LIVESTRONG:

And in June 2013 we are back in the revolving door of doctors, this time for my heart. So the focus has shifted, BUT... I continue to THANK YOU for your prayers, love & support. I receive them with open & loving arms. My wish is that I will gain strength from you, will provide strength to others & will help to strip away the fears we each experience.


LIVESTRONG: I am strong. I am loved. I am healthy. WE WILL WIN!

Have you or your loved one had their annual mammogram? PLEASE, don't put it off. Speaking from experience, I highly recommend monthly self exam as well.

WARNING:
Contents may be uplifting, sad, funny, scary, downright depressing ~ THAT IS CANCER .... at it's best, at its worst.

PLEASE ~ Feel free to share this blog with anyone who is interested to learn about my journey. While I welcome their support, I hope that by sharing this experience freely to the universe I may help to support others by breaking down some of the barriers and fear associated with breast cancer and the treatment.

My Diagnosis and Staging

Update Post-Chemotherapy and Surgery of 6/24/11
My cancer was not staged during the first seven months since my surgery followed the four months of chemotherapy. By that time, the chemo had shrunk the tumors significantly, which was very good. But it is hard for me to know how to understand the staging now.


My stage is 1A, more accurately described as: Yp,T1a,NO,MX, Group 1A 
Yp: signifies staging after chemotherapy, which is considered post neoadjuvant therapy
T represents the size of the tumor. A T1a means Tumor is larger than 1 mm but smaller than 5 mm in greatest dimension
     For me, the residual tumor invasive component measures 1.5 mm
N signifies the nodes. NO is node negative, which means there is no cancer in my lymph nodes 
M refers to metastases. MX tells that my cancer has not metastasized and is contained within the breast.


The SBR histologic grade is still III/III.   
Based on the microscopic appearance of cancer cells, pathologists commonly describe tumor grade by four degrees of severity: Grades 1, 2, 3, and 4. The cells of Grade 1 tumors resemble normal cells, and tend to grow and multiply slowly. Grade 1 tumors are generally considered the least aggressive in behavior. Conversely, the cells of Grade 3 or Grade 4 tumors do not look like normal cells of the same type. Grade 3 and 4 tumors tend to grow rapidly and spread faster than tumors with a lower grade. The American Joint Committee on Cancer recommends the following guidelines for grading tumors:
Grade
GXGrade cannot be assessed (Undetermined grade)
G1Well-differentiated (Low grade)
G2Moderately differentiated (Intermediate grade)
G3Poorly differentiated (High grade)
G4Undifferentiated (High grade)
Infiltrating ductal carcinoma is 70%, in situ carcinoma is 30%. The "in situ" is new information as of this report. Ductal carcinoma in situ is the earliest possible and most treatable diagnosis of breast cancer.

More good news is that I am no longer TNBC as indicated below. Each test post the original biopsy showed a bit more estrogen receptivity until the MRI biopsy I had late May. I did not learn of this info though until my follow up oncology appointment post surgery. I am estrogen positive, which means my cancer, or some of it, is receptive to estrogen. So I will follow the radiation with five years of a daily pill of an aromatase inhibitor, most likely a drug known as Femara.


DIAGNOSIS: As of initial diagnosis of January 2011. Staging above did not take place until after chemo and then surgery on 6/24/11.
  • Infiltrating (Invasive) Ductal Carcinoma (left breast)
  • Hormone Receptivity:  Triple Negative Breast Cancer (TNBC)
  • High Grade: 3
  • Tumor size: 3-5 cm (there are 3 tumors) - largest area 7.9 cm, but this is as the 3 are lined up in a row
  • Lymph Nodes: Still unknown, but from the breast MRI it appears they are not affected
  • Chest wall may be involved at onset, still unsure 
About 10-20% of breast cancers are found to be triple-negative. Having triple-negative breast cancer means that, in the lab, your cells tested negative for hormone receptors and HER2 receptors. Therefore, the cancer will not respond to hormonal therapies. Triple-negative breast cancer also will not respond to medications that target HER2, such as Herceptin or Tykerb. However, triple-negative breast cancer can be treated with chemotherapy and radiation therapy.



In addition, triple-negative breast cancer:
  • Tends to be more aggressive than other types of breast cancer.
  • Tends to be higher grade than other types of breast cancer. The higher the grade, the less the cancer cells resemble normal, healthy breast cells in their appearance and growth patterns. On a scale of 1 to 3, triple-negative breast cancer often is Grade 3.
  • Usually is a cell type called “basal-like.” “Basal-like” means that the cells resemble the basal cells that line the breast ducts. This is a new subtype of breast cancer that researchers have identified using gene analysis technology. Like other types of breast cancer, basal-like cancers can be linked to family history, or they can happen without any apparent family link. Basal-like cancers tend to be more aggressive, higher grade cancers — just like triple-negative breast cancers. It’s believed that most triple-negative breast cancers are of the basal-like cell type.
Remember that triple-negative breast cancer is a treatable disease. Researchers also are paying a great deal of attention to triple-negative breast cancer and working to find new and better ways to treat it.


At this point all three of these steps will be employed to blast away the Infiltrating Ductal Carcinoma (IDC) and return my cells to health!
  • First plan of attack is a 16-week regime of chemotherapy. The plan is that this therapy below will reduce the size of the tumors or even dissolve them entirely. That is the perfect case scenario. It is possible that this regime will only hold the cancer at bay, or at worse the tumors could increase in size. But we will be checking this along the way and actions will be taken if things are not going as planned.
Drugs during the first 8 weeks are Adriamycin (aka Doxorubicin, or Rubex) and Cyclophosphamide (aka Cytoxan®, or Neosar®). The drug during the second 8 weeks is Taxol (aka Paclitaxel, or Onxal). Each series of drugs are administered every 2nd week of the two 8-week sessions, so a total of 16 weeks provided my blood count returns after each series. If the blood counts are slow to build back up, the following chemo treatment could be delayed a day or so.
  • Second plan, surgery. This will be either lumpectomy or mastectomy, depending on results of chemo.
  • Third plan, radiation.

SIDE EFFECTS OF CHEMO:  Oh so many!!!!!

  • Low white blood cell count (Neutropenia), low red blood cell count (anemia), and low platelet count (thrombocytopenia)
  • Nausea for sure, vomiting.
  • Mouth sores.
  • Bone aches, both from the chemo and Neulasta.
  • Hair loss ~ A GIVEN. Complete and utter hair loss, all of it, lashes, brows, and "down there" too. No need to shave my legs for a few months. This will happen about a week or two after the first chemo treatment, or around the time of the second treatment.
  • Fatigue.
  • Constipation, diarrhea.
  • Pain
  • Numbness and tingling
  • Forgetfulness and inability to concentrate
  • And the list goes on.....

1 comment:

  1. All of this information is so overwhelming. How do you do it, Debbie? You continue to amaze me with your courage, strength and positive attitude.

    I know the love and support from your family and friends is sending positive energy to you and getting you through the tough days.

    I will continue to pray for the tumors to shrink away, that your blood count stays good so that you can keep on schedule for your treatments and that your side effects are as minimal as possible.

    Hugs and prayers... ~Michelle

    ReplyDelete

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Debbie