BC Becky

Never thought I'd want to be a breast cancer survivor

Category: Pathology

  • Radiation therapy

    Radiation therapy

    Went up to Halifax today to have a consult with the radiation oncologist. I was expecting to be told that they recommended wide spectrum prophylactic radiation for four to six weeks – which would be a more typical treatment regime for someone on original diagnosis who had a lumpectomy and positive lymph nodes. That isn’t me.

    Both the oncologist and resident were clear I was special – that it would be experience that guided treatment recommendations. There is no direct clinical evidence-based recommendation for my specific case.

    We first saw the resident – who was there on her first day – One thing she mentioned was the difference between “local” recurrence – which would be if it recurred in the skin of the breast or chest wall, as that is still breast, and a regional recurrence which is what it is in my case – where the cancer recurred (and mutated) in the lymph nodes.

    At one point the oncologist said we were dealing with a different cancer – in that it has a totally different pathology from my previous cancers – with lower estrogen receptor and the new HER2 positive receptor. So, in many ways, we are dealing with this like a new cancer, hence the full chemo regime.

    She did throw a number out there, that no one else had mentioned – and that is that I have a 50% chance of recurrence – in part again because it is rare for the cancer to come back almost 10 years later. It isn’t that uncommon for it to mutate if it comes back, so the change in pathology isn’t a huge surprise.

    The radiation oncologist recommends radiation to specific lymph nodes that are further in from the ones that were removed. These are nodes that if they did get cancer, it would be very difficult to remove them surgically. One of them is very close to the brachial nerve which affects motion in your arm. Those who end up with tumors there are often in a lot of pain. There isn’t much she can do after a tumor grows there – but we can do radiation now to reduce the likelihood of spread to under 5%. So, although there aren’t specific numbers for me, there were a couple of numbers mentioned.

    The radiation would be for three weeks (15-sessions) and would only be to the series of lymph nodes (between the axilla where they were removed and the lymph node under under my collar bone near my neck). They won’t be doing radiation to my chest wall, sternum, or left side as there is nothing to warrant it. This makes me feel better, as I feel like what is suggested is very specific targeted radiation that has a very specific purpose, and not a general overall prophylactic radiation to “catch errant cancer cells”.

    The radiation oncologist (rad onc) mentioned that typically with HER2 disease they do a CT scan of the head as well as the core of the body. When I was diagnosed, they checked my bones and ensured that I didn’t have cancer there, but they didn’t validate that my brain is clear. With HER2, it is quite common to metastasize to the brain. She is going to order a head CT that can be done in Bridgewater. That is going to generate a whole new set of scanizety for me.

    The next steps for radiation is what is called a simulation or marking appointment. It is an appointment where you go to the radiation treatment centre and they use a CT find exactly what they want to irradiate, and then they measure and mark you – with small tattoos. These are used during treatment to ensure everything is lined up. A couple or few weeks after the simulation, treatment will start.

    They do have some things organized – for example, late Monday and early Friday appointment time slots are reserved for those who are staying at one of the lodges and are travelling home for the weekend – that we would be me. It was on my list of things to ask about, however, they had already answered it in one of the patient information leaflets that we picked up on the way in (to read while we were waiting). There are two lodges where they typically put people up during radiation treatment. All that is setup after the simulation appointment when they are making the specific radiation treatment schedule. I asked about Scott staying with me, and that did not seem to be an issue.

    We also asked the rad onc about lymphedema. This of course is the biggest risk, and for me, has already happened, so she can guarantee that radiation therapy isn’t going to make it any better. We asked about doing treatments for it while doing radiation, and that was not recommended. When I asked more about how it is treated here (as in Nova Scotia as opposed to California), she said that typically a physiotherapist does manual lymphatic massage, and once things stabilize you look at getting appropriate compression garments. It made me realize that I probably bought my garments too soon – they aren’t working well for me, and part of that is that the lymphedema hasn’t stabilized yet – it is quite variable and chemo and radiation won’t help the variability. It doesn’t hurt or really bother me much now, so I’m pretty much going to keep doing what I’ve been doing and make more concrete plans after radiation is complete. I have a lymphatic massage apt with my physiotherapist next week.

