In the three weeks since I've been diagnosed with breast cancer I've met with many doctors, had lots of tests, and filled out many forms. It's been a lot of information and a lot of thinking. We now have a plan with my team of awesome doctors to help me live a long and healthy life.
Here's the plan:
Chemotherapy starts on August 14th
Dr. B, my medical oncologist, will help me kill the cancer inside me with chemotherapy and long-term, work with me so that it doesn't come back. The first appointment with Dr. B was hard because he gave Jason and I handouts that walked through my odds of recurrence and death based on different treatments. Don't worry, I'm planning to be around a long time.
Based on my cancer and age, Dr. B says the best approach is chemotherapy and surgery. I can do chemo before or after surgery. I can choose between a 3 month or 5 month regimen. Even though this was completely overwhelming to hear at first, the good news is that I have options because my cancer is in such a good, treatable state.
I decided to do chemotherapy before surgery because it can treat my whole body immediately. Since my cancer is invasive, my biggest worry has been that it has spread beyond my breast. From ultrasounds and MRI there is no evidence that this has happened but I admit right now there's still that worry.
My chemo cocktails
Whoever came up with the idea to call chemo combinations 'cocktails' is just plain mean. Especially considering that with cancer, drinking good cocktails is not in the picture. There's nothing foo-foo, yummy or fun about chemotherapy.
What IS great about these types of cocktails is that the combinations of chemicals attack all different kinds of cells in the breast cancer and they keep the cancer cells from figuring out how to protect themselves or develop resistance.
Of the two chemo regimens Dr. B recommended, I chose the ACT regimen, a more aggressive option. For 8 weeks on every other Friday, I'll get a combo of Adriamycin (chemical name: Doxorubicin) and Cytoxan (Cyclophosphamide). Then for 12 weeks every Friday, I'll get Taxol (Paclitaxel).
The downsides of chemo
Chemotherapy kills the cancer cells (yay!) but it also affects good cells which results in a variety of possible side effects and risks. Everyone is unique so each person reacts differently. Not knowing how your body will react is scary but Dr. B will work with me to tailor the treatment and address issues as they come up.
I could list out all the possible side effects but that gets pretty depressing quickly. I may get some of them but it's unlikely that I'll get them all. Knock on wood. What you can expect is that I will be tired, feel sick, lose my hair and will be more likely to get an infection. If you're sick, stay away!
One less common side effect is that Adriamycin can affect the way the heart works. I'll do an echocardiogram before chemo starts to make sure that my heart is healthy and they will continue to monitor for problems throughout the AC treatment.
My new friend, the port
To safely and easily give me my cocktails, Dr. C, my breast surgeon, will do a small surgery to insert a port under my skin in my upper chest. The port is a round, purple object about the size of a quarter and about a quarter inch deep. Attached to the port is a tube called a catheter which will be placed into one of the large veins in my chest. At each chemo session, the nurse will deliver my chemo through my handy-dandy port.
Double-check that it hasn't spread
I got an MRI recently which showed no evidence that the cancer has spread anywhere else. If the cancer were to spread, one of the earliest sites would be to my lymph nodes under my arms. The most conclusive way to check is to do a sentinel lymph node biopsy.
A sentinel lymph node is the first lymph node to which cancer cells are more likely to spread from a tumor. Sometimes there can be more than one sentinel lymph node. While I'm getting my port inserted, Dr. C will inject a dye to identify the sentinel lymph node(s) and then remove them. They'll be sent to a pathologist who can determine if cancer is present. If no cancer is in these nodes, then it's unlikely the cancer has spread.
After chemo, then surgery
I knew Dr. C would be my surgeon when he gave me a hug after our first visit. Dr. C will cut the tumor out of me either by mastectomy or lumpectomy. Based on data going way back when, the outcomes of mastectomy vs. lumpectomy are the same.
A lumpectomy is called breast conserving surgery because it tries to keep the original look of the breast by removing the tumor and surrounding tissue. The 3 cm size and 12 o'clock position of my tumor would make it difficult to do so without first shrinking the tumor with chemotherapy. Doing chemo first makes a lumpectomy a possible option for me.
A mastectomy is the removal of the entire breast. If I decide to go this route, Dr. C says it's up to me if I'd want to do one or both breasts. In my recent MRI we found a suspected fibroadenoma mass (which are benign) in my right breast (my cancer is in my left). You can't help but fear that more masses, benign or cancerous, could appear which makes a mastectomy sound appealing.
The Angelina Jolie test
One factor in helping me weigh my surgery options is the Angelina Jolie test. No, it really isn't called that but her name comes up every time. The genetic test for BRCA1 and BRCA2 gene mutations is the reason she had a double mastectomy without being diagnosed with cancer. BRCA1 and BRCA2 (BReast CAncer genes 1 and 2) are the best-known genes linked to breast cancer. People with these mutations have a greatly increased risk of breast cancer and for women, ovarian cancer.
I was a candidate for this test because I'm under 50 years old and I have a family member, my Aunt Judi, who had breast cancer. I'm waiting to hear back on my results but the odds are good that I don't have this inherited gene mutation. Only 5 to 10 percent of breast cancers in the U.S. are linked to BRCA 1 and BRCA 2.
If lumpectomy, then radiation
If I choose to do a lumpectomy, then Dr. R will do radiation treatments following surgery to get rid of any microscopic amounts of cancer. The radiation targets just the breast area. If I do a mastectomy, no radiation treatments are necessary.
If mastectomy, then breast reconstruction
If I choose to do a mastectomy, then Dr. M will reconstruct me with fake boobs. Not only did I never expect I'd get cancer, I never expected I'd get breast implants. I joked to Dr. M that I have never talked about boobs, especially about my own, as much as I have now. He laughed saying he talks about boobs all the time.
He brought out his 'bucket of boobs' to show me just a few of the shapes and sizes to choose from. There's so many options he said, "It's like choosing between all the various flavors of Coke." As far as leakage worries, there are none. You can cut through today's new silicone implants and they remain intact. With implants you'll always be perky and you can opt to go a little bit larger. Buy me a coke!
It sounds great but then it gets a lot more real. That day Dr. M saw 5 breast cancer patients. Fifty percent of his practice is breast cancer reconstruction. He showed me photos of women post-mastectomies. In place of breasts were long scars and sometimes deformed remains of breasts. Then we looked at the same women post-reconstruction. Initially you can't help but be shocked at both photos. While the post-reconstruction is much better, the reality hits that your breasts will never be the same.
If I choose to have breast reconstruction Dr. M recommends I do a delayed-immediate reconstruction. As soon as Dr. C performs the mastectomy, Dr. M would insert an expander to preserve the breast's shape and skin while the cavity heals. Three months later, he would replace the expanders with implants.
Whew, you got this far
It's not only tiring to read about it, it's also tiring to think about it. You start adding up all the treatments and it's a long time. After chemotherapy, surgery, possible radiation or reconstruction there will be hormone treatment. There will be more drugs. There's probably things I don't even know about yet.
Right now I'm feeling much better than when I was diagnosed. I've been thinking about it like I'm running a marathon. It's going to be long, hard and I'm not sure what's going to happen at each mile but I'll take each step at a time. I also have an amazing team of family and friends that I know will be with me along the way. It's meant the world to me to hear all your touching and supportive words.
My sorority sister and amazing photographer Michelle told me that to deal with her dad's recent passing and a friend's cancer scare, her family found that swearing at each other helped pull them out of their sadness. So she said this to me with much love... YOU GOT THIS BITCH! I do have this. Feel free to swear at me anytime if you can't think of anything else to say or just want to cheer me up.