Game Plan - boring medical details regarding my treatment (Post #3)

This post shares information regarding MY cancer and MY journey. I've always believed that everyone's personal health choices are exactly that - personal. In sharing my own choices, I am not passing judgment on anyone else's decisions, merely laying out my own personal plan. This post also contains a lot of medical information that will probably not mean a lot to most people.  I will certainly not be hurt if you stop reading here. (Besides, I won't know, will I? 😊 Go on now, I said you could stop!)

I may need to up my hat game...💇

Wednesday, June 1, 2022  was TP-day. We met with our surgeon to go over our treatment plan. (TP = treatment plan; what did you think I was referring to?? 😉)   His name is Dr. Dave Olson and he has a 5-star Google rating. I admit I was skeptical; a surgeon with a 5-star rating? I get the hype now; he’s amazing!  His manner is reassuring, he’s not condescending, and he answers all your questions before you even have the opportunity to pose them…in other words, I’m not sure he knows how to operate, because you can't do it all, can you? He’s the head of the Comprehensive Breast Care Program (CBCP) and wow, does he know his stuff. Hubby and I both left the appointment feeling reassured, which was a huge answer to prayer.

So what did we learn today?  Well, we learned that my cancer is:

1. T2 Multifocal 
2. Grade 2 
3. Clinically and radiologically lymph node-negative
4. ER+
5. PR+
6. HER2+

So what does that mean in layman’s terms? Our usual lexicon utilizes the term “Staging” to determine how bad a particular cancer is:

Staging is a way for your health team to find out how much cancer there is and where it is in the body. Sometimes, the cancer is not just in one area. Your doctor will be able to tell you the stage of your breast cancer after all tests, biopsies, and surgery are complete. Most doctors use the TNM way of staging cancer: *

T is the tumour size 

TX: Unable to measure tumour. 

Tis: (T in situ) Tumour hasn’t grown through the wall of the duct into nearby tissue. 

T1 to T4: Tumour of increasing size (numbers 1 to 4 describe how large the tumour is). 

N refers to whether cancer is found in your lymph nodes

NX: Unable to evaluate lymph nodes. 

N0: No cancer found in lymph nodes. 

N1 to N3: Cancer has spread into lymph nodes. (numbers 1 to 3 are based on how many nodes are involved).

M refers to whether cancer is found in other areas of the body (metastasized). 

M0: Cancer hasn’t spread to other parts of the body.

 M1: Cancer has spread to other parts of the body.

                                           _______________________

However, staging can only be determined once the surgeon has operated. So what we know at this point is:

- T2 Multifocal means that I have 2 tumours that we know of; they don't anticipate finding more.

- Biopsy #1 revealed a 1.8cm tumour including calcifications (The actual tumour is 1.1cm.)

- Biopsy #2 revealed a 3.4cm tumour closer to the chest wall.

- Both tumours are in the same quadrant of my left breast.

- The total area that requires removal is just over 6cm.

- My grading is Grade 2: 

Grade 1 - low grade (well-differentiated): Grade 1 cancer cells look a little different from normal cells and grow in slow, well-organized patterns. Not many of the cells divide to make new cancer cells. 

Grade 2 - intermediate or moderate grade (moderately differentiated): Grade 2 cancer cells don’t look like normal cells and grow and divide a little faster than normal.

Grade 3 - high grade (poorly differentiated): Grade 3 cancer cells look very different from normal cells and grow and divide quickly into disorganized and irregular patterns. 

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Using ultrasound and clinical findings (physical exam) they think my lymph nodes are clear. However, this may change after they biopsy them during my surgery.

Whether or not my lymph nodes are cancerous does not change the surgery outcome, just the post-surgery treatment

                                           _______________________

- My tumours have both estrogen and progesterone positive, which means they are ER+ and PR+; this refers to hormone receptors. 

Your body has estrogen and progesterone hormones. Sometimes, these hormones attach to receptors on the cancer cells, which can make your cancer grow faster. In addition to the staging and grading, the cancer cells will also be tested for these receptors. Your cancer cells will be tested to see if they have estrogen or progesterone receptors. Cancers are called hormone receptor-positive or hormone receptor-negative based on whether or not they have these receptors. About 8 out of 10 of cancers are hormone receptor-positive. 

                                            _______________________

- My cancer is HER2+ which refers to:

About 2 out of 10 people have a type of breast cancer that makes too much of a protein called HER2. These are called HER2-positive breast cancers. HER2-positive breast cancers tend to grow and spread faster than other breast cancers, but there are treatments that work very well for them.

Okay, that’s a lot of information I hoped to never need to know, who knew that my cancer has its own pronoun! (Her2+?) What does it all mean in terms of my care plan? Good question!  

                                           _______________________

Surgery is a given. The whole idea behind surgery is to get the tumour out of my body as soon as possible. Unfortunately, he was unable to give me a definitive surgery date today, as my hematoma is still too big. (Large squishy, ouchy bruise under my skin; think of a ketchup packet under your skin…😲)  This also brought up the question as to why I got a hematoma, bled like I'm a stuck highly vascular, bruise so easily, hemorrhaged after delivering both boys, and the list goes on. Dr. Olson thinks I may have Von Willebrand’s Disease, which is a bleeding disorder. Not a huge deal, but can complicate surgery. Hence, I have to see a hematologist asap, so they can see if I need a special surgical protocol. So tomorrow, I go for bloodwork. Dr. Olson’s assistant is also supposed to call me tomorrow with a tentative surgery date and provided everything is in order, surgery should take place within the next 4 weeks. 

Trigger warning!  Gory details regarding the surgery! 

    The type of surgery Dr. Olson plans to undertake is called Round Block Oncoplastic Surgery.  It’s a type of breast-saving surgery that allows him to take out the “piece of the pie” with the tumours in it while saving the rest of the breast.  Basically, it’s a nip and tuck with a twist. The outcomes are the same, both short and long term when compared to the more radical surgical option of a mastectomy, so the decision is a bit of a no-brainer. 

Because I’m HER2+ I have to undergo chemo treatments…for 11 months. 😬 Now, I’m not sure what this all entails, and what the side effects might be, so don’t lend me your wigs just yet! I do know that I will be receiving Herceptin. I will also pursue BRAC1 and BRAC2 testing, which looks for the gene mutation that increases your chances of getting ovarian or breast cancer.  Although I have no family history of breast cancer, it has to start somewhere, and I’d much rather know than wonder.

I will also need radiation. This will take place after I've completed chemo. It involves receiving radiation treatments 5 days a week (weekdays) for 4 weeks straight. 

At the conclusion of my treatment, I will require Tamoxifen or Letrozole for 5-10 years. This is a hormone treatment. 

So…while we received the answers to many questions today, the appointment with the surgeon also raised many more.  The appointment wasn’t short and the information overload was real! Thankfully, the CBCP Nurse Navigator will call me and hopefully provide some of the information I’m missing.  My next appointment with Dr. Olson is in 2 weeks; until then we need to pray that the hematoma is absorbed. 

Also, as an aside I’d just like to thank the Oilers for continuing to entertain me through this unpleasantness.

* All italicized information is taken from the AHS Your Journey Through Breast Cancer Surgery booklet.