    Radiation cannot start until at least 4-weeks after my last chemo treatment. The nurse figured that I’d likely have my simulation appointment in two to three weeks. Radiation would likely start early to mid February. Since my birthday falls on a Friday this year, I don’t expect radiation to start until after my birthday.

    Overall, it feels like a good day. I went in expecting a recommendation of 6-weeks and broad treatment, and came out with a recommendation of 3-weeks and very specific treatment – which is something that I find my easier to get on board with.

  • A surprise diagnosis

    A surprise diagnosis

    The oncologist appointment finally came Oct 10 – just after Thanksgiving. Since this was an in person appointment, it meant driving up to Halifax. We took the opportunity to book a hotel and spend the night, knowing that we had some shopping we wanted to do in the city.

    Shortly after the oncologist got into the office, he shared some unexpected news. The second round of pathology (which I wasn’t expecting) indicated that at least some of the cancer cells were HER2+. This changes everything. It means that there is no choice about chemo. He said that in some ways this is good news as it gives another way to target the cancer (especially, with the reduction in HR number (originally 95% now only 25%). The drug that is given specifically for HER2 is Herceptin and it is given as an infusion every three weeks for a year. Fortunately, for most people it has few side effects. Unfortunately, for herceptin to work it must initially be given with chemotherapy – in this case it will be TC (Taxotere and Cytoxan). This is given once every three weeks for four cycles. So, I will start chemo with TCH for four cycles, and then just H for a full year.

    Radiation is still necessary, and that can happen with herceptin, but not TC. So, the next step in treatment is TCH chemo then a recovery period then radiation. After that there might be endocrine therapy (also called hormone therpy) – but I haven’t tolerated that well in the past, so we will see. With the lower hormone numbers, it might not be worth the side effects.

    The key words the oncologist said were, NED (no evidence of disease) – the surgery removed all evidence of disease and the scans they did showed no disease in the organs or bones, and as a result they are treating this as curative. That is they expect this treatment to “cure” me.

    In the breast cancer world herceptin has been a miracle drug. It has taken a type of cancer that has been known to be aggressive and one of the deadliest forms of breast cancer to making it one of the most survivable forms. That is good news.

    I’m still getting my head around all this. There are a couple of things that need to happen before chemo can start. First I need to get a port. I don’t have usable veins in either arm, and with so many infusions, a port is the best way to go. The second thing is a heart test. Herceptin is also cardiotoxic – in that can damage your heart – fortunately, not in the same way as andriomacin which is one of the drugs I had the first time I had chemo.

    Unfortunately, TC also causes low white blood cells, so they typically give you a white blood cell booster. They call it something different than neulasta, but I think it is the same thing. It causes bone pain the same way and is recommended to take Reactin (interestingly, neulasta they recommended Claritin and I found Reactin to be less effective for me in the past). What is neat here is they will setup to have the VON (Victoria Order of Nurses) come to give the injection – so a nurse will come to be house 1-2 days after chemo to give the injection. I think I still need to get it from the pharmacy myself, that is a question I didn’t ask.

    All the chemotherapy can be done in Bridgewater. There are a couple of chemotherapy specialists here – he was short of calling them oncologists – but they are able to supervise the treatment, and report back to my oncologist. This means I don’t need to drive for over an hour to get to the chemo sessions. The port insertion will also happen in Bridgewater, likely by the same surgeon who did the node dissection. I continue to be amazed at the level of support given for treatment. Information doesn’t always flow as quickly as I’d like, but the treatment itself is moving forward well. I feel well taken care of and I’m not missing the US system. I certainly won’t miss the drives back and forth to Stanford for treatments and doctors appointments. The local hospital is a five minute drive – which makes getting to and from treatment a whole lot easier – and if I don’t want someone with me, that works out ok, as it is easy enough to call for a ride home afterwards – or if I’m overly energetic it is a 25 minute walk.

