the D day

Today was the day I finally had my first post-radiation doctor's appointment, and let me tell you, it felt like the grand finale of a dramatic medical drama. Cue the suspenseful music! After all, I'm a bona fide cancer survivor now, and who doesn't love a good survivor-turned-superstar story?

"Congratulations," the doctor says with a grin that could rival a Cheshire cat's. "You're officially a cancer survivor now!" I half expected confetti to rain down from the ceiling and a marching band to burst through the door, but alas, it was just me and the doc.

According to the all-knowing Dr. Google a bit of cancer survivor statistics: 

Apparently, as of January 2022, there are a whopping 18.1 million cancer survivors in the United States, which is approximately 5.4% of the population

So officially I am in remission and if all signs and symptoms of cancer vanish into thin air, doctors might start throwing around words like "cured" after you've been symptom-free for five years.  So starting the count down...

So there you have it — today's appointment was the grand finale of my cancer saga,  and an much expected happy ending. 

Symbolism

Symbolism is everywhere... 

On my last day of radiation, George and I decided to get lunch as a celebration and finally try the Japanese restaurant on the final day of Boston restaurant week. We drove to Kenmore Square and ended up smack in the middle of a cancer walk with crowds of people dressed in pink going past the restaurant. The restaurant was full and we couldn't get in without the prior reservation weeks in advance (a sign to switch to healthy eating maybe).

All these people in pink made me think that it was some sort of fan club for the movie "Barbie" 😂 that I hear is quite popular, before I read the signs for breast cancer.

I thought it would be great and quite symbolic to get a picture of a breast cancer patient with the pink crowd. A few pictures and several hugs from random strangers -- I take it as a great sign from the universe that hopefully this experience is over and I can move on to better things...

Cancer statistics

Breast cancer is one of the top three cancers in the US, after lung and prostate.

Approximately 13% of women (1 in 8) will be diagnosed with invasive breast cancer, and 3% (1 in 39) will die from the disease in their lifetime.

Breast Cancer Statistics, 2022 - Giaquinto - Wiley Online Library

During out last's week book club, it turned out that out of 8 women around the table, 4 had some form of breast cancer --- mine was the most severe out of the group...but still it is telling how widespread it is. Granted, we are all probably in the right age group to start getting it, but still most of us are under 50 years old.

Dana Farber Cancer, second opinion 12/19

A week after my appointment at Lahey regarding our options and treatment roadmap, George and I were sitting in a brightly lit waiting area of Dana Farber Cancer Center meeting with another team for a second opinion appointment.

And within the first 20 minutes, it became apparent why Dana Farber is the leading cancer center.  The doctor was able to explain the entire course of treatment in great detail, with printouts and explanations, rather than the Lahey approach of giving general descriptions of chemo and promises of details later. Lahey didn't even mention radiation as a required step in the treatment

We walked out of the meeting and decided that we are switching to Dana Farber (especially as they were working on squeezing in my first chemotherapy before the holiday bonanza during this week,  this coming Thursday, 12/22).   

Haircut

It looks like chemotherapy is the first order of business for the next few months and it is coming up fast, next Friday 12/23. 

I was told that the hair is the first to go, so decided to chop off most of mine in the beginning, so that the loss would be more gradual (who know, maybe I will be lucky and most of the mane will stay?)

I wanted it to be even shorter, but the hairdresser kept it more "feminine" as she put it :)

Second opinion

Lahey clinic was just the luck of the draw -- the only place that would take me off the street for my first mammogram within several days of the phone call. 

Once I finally got my diagnosis via biopsy, and while still going through the motions with Lahey, I reached out to Dana Farber Cancer Center to schedule an appointment for a second opinion.

I want to cover all my bases and compare all the options, especially considering that Dana Farber is one of the leading cancer centers and located in Boston.

I wonder, if they read the test the same way and would offer the same treatment plan as Lahey....

Treatment 11/12

Today was the day of reckoning -- at least half the tests came back. We had an appointment first with surgical oncologist, followed up with medical oncologist to discuss treatment options. George filled out half the notebook with notes...

