Tuesday, July 5, 2016

Lots of Big Words!

I'd like to go a little more in depth on what has happened between my appointment on June 16th through today (July 5th). My appointment for my MRI and with the breast surgeon is tomorrow & I don't want to get behind before I've really gotten started.

On June 16th I brought this lump to my new GYNO's attention and she scheduled me for an appointment for a mammogram the next day (June 17th). After the mammogram they took me back for an ultrasound. I knew something was up after the technician looked at me for a good 20 minutes and then the radiologist came in and looked for at least 10 minutes. After my ultrasound the doctor told me he was "highly suspicious of cancer" due to some irregularities in the shape & calcifications of the tumor as well as some irregularities in a lymph node in my underarm. I was scheduled for a biopsy on June 28th. I found out later my mammogram was given a BI-RADS score of 5. 

BI-RADS? That was the first word that didn't make sense. It's easy to explain though. When the radiologist reads the mammogram they give it a score of 1-5 to communicate with other doctors how concerned they are about what they saw. This number is called the Brest Imaging Reporting and Data System (Bi-RADS) score. A 1 is a good score - it means no signs of cancer were found. 3 is a gray zone that means your mammogram is probably normal but you have some signs of cancer (2%) and will need a follow up mammogram in 6 months. 4 means you have suspicious findings and you have a 25%-35% chance that breast cancer is present. Then there is a 5. A score of 5 meant my results were "highly suspicious" with a 95% chance of breast cancer & I needed to have a biopsy.

I went in for my biopsy on June 28th. I was scheduled for a Core Needle Biopsy. This sounds so scary but mine was pain free. I'm a little bruised & sore now, but the actual biopsy was no big deal. I was numbed up while lying on a table & the radiologist used ultrasound to guide him. I was given a little incision & the doctor placed the biopsy needled in through the incision. When the doctor pulls the trigger on the "gun" attached to the end of the needle, the needle enters the tumor really fast and cuts a core of the tissue. I thought the gun looked like the ones they use to pierce ears! I had this done three times. Then they put some steri-strips on & I was on my way. They asked if I wanted to come in to receive my results or just be called & I chose to have them call me. They also placed a tiny metal marker in the tumor so if it did come back to be nothing, it would be known in the future that it had already been biopsied. I had to have another mammogram to verify placement & I asked to see it. It looked like a cancer you see in a text book. One big circle with tentacles coming out of it. I felt pretty confident then I knew what my phone call was going to say & I told my husband the same. 

I received a call the next day (June 29th) saying my preliminary pathology reports were in & they were positive for cancer. I had a 3cm tumor & possibly affected lymph nodes. They would have a more specific type of cancer & grade by the next day. I would be scheduled for surgical & oncologist consult as soon as possible and to expect a crazy 6 months. Since I work for the same health care system as I'm receiving care in, I was able to reach out to a large group of co-workers and find out who people thought were "the best" and I feel good in my choices for both doctors. I also live in pretty large urban area & feel like I'm going to get excellent care. My GYNO. is also a breast cancer survivor & she's been an excellent resource. 

My Nurse Navigator (cancer nurse buddy) called the next day (June 30th) to let me know that I was diagnosed with a Grade 3 Invasive Ductal Carcinoma. There's more big words! Everyone wants to know what "Stage" I'm in but I don't know yet. The surgeon determines that after further testing. 

Grade 3. That's easy. A Grade score let's you know how different the cancer cells' look and grow from a normal, healthy cell. They are given a score of 1 - 3. 1 (well-differentiated) just look a little different and are growing slowly. 2 (moderate) don't look like normal cells & are growing a little faster. My score of 3 means the cancer cells look very different. They are growing quickly in disorganized irregular patterns and diving to make new cancer cells..... Well that sounds bad. But maybe not. High grade cancers may respond better to chemo & radiation because those treatments target fast-dividing cells. Again, please remember that this Grade is not the same as a Stage (which is usually referred to as a number 1-4 in roman numerals). Stage is based on the size of the cancer and how far it has spread & I don't know that yet. 

Invasive Ductal Carcinoma (IDC) is the most common type of breast cancer. Invasive means that the cancer has "invaded" to the surrounding breast tissue. Ductal means my cancer began in the milk ducts. Carcinoma is any cancer that begins in the skin or tissues that cover internal organs (like breasts). So combine those three terms and you get a cancer that has broken through the wall of the milk duct and started invading the tissues of the breast. This cancer can spread to the lymph nodes & other parts of the body. They are concerned that has happened with mine but we won't know for sure until we meet the surgeon. 

I found out today a few more in depth things regarding hormone receptors. I was tested to see if my cells are responding to estrogen and/or progesterone. I am both ER and PR positive. When a breast cancer is hormone receptor positive, this allows estrogen & progesterone to "feed" the cancer cells. A cancer is called ER-positive if it has receptors for estrogen and PR-positive if it has receptors for progesterone. I am positive for both. This means that I may respond to hormonal therapy that will reduce the amount of estrogen in my body. This also means no more hormone based birth control for me. 

I also had my HER2 status checked. Ther HER2 gene is responsible for making HER2 proteins, which are the receptors on breast cells. Normally they help control how breast cells grow but in about 25% of breast cancers, the HER2 gene becomes abnormal & can cause the breast cells to grow & divide in an uncontrolled way. If this is happening, it is described as HER2 positive. HER2 positive cancers tend to grow faster, are more likely to spread, and more likely to come back, but they also respond to targeted treatments made to work against HER2 positive cancer cells. My HER2 status is borderline. They are running another test to give me a more definite status. 

Well. There you go. That's all the big words I have for today. I have an MRI in the morning and then meet with the surgeon tomorrow afternoon so I hope to have more big words like Stage and Surgical Margin and Lymph Node Involvement soon. 

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