    Mentally and emotionally, I’m still trying to wrap my head around what all this means. Now that I like to sew and I’m setup for it, I’m looking forward to making my own head coverings. I’m not that concerned about losing my hair – more I’m concerned about how (and whether) it will grow back. Losing my hair will mean I look like a cancer patient – and I now live in a small town. That will feel different than before.

    In the mix with all this is that I’d really like to move into Treehouse before chemo starts – which will likely be within 2-3 weeks. It seems that 2-3 weeks is the pace of pretty much everything here.

    Moving into Treehouse is a bit daunting, but my neighbours are all pitching in to help get my unit ready. It is close – so I expect by the end of this weekend the work could be finished. Unfortunately, hubby is being pulled in many directions with so many critical project tasks that he cannot focus on our unit – so I’m doing what I can to get both it ready and what we need from the house moved. We aren’t moving much stuff – trying to move the minimal amount. Fortunately we still have our house, and don’t need to sell it soon – we want to finish renovating it before selling. There is another Treehouse family living here, which complicates things a little, but will also help – as they can do some of the packing up at the house for us – mostly this will be packing up things like all the food that is in the kitchen so it can be moved. I have most of my open food in boxes but a lot of other stuff that isn’t.

    Our kitchen at our new place isn’t ready quite yet. The upper cabinets need to be moved up, which I’m told isn’t a difficult task. Fortunately there are people other than hubby that can do it, so hopefully that will be done this weekend. We have doors for the upper cabinets, which is nice. We don’t have covers for the lower cabinets, which are almost all drawer pulls. This is good, as I don’t yet know what heights I want the various drawers to be at. I will have a chance to put things in the various drawers and we what makes most sense. I’m excited about having my own kitchen again with my own appliances. I really miss my induction cooktop!

    On top of all of this, I keep over doing it with my right arm. The incision has healed but the muscles haven’t. Plus I have swelling from lymphedema on the right arm and on my right side (making my right breast appear larger than the left! I had started swimming which really helps, but I pulled something in the arm this afternoon while throwing the ball at the beach. It had been weakened by all the lifting I did as we bought things first at Ikea then at Costco – helping with loading and unloading. This is where I need to stop and remember to ask for help. I feel like I’m not pulling my weight, asking other people, who I now are also tired, to help finish paint the unit so that it is ready for us to move in. I need to remind myself that people want to help – but also, I did a lot of painting of the first 18 units, and most of the painting in my unit – so it is OK to be asking for help.

    I’m reminded of something that my friend Janet Lee always says – something that she learned from Arnie and is making a documentary about – “Always ask for help”. I will try to make that one of my mantras.

  • Lab results

    Lab results

    After a slightly frustrating Tuesday, I did receive the lab report first this Wednesday morning. It was really helpful to be able to read the report and process the information – especially given the way the surgeon will rush through things if I don’t slow her down.

    She took a huge chunk out of me – 10.5 cm x 6.5 cm x 4 cm. That explains the 3.5 inch incision, which has nicely healed. I got the go ahead to start physical therapy and introduce more activity. Mostly it is just listening to my body and not overdoing it. Anyways, back to the pathology report. It confirms that it is breast cancer. In the huge chunk there were 10 lymph nodes. Five of the 10 lymph nodes had cancer. Two had extranodal extension. The largest one was 2.5 cm – this aligned with the size the radiologist said when she was doing the ultrasound guided biopsy.

    In my original cancer, my right side was >95% ER and >80% PR positive, HER2 negative. In this one, the numbers are much lower – 25% ER and 10%PR. HER2 is still negative. I don’t know if the lower numbers are “too low” for hormone therapy, or what the extranodal extension means for treatment. Everything is now being passed over to my oncologist and a referral is being said to a radiation oncologist.

