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No Hill For a Climber, First Oncologist Visit

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"Hurry up and wait!"

"Hurry up and wait" has been a military mantra that has existed since the beginning of time. I had hoped when I retired from the military that I had left that mindset permanently behind me, Hell no, it appears that "hurry up and wait" also applies to the medical community when it comes to dealing with cancer.

A lump, or abnormality is found during a routine doctor visit - hurry up and wait to get in for a mammography.

Mammography confirms the presence of a lump - hurry up and wait to get a biopsy done.

The biopsy has been completed and the pathology reports are returned - hurry up and wait for a mastectomy which is performed by a breast oncology surgeon.

The mastectomy was expertly performed, which is followed by three weeks of more waiting in order to hurry up and see another oncologist on the treatment team for a treatment plan.

We saw the oncologist today to learn we will be waiting for more pathology testing to be done and treatment will have to wait until Loraine has fully healed from her mastectomy. And now, we also have to wait a short time to see the radiologist who will be doing the radiation treatments that are necessary before either chemo or hormone treatments.

There is a lot of "hurry up and wait" when it comes to cancer. While the diagnosis is scary as hell and you want the cancer removed and or treated "right now", it does not work this way. All this being said, Loraine's cancer treatment team of doctors and nurses are phenomenal. I am only relating this information to you in order that you can know before hand, should God forbid you ever receive a cancer diagnosis, that there is a process that has to be followed. Treatment is not done right away, surgeries have to be completely healed, pathology's have to be completed. Successful treatment requires that all the proverbial ducks are in a row, and none are straying. We want answers and treatments right now, there is a fear that comes with not knowing what the future holds. The "not knowing" can make time stand still when you have to "hurry up and wait" between visits with the treatment team. As afraid as we might be, we have to place our trust in the wisdom of the physicians involved. Our sense of urgency is obviously going to be high, but the professionals on the treatment team see these kinds of things every day when they report to work. I am quite thankful to say, Loraine and I are completely comfortable with her treatment team, and they have our full trust that they are going to take excellent care of her.

After a biopsy has been performed, a pathologist examines the tissue microscopically to check for cancer. The pathologist will make a report that provides information that helps to describe the breast cancer and helps you and your oncologist to make decisions regarding your treatment options.  The pathologist helps to determine the stage of the cancer by a system called TNM: the T describes the type and size of the tumor; N is for the number of lymph nodes that have cancer present, and the letter M signifies that cancer has spread outside of the breast and regional lymph nodes. The pathologist also determines several characteristics of the breast cancer that help the oncologist to formulate treatment options and make predictions about the risk of spread. These include hormone receptor status, tumor grade, growth rate, margin status and HER-2 expression (normal versus over-expression).

Loraine's breast cancer is a ductal carcinoma  which means it originated in a milk duct. Her cancer involves Non-invasive (In situ) and Invasive cells. The tumor was 3.8 cm, or about the size of a golf ball. For a better understanding of the two types of cells:

Non-invasive (In situ) cancer cells stay inside the milk ducts or milk lobules in the breast. These cells did not spread into or invade normal breast tissues.

Invasive which most cancers are, break through the small area where they start and then venture into normal breast tissue or other areas around the breast. Sometimes, these cell spread to other parts of the body through the blood or lymphatic system.

Because the margins were negative, it appears no more surgery will be required. Good lord I hope not. As Loraine likes to joke - never take a nap at Saint Luke's North, they steal body parts from you...

Tumor Grade

Tumor grade compares cancer cells to normal breast cells, Based on the comparisons, a "grade" is given to the cancer. Note: The "grade" is not the "stage".

Grade 1 (low grade or well diferentiated) These cancer cells still look like normal cells. These cancers tend to be slow growing.

Grade 2 (Intermediate/moderate grade or moderately differentiated) These cancer cells do not look like normal cells. They appear to be faster growing and they tend to stick together.

Grade 3 (High grade or poorly differentiated) These cancer cells have irregular shapes and and stick together. They tend to be fast growing.

Loraine's cancer is "Grade" 2

Lymph Node Status

Loraine's cancer has spread to one lymph node and these cells have extra-capsular extension which means the cells were coming outside the lymph node.

Whether or not you have cancer cells in the lymph nodes which drain from the breast is one of the most important pieces of information about the risk of cancer spreading. In general, negative lymph node status is better than positive, and a low number of positive nodes is better than a higher number.

Hormone Receptor Status

Loraine is positive for both Estrogen and Progesterone.

Normal breast tissue has receptors for estrogen and progesterone. A breast cancer that is hormone receptor positive for either Estrogen or Progesterone means you may benefit from hormonal therapy. Most hormonal therapy is in the form of oral drugs. A breast cancer that is negative for Estrogen and Progesterone will not benefit from hormonal therapy.

HER-2 (neu) Expression Status

HER-2 is a promoter gene that helps control how cells grow, divide and repair themselves. Twenty five percent of breast cancers over-express HER-2 and these tumors tend to grow faster and have a greater likelihood to metastasize. Loraine's IHC, or ImmunoHistoChemistry test came out negative. This is a good thing!

Where we are right now.

Surgery has been completed with the removal of both breasts i their entirety. Loraine is in high spirits and is healing nicely, my dear wife is a tough one! Being as the cancer has spread to a lymph node, radiation is a given for the next step in this journey. However, no treatments can begin until she has fully healed from the mastectomy.

Tissue has been sent to a lab in California for further analysis, or testing called OncotypeDX. Once this testing has been completed, we will know for sure whether she can receive hormonal treatment to if she will have to endure chemotherapy. Hopefully she will only have to do the hormone treatments. If you have never heard of hormone treatment here is how it works in laymans terms: Cancerous cells that have formed because of Estrogen are unlike normal tissue cells. Think of a normal tissue cell like you would a room in your home with maybe one or two doors leading into it, you have better control over who or what enters that room. Cancer cells that are a result of hormones, are akin to that same room in your home except that it now has several open doors allowing bad players to invade your space as the please. The hormonal treatment cuts off the hormone production which then slams all those damn open doors closed to the bad guys. The bad guys will find themselves evicted with hormone treatment.

Physical Therapy

Tomorrow morning we will head to the physical therapist office for Loraine's first therapy session and also to pick up her compression sleeves. Unfortunately, she will likely need to wear compression sleeves the rest of her life in order to prevent lymphedema from occurring in her arms and hands. This is a risk anytime lymph nodes have been removed. The other component to combating lymphedema is a healthy diet and weight loss, and then weight management along with light exercise.

We still have many days of "hurry up and wait" ahead of us, but the future should be less stressful as we are now armed with more information that we had been. The not knowing, second guessing, predicting outcomes and everything else that comes from a lack  of full knowledge is maddening to say the least. Hopefully now our stress levels will continue to drop as we lean forward and drive on.

To all our family, friends and others who have expressed their love and support, we are eternally grateful to each and every one of you. God bless, and thank you for reading.

 

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