A New Diagnosis

It's been a while since I posted, but not for lack of news.

On November 16th I learned that I now have breast cancer. I had started getting mammograms and breast MRIs a few years ago due to my increased risk after the total body irradiation. I received my annual reminder letter in August. As you may remember, at that time I was going through radiation for my arm. I made sure that I could have the testing while undergoing radiation, that my insurance (which had changed since the previous year) would cover it, and then I sat on it. I finally scheduled everything for November 3rd. Then, November 1st I found a lump.

An MRI, mammogram, ultrasound, and needle biopsy later, I received my third cancer diagnosis of 2011 (I had a basal cell carcinoma removed in September). The tumor is fairly small (1.3 cm - Stage 1), the lymph nodes looked normal on MRI (but a biopsy will be done to make sure they're clear), and the prognosis is good. However, the suggested treatment regimen includes chemo, followed by lumpectomy plus radiation or mastectomy.

There are multiple types of breast cancer, which vary in their responses to treatment, in their aggressiveness, and are actually thought to be different diseases. My type is referred to as triple negative, as it is negative for estrogen receptors, progesterone receptors, and Her2/neu. Triple negative breast cancer is more common among younger women, is considered to be aggressive, does not respond to hormonal therapy, but responds well to chemo.

Because much of my anxiety post-diagnosis was regarding the fact that this happened so quickly after the MPNST treatment, I was scheduled for a PET scan. A PET scan looks for possible cancer cells in the whole body - radioactive glucose is injected into the body prior to the scan. Because cancer cells have a higher metabolism than other cells, they take up more of the radioactive glucose and are visible on the scan. It's commonly done when metastasis is suspected, so not standard in my case if it was the breast cancer alone. The PET scan was Friday; I was hoping to receive the results yet that day but didn't hear anything. I'm trying to stay positive.

Chemotherapy will include four rounds of the drugs cytoxan and taxotere (CT), given three weeks apart. I am going to receive chemo prior to surgery to remove the tumor; this way, they can use MRIs to assess whether the tumor is responding the the chemo (chemo is given to kill any "micrometastases" that have broken away from the primary tumor - if the cells of the primary tumor respond, then these cells are likely responding as well. If the tumor is removed prior to chemo, you can't know this). If the tumor doesn't shrink, they can change my drugs. Best case scenario is that the tumor disappears. (I would still have surgery - a little metal clip was placed in the tumor during the needle biopsy, and the surgeon would remove this clip and the surrounding tissue.) I am starting chemo Tuesday, December 13th (yes, two days from now).

First, though, I am having surgery to place a port and to do a sentinel lymph node biopsy. A port is a little catheter placed under the skin underneath the collarbone that allows IV medicines to be given without the need for multiple needle sticks. It will look like a little button sticking out of my chest. For the lymph node biopsy, a blue tracer dye will be injected into the breast, and followed to the first (or first few) lymph node it reaches. This lymph node will be removed and examined for any signs of the cancer spreading. I think 1-3 lymph nodes are typically removed, a lot less than before the sentinel procedure was introduced and thereby reducing the risk of lymphedema. Surgery is tomorrow (Monday, December 12th).

The days since November 1st, when I found the lump, have flown by, while at the same time I freak out about six weeks passing between discovery and start of treatment. There were a number of people with whom I wanted to speak in person before updating this blog, which took a lot longer than I expected. Plus I've been spending a great deal of time reading, on the internet, on the phone, and at doctor appointments. Once again, I'm realizing that battling cancer can be a full time job! The last few days I've been trying to get stuff done so I can get it out of the way prior to chemo, when I don't know how I'll feel.

One of the things I've done is purchase a wig. I didn't think I'd wear a wig again, but then I started thinking about work travel, and meeting the staff at my study sites. I don't want baldness to be the first thing they notice about me. As for the rest of the time, I'm looking for cute hats, have some turbans that I bought back in 1989, and would use scarves if I can figure out how to tie them! After trying on wigs, though, I thought maybe I would wear the wig more than I first thought - it's nice for bestowing a sense of normalcy.

I also had my first acupuncture session. The possible side effects of chemo include fatigue, loss of appetite, edema, constipation, and diarrhea (sorry if that's TMI), and vary among individuals. A few things I've heard about getting through chemo: hydrate, hydrate, hydrate (one of the metabolites of cytoxan is toxic to the bladder, plus the more you drink the faster you get all those toxins out of your body), understand your side effects so you can be prepared for them the next round, exercise (which is the one thing scientifically shown to help combat fatigue), and consider acupuncture.

I will try to update this blog more frequently the next few days as I learn the results of the PET scan, the lymph node biopsy, and go through my first chemo infusion.