    We learned some interesting things – like they don’t do stage and grade in a recurrence. They just call it recurrent breast cancer. They call it a “local recurrence” because my other scans came back clear. That being said, the words metastatic and metastasized came up a lot in our conversation because the cancer is considered to have metastasized to my lymph nodes. That is not to be confused with Stage 4 metastatic breast cancer (MBC). The local recurrence is something that can be “cured”. Where a diagnosis of MBC is terminal.

    I’m not sure how I’m feeling. Of all the things this cancer could have been, this is one of the “better” outcomes. I’m bummed about the number of nodes that were positive; however, the surgeon did say that “at least not all of them had cancer”. That is encouraging, I suppose. I think I’ll get a better sense of how I’m feeling when I know more about the treatment options. Until then, I really don’t have a lot more information – just that I can no longer pretend that it isn’t cancer. It is!

  • Memories of clear nodes

    Memories of clear nodes

    It was two years ago today that I got the very good news that the initial pathology returned that my lymph nodes showed no signs of cancer. It was a few days later when the final pathology report came in that it was confirmed that my lymph nodes did not show any signs of having had cancer – so no dead cancer cells. Since I did chemotherapy first, if the cancer had spread to my nodes, the chemo may have cleared it out. We will never know 100% for certain what the pre-chemotherapy results might have been. It doesn’t really matter.

    Scott told me that I asked him over-and-over again about the status of my nodes as I woke up from anesthesia. It was the biggest unknown in my treatment. I had known that I had tumors. Scanning gave us a pretty good sense of how big they were. Although scans didn’t show us any signs of lymph node involvement, I wouldn’t know for certain until they removed the sentinel nodes (the first couple/few) and tested them for cancer.

    The sentenal node dissection was only a small part of the surgery that I underwent on November 19, 2014. I also had three lumpectomies (which were not really that successful – in that one didn’t have clean margins and one missed the tumor altogether). I knew that my surgeons were not really concerned about the success of the lumpectomies. They knew that they would be going back a month later to do a full bilateral mastectomy. The primary reason for this surgery was a devascularization of the nipple and areola. This was the first stage in the nipple sparing mastectomy. In addition to doing a biopsy of the lump nodes, they also took tissue for a biopsy of the skin under my nipples. If that showed to have cancer, then they would remove the nipples during the mastectomy. Fortunately, the nipple biospies were also negative for cancer.

    This was the first of three surgeries.

    It is hard to believe that was two years ago.

    Feature image CC-Share Alike 4.0 by Cancer Research UK / Wikimedia Commons

  • Talking about blogging with bloggers #vcept

    Talking about blogging with bloggers #vcept

    I’m excited that on Thursday I’ll get to meet a bunch of illness (health) bloggers that I have followed for some time (e.g. Marie Ennis O’Connor (https://journeyingbeyondbreastcancer.com/), Beth Gainer (http://bethgainer.com/), Caroline Frankovich Ronten (http://carolinemfr.blogspot.ca/), Britni Brown O’Donnell (https://bestliaryouknow.wordpress.com/), Alicia Staley (http://www.awesomecancersurvivor.com/), Terri Coutee (http://diepcjourney.com/), and Scott Johnston (https://scottx5.wordpress.com/) . I’ll be meeting them virtually, but synchronously using Google Hangouts on Air video chat. We’ll be talking about why we blog as part of a new project I’m working on with Virtually Connecting.

    If you are curious about why we chose to blog, you can watch the hangout from the Virtually Connecting YouTube channel embedded in the event announcement: http://virtuallyconnecting.org/announcements/making-the-private-public-why-we-chose-to-blog-a-vcept-discussion/

    I hope to be hosting more of these discussions over the next year or so, exploring the digital health literacies used by ePatients. If you have a topic you want us to talk about or you want to participant in a discussion, leave me a comment or note.