"The cancer is a 4 cm invasive ductal carcinoma. Ductal means it started in the lymph glands, invasive means it spread to the breast. The tumor in the lymph isn’t strictly measured, it’s 2mm in the biopsy, but that’s just the part that was in the biopsy. The cancer is triple negative, which means it doesn’t respond to 3 hormones, estrogen, progesterone and human epidermal growth factor (HER2). It should however respond to chemotherapy."

Surgery on the breast will probably be a lumpectomy, just the cancerous part of the breast, rather than mastectomy, complete removal, unless genetic testing reveals a hereditary tendency towards cancer. (still waiting on results) Lumpectomy would be about 2 weeks recovery, mastectomy would be 2-3 months recovery."

Well, there are three options:

One: 6 months of chemotherapy, every three weeks for 4 hours each and every week an additional hour of immune treatment. After half a year of chemotherapy, the surgery of hopefully reduced tumors and limited lymph nodes and another year of milder oral chemotherapy (depending on the overall outcome)

Two: much more extensive surgery now, with removal of several lymph nodes (up to 24) which might result in lymphoma, followed by chemotherapy for 1 year

Three: with no treatment projected death within six month to a year

It looks like we picked door number one for now.

Letting people know

Cancer. Breast cancer, triple negative. How do you tell people? Just come out and say it -- and then there is an awkward silence, or crying or hurried reassurances that "in this day and age they will figure it out". 

I think so far that has been the hardest part -- whom to tell, how to tell, and how to handle their crying. Or their prying eyes that try to find the cancer now -- you look kind of pale... and I don't. Who would have thought that this would be something I would have to think about and figure out now... 

With all the tests, hospital visits and insurance calls between the normal daily life, I have just been able to tell very few close friends and few family members. But then again, what do you say? Got cancer, but do know yet what to do with it, or how to treat it and it is a rare kind, fast growing... and, by the way, please don't panic.

I got my diagnosis December 1st, a few days before my mom's birthday. George, who is in complete panic mode insists that I tell my parents and kids right this minute. 

So I waited to tell after mom's birthday and then told my daughter who is in college, though it is her exam week and she would be home at the end of December.... 

George felt it couldn't wait and everyone deals with this in their own way.

Cancer Call 12/2

On Friday, 12/2, I got a 5-minute phone call from the nurse at 4:30 who hurriedly explained that based on the biopsy I have stage 3, fast growing breast cancer with metastases in lymph nodes. This breast cancer is "triple negative" and can't be easily treated with hormonal therapy (whatever that means). 

The next steps would be to do an MRI and a CT scan to see if the metastases have spread to any other part of the body. But, alas, it is Friday evening, so she plans to work with scheduling all of these tests sometime next week. 

"Have a great weekend," to be brief and to the point. 

Oh joy, what a delightful surprise to receive a cancer diagnosis at the end of Friday! It's the perfect way to end a long week, isn't it? You can just sleep it off over the weekend and wake up fresh as a daisy on Monday, ready to tackle the next step in your journey. Nothing like a little cancer to add some excitement to your life, am I right?

Good thing that I have a stable psyche and to some degree I was prepared, because of all of my self-diagnostics with Doctor Google. 

And I am off to Doctor Google to figure out what is the "triple negative cancer". This is a less common, fast-growing type of cancer, with a limited number of treatment options that occurs in 12%-15% of the population, with high likelihood of reoccurring... 

Now I will wait for the official explanation with the oncology team in a week, shouldn't just trust some Google search.

Official Biopsy Result

Diagnosis  A. 

LEFT BREAST 1 OCLOCK : INVASIVE CARCINOMA

HISTOLOGIC TYPE: INVASIVE DUCTAL CARCINOMA

GRADE 3/3, AT LEAST 10.0 MM IN LENGTH, INVOLVING MULTIPLE CORES 

Breast Biomarker Report for Invasive Carcinoma (ER/PR/Her2-neu):

Estrogen Receptor (ER) Status Results: Negative

Internal control cells Present and stain as expected

Progesterone Receptor (PgR) Status Results: Negative

HER2 (by immunohistochemistry) Results: Negative (Score 0)