What’s Next?

I’ll be frank.  Yesterday was a rough day.

It is rather surreal to walk into a place and know that every patient there had some sort of cancer.  I knew it was a big building.  I wasn’t prepared for how many people would be there.  It was a hoppin’ place.

We arrived a bit early, checked in and sat by the windows.  The 3rd floor of Seattle Cancer Care Alliance is the Women’s Health Center.  The waiting room has floor to ceiling windows that overlook Elliot Bay.  I love to watch the boats go to and fro.

I knew the appointment would be long.  It was scheduled from 12-5 with a 1 hour break from 1-2.  I met with a medical assistant, a nurse advocate, physical therapists, a survivor volunteer and the whole medical team.  It was quite the production.

The short version is… there are still many unknowns.  I walked in wanting a clear cut plan.  I wanted to know what was going to happen.  

I have a general idea of what could possibly happen.

Answers… No.  A direction… Yes.

The basics are that most indicators point to good things.  The tumors (there are 2) are ER+.  One is ER+ and PR-.  Both are Her2 negative.  Both are Ki-67 positive.  The initial ultrasound and (many) physical exams show the lymph nodes are not affected.  However, the tumors are a grade 3; add that to the Ki-67 positive and you have a bit quicker moving cancer.  The doctors won’t know more until they run a few more tests and ultimately get in there and look at the lymph nodes.

What’s next?

First I have to have an MRI.  This will give them a better picture of what this thing looks like and maybe if there is lymph node involvement.  Second, I have to go for genetic testing.  Since I’m an adoptee I dont know my family history.  I need the genetic testing to see if I’m a carrier of the BRCA genes or other genetic indicators that lead to breast cancer.  Third I meet with a plastic surgeon to discuss options for reconstruction.

Once I have all of that done, I can go forward with scheduling my actual cancer surgery.  This is where my headache started to set in yesterday.

I was hoping for lumpectomy.  I like this doctor.  She was frank.  She didn’t sugar coat it.  I need a mastectomy.  At the moment it’s only a single.  Depending on genetic testing it might become a double.  That would be my choice.

Radiation is up in the air.  It depends on exactly how big the tumor(s) is as well as lymph node involvement.

Chemo is also up in the air.  They’ll send a sample out for testing and make a decision after that.

For now, I know surgery and long term hormone therapy.

As to how I am feeling.  I’d like to adopt my friend Kate’s motto of #nobaddays.  I’ll be honest.  I can’t.  I’m 40.  I am a wife and a mom.  I have a career.  I have all of these things I’m dealing with and the thought of 4-8 weeks of recovery following a surgery that I can’t schedule for probably another 4 weeks, plus potential additional treatment has me very very tired.  

I can only communicate information to so many people at once before I become completely exhausted.  I am going to use this website to be my main source of keeping you informed of what is happening.  

Thank you to everyone for their love and support.  This is just the beginning.  We’ve a long road ahead of us.

11 Comment

  1. Marsha McBrady says: Reply

    You are loved & in our prayers

  2. TK says: Reply

    M has one tumor, and it’s Grade 2 Triple Negative (ER -, PR-, Her2-). Her PET Scan revealed that there is at least one lymph node involved; maybe three. We spoke with a surgeon, followed by her oncologist. Because her tumor is hormone negative, that reduces treatment options to surgery, chemo and radiation. The surgeon suggested chemo, then surgery in order to kill cells ASAP and try to reduce the size of the tumor. The oncologist said that surgery then chemo or chemo then surgery had the same outcome. We opted for chemo then surgery. Her tumor has shrunk; she’s completed 5 out of 8 chemo sessions. Since then we have learned that following surgery, she will also have five weeks of radiation.

    M also had genetic testing and it came back negative for BRCA1/2 and a few other cancer markers. Therefore, lumpectomy is still an option. If it would have come back positive, she would more likely have a full mastectomy.

    1. TK says: Reply

      Oh, and interestingly the biopsied lymph nodes showed negative for cancer, but the PET scan showed positive.

    2. admin says: Reply

      The whole surgical team agrees that I’m not a candidate for chemo then a lumpectomy. The primary tumor is mostly right in the center, but infiltrates the 1 o’clock quadrant and the second is in the 4 o’clock quadrant. She wouldn’t be able to do a lumpectomy without severely deforming the breast. Even with chemo to shrink the tumor it would still not work. She tried to figure it out, but couldn’t come up with a viable option.

  3. TK says: Reply

    What is Ki-67 positive? I don’t think this was something we discussed with M’s oncologist.

    1. admin says: Reply

      Ki-67 is a protein in cells that can tell a doctor how soon a cancer cell is going to divide. While this information may not primarily impact treatment decisions it does give information about how quickly a cancer is growing. It isn’t something that is normally discussed or even included on pathology reports. Some doctors aren’t sure what to do with the information. My oncologist brought it up in conjunction with the grade so it plays into how fast things are growing.

  4. Missy,
    How I started my walk with cancer…first I bought 10 movies that I love, all positive. Then some new PJ’s, that’s a must. Then I surrounded myself with close friends, people I love who love me back. Then it was one day at a time. You will learn to rest. My kindest thoughts are with you. Love,

  5. TK says: Reply

    Thanks for the clarification. Sorry you have to go through it. It all SUCKS but sounds like you have a good team.

  6. Nathe says: Reply

    Love you!

  7. Mom says: Reply

    You are going to come to the other side and encourage others. That’s how you roll! Hugs ??????

  8. Jenny says: Reply

    Like the update thing. The GS crew are here for you. Cancer really sucks. It sucks you have it. Yuck!

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