  • My biography

    My biography

    I spent the day today preparing my biography for an upcoming Commonweal cancer help program. We were tasked with writing our biographies. We could write as much or as little as we wanted. We could talk about any aspect of our lives.

    It was an interesting reflection. I started at the end really. I wrote a long post on my other blog – a biography of sorts – autopathography – where I interwove quotes from Arthur Franks – The Wounded Storyteller.

    I then created an outline of key events in my life. I shared the short story, which is really my long bio. I looked through our Going East blog for posts about our journey but also about our values. I search through my academic blog for some key reflections, and I search through this blog for others.

    Through the process I didn’t really come up with a theme. The bio seems more of a disjointed connection of stories. I enjoyed the process, but also cannot spend any more time on it right now. I have work to do.

    I’m not going to share the bio with anyone except the folks at commonweal, and maybe Scott if he is really nice to me :-). It is 29 pages and 13629 words.

    I will, however, share with you this word cloud that results from the stories. It is rather jumbled which aligns quite well with how I’m currently feeling.

    20160119 Bio

  • Auspicious dates and my diagnosis story

    I have a lot of anniversaries coming up … so I’m expecting that my life will be filled with emotion.

    In preparing this post, I realized that I never really wrote out my diagnosis story. I spoke it many times at support groups, but never actually wrote it out in this blog.

    It all began with the feeling of a hard spot under my left breast (June 1st). Since my stuff had arrived from Canada earlier that week, we had been unpacking. After a few days of unpacking, we decided to take Sunday afternoon off and go for a bike ride. I actually wrote a bit about the bike ride and shared some pictures when I talked about my cancerversary –http://bcbecky.com/2014/08/my-cancerversary/. I had no idea then how I would be feeling now!

    Each day, as I got out of the shower, and before I went to sleep at night, I kept checking my left breast, in hopes that the hard spot would be gone. It wasn’t. After a week – on Monday June 9th, as 8:30 in the morning I called my primary care’s office to see if I could get in and get it checked out. They had a spot open at 9:20am. I remember walking in all cavalier, and says “this is probably nothing” and “maybe I’m overreacting” but for “peace of mind” I wanted to get it check out. She did a breast exam and confirmed that I was feeling something. I could tell there was definitely some concern in her eyes. She put in a referral for diagnostic (not screening) mammogram and ultrasound. The way she explained it and the way it happened were different.

    I proceeded to go downstairs and book an appointment. The soonest they could get me in was Thursday afternoon. I went home, and jumped on my recumbent bike and went for a long bike ride. I ended up out at Scott’s office, and we rode home together. I remember upon arriving at his office that some of his coworkers were there. They wanted to try out my bike, so we did a little bit of that, before heading home. As we left the Alcatel parking lot, I told Scott that I had found a lump in my breast and that I had an appointment on Thursday to have it looked at.

    Originally, he was not going to be with me at the Thursday appointment – however, I read the information page they gave me, and at the bottom it said “You will get your results immediately”. With that, I decided that it would be better if he did come along (thank goodness!).

    The diagnostics began with a mammogram – which was horribly painful given the large lump in my breast! Then an ultrasound. The tech said – this is what you were feeling?  Uh- yah!

    After the ultrasound, they said I could get dressed and that the radiologist would like to speak to me. I mentioned that my husband was with me in the waiting room and could he please come to the discussion with the radiologist. They had no problem with that, showed us to an office, and the radiologist came in. He was pretty up front. He said – It is cancer. He had called upstairs to the surgeons office, and in 45-minutes the surgeon could seem me to do a biopsy. He commented that if his mother or wife had cancer, this is the surgeon he would recommend. At the time, I did not understand that the surgeon is the first doctor you see when you are diagnosed with breast cancer. I was surprised I wasn’t being referred to an oncologist.

