastles. It was a wonderful escape from an especially cold winter.
All vacations are bittersweet. They have the highs of anticipation and of leaving regular life behind for relaxation and/or adventure; and they have the lows of returning to reality (work! school! laundry!) afterward and no longer having a vacation to anticipate. When on vacation, we are always aware in the backs of our minds that it will come to an end. That's part of the fun -- that it's something new and different, a break from normal life. The temporariness of vacation heightens the experience.
In the case of our vacation, this one was more bittersweet than ever. The highs were higher and the lows were lower than the typical vacation. The trip was an escape from a reality that has been very hard to accept. It's still a shock to me that I, someone who cares about and vigilantly guards my health, have been diagnosed with cancer. More than ever, I needed a temporary escape from dealing with constant appointments and tough decisions, a break from cancer taking over my life. And so the days on the beach were sweeter than ever before -- more of a break than any other vacation has been. Six whole days without a doctor appointment or even a phone call about doctor appointments!
But the return was also harder. Not just seeing snow falling as the plane landed, but knowing that the following day would be more setting up appointments and smoothing out insurance issues. Despite how healthy I feel and look, it's time to own up to the fact that I am soon to undergo a big surgery and months of chemotherapy that will alter how I feel and look.
Today's gratitudes:
- a safe vacation that met my high expectations for relaxation and sunshine and family time
- 2 phone calls from friends offering help as needed
- a chance to volunteer at the kids' school, something I will not take for granted as my health worsens
- quiet time alone in the house
All vacations are bittersweet. They have the highs of anticipation and of leaving regular life behind for relaxation and/or adventure; and they have the lows of returning to reality (work! school! laundry!) afterward and no longer having a vacation to anticipate. When on vacation, we are always aware in the backs of our minds that it will come to an end. That's part of the fun -- that it's something new and different, a break from normal life. The temporariness of vacation heightens the experience.
In the case of our vacation, this one was more bittersweet than ever. The highs were higher and the lows were lower than the typical vacation. The trip was an escape from a reality that has been very hard to accept. It's still a shock to me that I, someone who cares about and vigilantly guards my health, have been diagnosed with cancer. More than ever, I needed a temporary escape from dealing with constant appointments and tough decisions, a break from cancer taking over my life. And so the days on the beach were sweeter than ever before -- more of a break than any other vacation has been. Six whole days without a doctor appointment or even a phone call about doctor appointments!
But the return was also harder. Not just seeing snow falling as the plane landed, but knowing that the following day would be more setting up appointments and smoothing out insurance issues. Despite how healthy I feel and look, it's time to own up to the fact that I am soon to undergo a big surgery and months of chemotherapy that will alter how I feel and look.
Today's gratitudes:
- a safe vacation that met my high expectations for relaxation and sunshine and family time
- 2 phone calls from friends offering help as needed
- a chance to volunteer at the kids' school, something I will not take for granted as my health worsens
- quiet time alone in the house
Wednesday, February 2, 2011
Update: Now We're Cookin'
After a month of nothing happening, I finally have cancer treatments
lining up. The lumpectomy in early January did not have 'clean margins',
meaning that the next step involves the removal of more tissue.
Meaning, I will have a mastectomy on March 3. Blah. For awhile there, I
thought I would get off easy. (Then again, for awhile there, I was
expecting a call back from my doctor telling me they were wrong: no
cancer. Funny how delusional one can get.)
Today we also met with a medical oncologist at Fox Chase Cancer Center to discuss chemotherapy:
-will I need it?
- if so, what regimen?
Here's what was taken into account:
-what is the tumor size? (smallish)
-did it spread to my lymph nodes? (no)
-positive for cancer-related BRCA mutations? (no)
-what grade of cancer (grade 1/2)
-Oncotype DX results (high end of intermediate risk)
The last one is the sinker. The results of this test of 21 breast cancer related genes, convinced the doctor that I'll need the "big guns": doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan), and paclitaxel (Taxol) or docetaxel (Taxotere). That's ACT in cancer lingo.
Let's cut right to the chase: this means I'll be losing my hair in about 2 months.
Bother.
Oh, and there will likely be nausea and fatigue.
Double bother.
And part of it will happen over the summer when the kids are not in school.
Triple bother.
But, surprisingly, I'm just grateful to finally have information. The waiting and unknown were difficult to handle. This was a case when any news is good news. The next big hurdle is getting past the surgery (and my surgery related anxieties) and then hitting a routine.
I am so very grateful for a group of three friends from church who have decided to undertake the coordination of my care: they are going to help me arrange rides to my treatments, childcare during treatment and recovery, help with errands or meals, and anything else that arises. Again, I did nothing to deserve this. They are in no way indebted to me, and I haven't been some sparklingly selfless friend. These are godly women just being obedient to God's calling and following Christ's example to serve one another in love. I am again humbled and in awe.
Today we also met with a medical oncologist at Fox Chase Cancer Center to discuss chemotherapy:
-will I need it?
- if so, what regimen?
Here's what was taken into account:
-what is the tumor size? (smallish)
-did it spread to my lymph nodes? (no)
-positive for cancer-related BRCA mutations? (no)
-what grade of cancer (grade 1/2)
-Oncotype DX results (high end of intermediate risk)
The last one is the sinker. The results of this test of 21 breast cancer related genes, convinced the doctor that I'll need the "big guns": doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan), and paclitaxel (Taxol) or docetaxel (Taxotere). That's ACT in cancer lingo.
Let's cut right to the chase: this means I'll be losing my hair in about 2 months.
Bother.
Oh, and there will likely be nausea and fatigue.
Double bother.
And part of it will happen over the summer when the kids are not in school.
Triple bother.
But, surprisingly, I'm just grateful to finally have information. The waiting and unknown were difficult to handle. This was a case when any news is good news. The next big hurdle is getting past the surgery (and my surgery related anxieties) and then hitting a routine.
I am so very grateful for a group of three friends from church who have decided to undertake the coordination of my care: they are going to help me arrange rides to my treatments, childcare during treatment and recovery, help with errands or meals, and anything else that arises. Again, I did nothing to deserve this. They are in no way indebted to me, and I haven't been some sparklingly selfless friend. These are godly women just being obedient to God's calling and following Christ's example to serve one another in love. I am again humbled and in awe.
Tuesday, January 25, 2011
The "C" Word
It's great to have so many friends and family members concerned for me. What a blessing!
I would never want to sound ungrateful, BUT right now I would be especially grateful for a conversation that doesn't include the word cancer. Really, it's taken over my life. (Ahem, malignant, much like a cancer)
And so I find myself wanting to avoid Bible study and phone calls and emails and -- oh bother!
Then again, there are other times I need to talk about it. When someone calls and I pour out my frustrations and difficult choices.
We humans are so complicated. Lord, give me the grace to be gracious.
I would never want to sound ungrateful, BUT right now I would be especially grateful for a conversation that doesn't include the word cancer. Really, it's taken over my life. (Ahem, malignant, much like a cancer)
And so I find myself wanting to avoid Bible study and phone calls and emails and -- oh bother!
Then again, there are other times I need to talk about it. When someone calls and I pour out my frustrations and difficult choices.
We humans are so complicated. Lord, give me the grace to be gracious.
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