I have breast cancer…

Although I first felt the lump in May, between waiting to see if it’ll go away, waiting to see my GP, then waiting to get an appointment for a mammogram, it’s taken a couple of months to get answers. But, by the time I got the first tests (a diagnostic mammogram, ultrasound and a biopsy all on the same day), it was just 3 days (over a weekend) to get a cancer diagnosis…and another 3 weeks to get through all the additional testing: more biopsies and mammograms, MRI, echo, EKG, and (still to be completed) bone and CT scans and genetic testing. For now, my medical oncologist and I have made a decision on the treatment plan.

Although it’s been a month since the diagnosis, save for a handful of friends I didn’t immediately speak to folks about this (not even to family except my niece who lives with me, and my nephew who lives in the Philippines because he’s close to me and I know he’ll worry if he hears about it from someone else). This was because (1) there was a lot happening all at once and (2) I wanted a solid plan before I could talk much about it.

First, how do I feel? You probably won’t see me cry or be emotional. Not right now anyway. Not specifically about having cancer. I didn’t when I got the diagnosis because back then I just had so many questions I still needed answered before I could “appropriately” react. I don’t think “why me” or it’s unfair or it’s sad. I think of it as something to be dealt with. There’s a task at hand. (Oh but I will cry about pain. I’m such a wuss about needles.) I know there will be rough days with the treatment ahead and that’ll will probably make me upset and emotional. But while I’ve been in this info-gathering stage, I’ve been mostly just really focused. Ironically, I feel the best after every conversation with various care providers even though they may be delivering not so great news because each time I have more information to research.

I have so far been able to approach this rationally, with resolve and little bit of gallows humor. I’ve appreciated that folks I’ve told have largely followed my lead. When I was met with so much gentleness by my well-meaning care team at the very beginning but wasn’t given much by way of specifics, that didn’t feel very good actually. It made me feel more helpless. Now, I come to appointments with, like, 40 questions that are categorized and have multiple parts — I know now to advocate that this is what I need. Empathy is wonderful, but getting answers (when available) puts me more in control of what’s happening to me. They have said to me: “you’re doing this exactly right” which I’m sure they tell every patient anyway.

I do have a lot on my mind: life logistics, working while in treatment, how the insurance plan I picked did not anticipate I would get sick so yeah this cancer is not cheap, how the side effects can be best managed because they don’t sound fun, how to stay healthy, fit and sane… But I am not worried about the outcome.

I have a type (cancer type, that is, but it’s not that important, actually)

I have invasive ductal carcinoma (IDC). Unless the scans next week show metastasis (doubt it), it’s stage 2 and that is determined by the size of the tumor (mine is just under 5 cm). The enlarged lymph node they saw at my 1st ultrasound was found to be benign. MRI showed some mild asymmetry in the axillary lymph nodes, but it’s not factoring into the determination of the cancer. Both the cancer stage and the type though are less important in determining treatment. Receptors (what feeds the cancer so to speak), I know now, are more relevant. Biopsies show I have hormone receptor (HR)+/HER2+ or “triple positive” breast cancer (BC). Meaning, the cancer has estrogen and progesterone hormones, and HER2 (human epidermal growth factor) is overexpressed. That last one plays a role in cancer proliferation, making the cancer high-risk and the treatments more aggressive.

Treatment plan as of now: neoadjuvant chemotherapy plus targeted immunotherapy 6 cycles x 3 weeks starting in approximately 1.5 weeks. This treatment, TCHP (docetaxel, carboplatin, trastuzumab and pertuzumab) is a typical strategy for triple positive. At the end of 6 cycles of chemo, there’s surgery. The type of surgery is determined by the results of genetic testing and the size of the tumor at the end of chemo. At the moment, I am borderline needing a mastectomy. The chemo is expected to shrink the cancer where I may well qualify for a lumpectomy followed by radiation. After surgery there’s another 9 months of adjuvant treatment (more infusions). It will either be a 2nd line chemotherapy which will likely be T-DM1 (trastuzumab w/ an anticancer drug) if the first round of chemo shows residual invasive cancer, or targeted immunotherapy for the HER2 receptors only. Finally, there will be 5-10 years of (oral) endocrine therapy (aromatase inhibitors) and ovarian suppression. Whew! It’s a marathon not a sprint. 

That last one is one of those “decisions” I also had to make over the last week or so. Having endometriosis and being on OCP for the last decade or so, I always knew reproduction was going to be an unknown should I decide it. But in the intervening years I just never fully decided, perhaps because it was never the right time in the scheme of my life, or perhaps because I didn’t really desire it. Now, it is foregone. It’s not difficult exactly. Just another book I had to close: no progeny will be forthcoming from this body.

Next… the fun party treats (chemo side effects! Including will I lose my hair? Yes, unless… But wouldn’t we rather talk about diarrhea and vomiting?!?)