    After a short walk around the PAFM Mountain View clinic, we went up to the surgeons office. The surgeon was pretty matter of fact about doing the biopsy. He said to book an appointment for the following week (when the pathology results would be known). Because of my age, he also recommended genetic counseling, so we booked that appointment too. He gave us the quick 5-minute version of the longer 45-minute talk that would happen the following week. The short comment was that I likely needed a mastectomy. While we were doing the biopsy and talking with the surgeon, the radiologist called. They wanted to see me back downstairs at the mammogram / ultrasound lab because the radiologist saw something suspicious in my other breast. So, downstairs we went, off with my top again, and he validated that it could be seen on the ultrasound. We booked an ultrasound-guided biopsy for the next day (Friday). I also had a chest x-ray and a bunch of blood work done.

    On Friday we met with the genetic councilor. We drew blood for that, but couldn’t submit the panel until we had confirmed pathology – at which time the insurance would cover the test. I did the guided ultrasound guided biopsy on Friday afternoon.

    As I was supposed to by flying to Ottawa on Saturday, I had to cancel my travel plans and inform a few people of what was happening. Because we didn’t have pathology, we didn’t want to make things public just yet. It was all very awkward.

    On the weekend, we went for a walk around Sausalito. I recall that walk because I found myself checking out women’s breasts. It was and odd thing really.

    On Monday, I received two phone calls from my surgeon confirming breast cancer in both breasts.

    On Friday, we went up to Stanford for a second opinion. After appointments, I did my first breast MRI. It was the breast MRI that showed the third tumor.

    So, there is my diagnosis story … details of how thing unfolded starting on the weekend after diagnosis are described in detail on the blog. I just seem to have missed the very start of the story.

     

  • An epic ride

    Today’s ride was rather significant for me. For the first time since treatment, I made the ride up Mount Hamilton from the Fire Station. The last time I did the ride was back on June 20 – just as I was starting this blog. Since then I’ve been through 16 weeks of chemotherapy and two surgeries. I am thankful for the time I’ve already spent with the Living Strong Living Well program, as it certainly has helped me gain some of my strength back. I was clearly not as strong climbing today as I was back on June 20th, but this time I also wasn’t stopping at every corner to cry (rather I stopped frequently to drink).

    After the first 30 minutes (and 2.8 km) I didn’t think I had any hope of making it to the top. But I stuck with it, and 2 hours later I made the last pedal strokes up to the Observatory (2.5 hours up, 35 minutes down).

    Photo & Video Sharing by SmugMug

    What is also significant about this ride, is that I was doing it in part to celebrate being 3-months cancer free. Technically, the last bit of known cancer was removed from my body on December 17th, 2014 – which was confirmed with the pathology on December 29th. March 17th, the 3-month mark exactly – is Tuesday – also the day in which I have scheduled for my next (and hopefully last) surgery. So, I’m not going to be able to ride on Tuesday … and who knows how long it will take me to recover from this surgery, but this time I’m going into it strong!

     

  • Pathology – What it means …

    I’ve gotten pretty good at interpreting what the pathology reports say, but I’m not great at what it means.

    Just before my oncologist walked into the room I said to Scott – “what I’m afraid of is that he will recommend more chemotherapy”.

    My oncologist walked into the room and said that he would be presenting my case at the case conference the next day. The case conference is where all the cancer specialists get together and collectively try to figure out the best course of action. The question was, do I need more chemotherapy after surgery, and if so, what chemotherapy?

    I actually didn’t think to get confirmation as to why my oncologist thought I might need more chemo – but I’m guessing it is because of the R1 results. This is the first time my oncologist mentioned the bilateral nature of my cancer and how bilateral cancer is rare – which is in part why they don’t have clear path for treatment. In addition, they have only been doing neo-adjuvant chemo for 15-years – so again, longer term outcomes are not completely clear. I’m pretty sure that if we were only dealing with L1, the idea of more chemo would not have been suggested.

