I went to the hospital on Friday to get the results from my mastectomy and node clearance. I sat in the waiting room with a touch of PTSD and a lot of a hangover (more about this in a later post) getting increasingly more nervous. Eventually the surgeon called me in and in the 30 seconds that it took me to sit down and for him to speak, I had once again imagined the worst possible scenario. I'm getting good at that.
Anyway, here it is in a nutshell:
The tumour measured 20mm and there was no more cancer in any of the nodes - so only one node with cancer in overall.
I also had intermediate grade DCIS. DCIS stands for Ductal Carcinoma in Situ which means that its a kind of pre-cancer - it's cancer that hasn't yet developed the ability to spread outside the ducts and so is not classed as invasive. It is apparently quite common to find DCIS as well as invasive cancer.
The cancer is grade 2 which is middle of the road as far as aggressiveness goes.
There are three grades of invasive breast cancer:
- grade 1 (well differentiated) the cancer cells look most like normal cells – for example, they are of similar size and shape to normal cells – and are usually slow-growing
- grade 2 (moderately differentiated) the cancer cells look less like normal cells – they are often larger and show variation in size and shape – and are growing faster
- grade 3 (poorly differentiated) the cancer cells look most changed and are usually fast-growing.
Grade is different to stage. The stage of my cancer, according to my histology report is stage 2A.
Very good margins around the tumour which were all negative (basically no cancer cells found in the tissue around the tumour).
No vascular invasion - vascular invasion is when the cancer breaks through the walls of the blood vessels in the breast and it increases the chance of the cancer spreading to other areas of the body.
The tumour is 8/8 oestrogen receptive which is the highest it can be - we knew this from the biopsy but they retest these once the tumour has been taken out.
Still awaiting the HER2 result - this was negative from the biopsy and this is apparently very unlikely to change, however it still does need to be retested.
There was lots of other bits and pieces on there but the above are basically the important bits! The main thing that concerns me is that the tumour that was taken out was still all made up of invasive cancer however none of the medical professionals I've spoken to seem to share my concerns!
So what happens now?
Throughout the whole treatment process I've been told that I will need radiotherapy however due to the fact that there was only one node overall involved and the margins were large and clear, the surgeon has told me that this is now up for discussion. I'm not sure how I feel about this. On the one hand, I feel like my body has been through so much that that if I am told radiotherapy will have very little benefit, I'm inclined to not put myself through it. Although nowhere near as bad as chemotherapy, it does bring with it its own side effects, including skin damage, possible lymphoedema and damage to my reconstruction. However, I also feel like I want to have everything they can possibly throw at me. None of it is foolproof, but at least I will know that i have undergone all treatment possible.
The surgeon has started me on a hormone therapy called Tamoxifen, which I will need to take for five years, perhaps ten. However, I'm being referred back to my oncologist to discuss ovarian suppression as well - this is basically the shutting down of the ovaries with a drug called Zolodex with the aim of reducing the amount of oestrogen being produced. However, it does bring with it more side effects, including hot flushes, weight gain, osteoporosis and mood swings. Looking forward to being an irritable, fat, sweaty Betty with brittle bones then! To be honest, I'd take that over cancer any day.
Now is a strange time. I feel like I'm in limbo. There is a chance that active treatment for this cancer may actually be over for me now, although I think it is likely that they will recommend radiotherapy, so perhaps not just yet. I'm full of contradictions. I feel relieved, but at the same time scared to feel too happy or positive just in case it bites me on the bum. Breast cancer can be a persistent disease that often likes to rear it's ugly head just as you think you've seen the back of it. Catching breast cancer early does not guarantee a positive outcome. In fact just writing these words makes me feel incredibly nervous, like I am somehow tempting fate. But then I don't want to spend precious time worrying about what might happen because as I know far too well, life is too short to spend it being miserable.
I feel excited about the future and a life rediscovered, but at the same time I feel hesitant and afraid of what it holds for me. The uncertainty feels almost overwhelming at times and I often wonder how I am going to be able to live happily and productively with the menancing cloud of cancer hanging over me.
I want my old life back, but I also want things to change - I want to feel that my presence in this world (however long that may be) is making a positive difference. I've been given one huge wake up call - I've stared my own mortality directly in the face. Where do I go from here? If the cancer really has gone, how do I use the second chance that I hope I have been given?
I feel like I should be making plans - there are so many things that I want to do, places I want to visit and ambitions that remain unrealised. But then, my life is still on hold. Because this isn't over just yet. Friday was one in a long series of hospital appointments and medical discussions that will continue, at least for now.
However, I am going to draw myself back in to the present and deal with the here and now. I'm going to tentatively allow myself to feel positive and try to deal with and enjoy each day as it comes. I'll also be repeatedly reminding myself of this mantra: