Day 4 - Pick Your Poison

So it's day 4 of this 5 year journey. Everything is still so new and surreal. It doesn't make sense that this is what I'm really suppose to be going through. I'm waiting for the morning that I wake up and I've dreamt it all. We spent the day today at the dog park with Tomo, at the pool with the Bailey clan and grocery shopping for the weekend. At the back of all of our minds I'm sure - Mike, my mom and I couldn't stop thinking about it. I'm a cancer patient. I'm going through what you watch on TLC or NatGeo. You don't ever expect to be going through it. This is one time I would much rather spectate, than participate.

So where are we now? We met with the first surgeon yesterday, Dr. Kercher. (Pros) She was incredibly nice, had a warm and caring bedside manner. I liked her, and trusted what she had to say. She definitely made me feel like she knew what she was talking about. The only issue is - (Cons) if I decide to pick her, she's 20 miles away, in either direction from work or home, in Littleton and the rest of the "team" that I would need to see on a regular basis would be scattered throughout Littleton and and the Tech Center area. Too far to be convenient, especially if I would need be there everyday. Tuesday is looking more and more encouraging -- meetings with the entire, potential, team that would be working on me ... everyone in one place, at one of the best cancer centers in the state, so I'm told. It was good to meet with Dr. Kercher first however. Get the tough news ahead of time -- have my huge meltdown (as I did when we got home during and after I talked to my sister) -- it gives me time to prepare for the next meeting -- time to focus my questions -- time to be quasi-decided on the path I'm going to take for treatment.

So treatment - where does it start. Dr. Kercher said my tumor was "good" -- meaning, it's not big, bad and nasty and out to kill me. This is good. It has a moderate growth rate, replicating itself every 120 days or so roughly. So I have some time to think through all my options without it being a danger to my health. This is good. So here's what she confirmed for us, based on my pathology reports:

1) The tumor is ductal. This makes for a tumor that grows into a nice little ball, instead of spidering throughout my breast tissue which is more difficult to detect early. Ductal breast cancer is accounts for roughly 75 - 80% of all breast cancer, so it's very common, doctors see it a lot, and there's a lot of historical data because of that.

2) Size -- we don't know for sure but the ultrasound is showing roughly 2.7 centimeters.

3) Grade - it's a 2, on a scale of 1 to 3. Grade = aggressive nature of the tumor based on a combination of various factors.

4) The tumor is Estrogen and Progesterone positive - meaning the tumor has receptors on it for estrogen and progesterone and these hormones are potentially feeding the tumor. Since these are present in birth control pills, I've stopped taking my pills. No need to feed the monster.

5) Ki-67. This is a "tumor marker test". High levels of Ki-67 indicate an aggressive tumor and a poor prognosis. A high score on this test means that the tumor cells are rapidly dividing and growing. The score for this test is between 1 and 100. My score is 16. This is good. It's not an angry monster. Dr. Kercher told us that most women my age who are diagnosed with breast cancer have scores of 98 and 99 on this test. So to have a 16 is a good sign.

6) Now, Stage. "What stage of cancer are you in?" This is the question. Stages are from 0 to 5. Right now, as my tests show, I have a Stage 2 cancer. This is based solely on the size of the tumor. Stage 2 is "tumor is larger than 2 cm or has spread to the lymph nodes under the arm." So, because of the size of mine, and because there are no signs that it's in my lymph nodes, I'm considered Stage "2A" ... meaning no lypmh nodes. All this could change however once they get in and take out a "sentinel node" (meaning taking out the node that catches the flow from the tumor) and dissect it under a microscope to ensure that not even 1 cancerous cell is present. If even 1 cell is present, then it has spread to my lymph system.

So here's the million dollar question - the answer to this question will determine my treatment. How do I want it taken out? I have 3 options for removal: lumpectomy, mastectomy, or double mastectomy.

Lumpectomy is just removal of the tumor and surrounding tissue. This would require radiation therapy and most likely chemotherapy as well.

Mastectomy will remove all the milk ducts and breast tissue, sparing the muscle and skin. This won't require radiation (I believe) because there won't be any breast tissue left on the right side, but it most likely will require chemo. Additionally, the chance of recurrence in the left breast is roughly 1% per year. Being that I'm 29 right now, I have a lot more years left to live. So, if I do one, why not just do both.

Double mastectomy will remove all the milk ducts and breast tissue in both breasts, sparing the muscle and skin. This won't require radiation, but most likely I will still need chemo. But both breasts are now, non-functioning.

In both mastectomy scenarios, tissue expanders may be needed before I could be fully reconstructed if I don't have enough skin to cover the implant. So I would be looking at a couple months before I'm fully recovered just from the surgery. Add treatment to that, and it's half a year before I'm maybe back to "normal" excluding dealing with side effects i.e. hair loss or infertility.

Do you see where this is going?

I most likely will need chemo - regardless of the option I choose above. Why? Dr. Kercher said I need to differentiate the treatment processes. Chemo isn't for my breasts, for the most part anyhow. It's primarily for cleaning my bloodstream. If just one of those cancerous cells broke off and entered my blood stream, I run the risk of it settling elsewhere in my body somewhere down the line in life - potentially settling in my liver, lungs, or bones. So -- the only way I'm going to avoid chemo, as I understand it right now, is if I choose to.

So really I have to pick my poison. Nice tumor or angry tumor, I still have to go through similar treatment processes. So what about kids? We don't have them yet, and I really, really want them. The "deal" was we would start trying one year after we married. But if I choose not to do the chemo that makes you lose your hair, and I choose the pill Tamoxifen, which is just a different form of chemo, it blocks hormones and I would be infertile while I'm taking the pill. Seems like the better option on the surface, only the pill has to be taken for 5 years. That's a long time to be infertile and to wait to have kids. But, if I did the chemo that makes me lose my hair, I would need to be careful of the drugs to ensure that they don't harm my ovaries. And most likely I would lose my hair, but this type of chemo could only be for a few months, instead of years.

It all just feels like bleak and bleak. Not an easy way around any of it. Unless, they let me choose my surgery and postpone chemo until after we've had kids and then I pick up chemo when the kids are toddlers and I'm fully healed from the surgeries. Don't know if this is a feasible option at the moment, but I'm going to ask.

So ... one boob or two?