    The key reason this question mattered now is that it determined whether or not my port would be removed on my upcoming surgery on December 17th. If more chemo is needed, then the port stays, otherwise it can be removed (making the breast and plastic surgeons jobs easier).

    Fortunately, on Friday afternoon I got word “Case conference discussed your case. No more chemo indicated, we will take out your port at the time of surgery. You will be recommended to take 5 years of Tamoxifen after surgery. No more chemo!” I broken down in tears after reading this. 

    So yay on the no more chemo. I’m cautiously optimistic that the recommendation will remain the same after my next surgery when the full breast pathology is available, but I’m still nervous about the R1 result – the chemo didn’t really work on that tumor, does it mean that I’m destined for recurrence? Or will the surgery be enough to kick this cancer?

    Looking back at the data about complete pathological response in neo-adjuvant chemo, the left breast response is good – it was pretty close to a complete pathological response and may very well have been one had I completed the three additional doses of taxol. So that looks good. That fact that I did not have a clear indication of response in the right breasts is a predictor of absolutely nothing (since the tumor wasn’t as big nor growing as fast – complete pathological response isn’t an indicator of prognosis) … that is, it in no way predicts whether or not my cancer will metastasize.  It is pretty much a roll of the dice … only time will tell.

     

  • Pathology – What it says

    On Thursday I received the first of the surgical pathology reports. I’ll get another at the end of the month after my bilateral mastectomy. This one reported on nine tissue samples that were taken on my November 19th surgery.

    First and foremost, my nodes remain “negative for carcinoma”. In addition, the sub-nipple biopsy also indicates negative for carcinoma. That means, that my upcoming surgery on December 17th will be a nipple sparing bilateral mastectomy with immediate flap reconstruction. The surgeons will do what they can to keep my nipples (yay). It may not seem like much to someone who isn’t going through this process, but the whole idea of looking down after surgery and seeing yourself has a huge psychological impact. As much as I may not feel that I ‘care’ about my nipples, I know that if they were gone I would really feel it. Since the technique is rather specialized, I’m also contributing to the education of residents & fellows during the process. For me, that gives some meaning to this horrible experience. It makes it important.

    The next part of the pathology talks about the three lumpectomies. I had three known tumors based upon the initial pre-chemo MRI (L1 was the largest mass at 2.4cm x 2.3cm x 3.0cm), L2 was a small mass only found on MRI at 1.0cm x .9cm x .8cm, R1 was a mass 2.7 cm x 2.1 cm x 2.0 cm). The earlier biopsies showed DCIS in the left breast. It is not uncommon to see DCIS (pre-cancerous cells) when there is IDC. In addition, chemotherapies doesn’t target DCIS.

    L1 – This was the biggest success. What was left in the area was scar tissue with a single .2cm cancerous mass. In addition, there was DCIS close to the margin (in essence, if I had been only doing a lumpectomy, this would be said as not having clean margins therefore additional surgery is required- it doesn’t matter because they are going to remove all the breast tissue on the next surgery).

    L2 – This showed only normal tissue. My guess here is that they go the wrong spot, because the marker was out of place. We will find out more about this in the mastectomy pathology.

    R1 – This showed the part that worries me the most. This showed a mass of 2.1 cm x 1.6 cm of IDC and additional DCIS. 10% of the invasive mass was DCIS. Here the margins were not at all clean with additional invasion at the margins. What concerns me most is that the chemo had little effect on this mass. It is a little smaller (so at least it isn’t bigger), but not significantly so.

    The pathology included staging for my cancer:
    Left: ypT1a ypN0 (post neo-adjuvant chemotherapy, stage 1A no lymph nodes)
    Right: ypT2 ypN0  (post neo-adjuvant chemotherapy, stage 2 no lymph nodes)

    In summary, the left breast shows definite signs that the chemo worked, where on the right the treatment effect is listed as “indeterminate”.

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