Plans in motion



what my breast cancer looks like-can you see it? 
amazing something so small can be so devastating.

I've met with more doctors in the last week than I have in two years, and been given more info than my tiny little brain can make sense of.  But I think we all have a plan, and it's being set in motion as of today. NOTE; this post is full of medical terminology and hoopla and I am feeling the need to be
'teachy'.  If not interested skip to bottom for the synopsis!

Met with Dr Sirridge at the KC Cancer Center today and he was almost ecstatic about some of the pathology that has come back since my meeting with Dr Failing.  I will try to explain it as best I can-

~Because there were two separate masses in one breast, it is still called Invasive Ductal Carcinoma-but is considered Multicentric Breast CA (CA is cancer).   The grade 2 from the previous post is basically the rate at which the cancer cells grow-they grow at a 1-slow rate, 2-medium rate, or 3-aggressive rate.  Mine being is a 2 is middle of the road-just like me, the middle child!

~My tumors are 100% Estrogen receptive  and 90% Progesterone receptive or ER/PR+, and this is fantastic-means they will respond fabulously to hormone therapy-namely Tamoxifen.  This treatment is done towards the end of chemo(if needed) and for 5 years from start to help against recurrence.  Cheers here!

~The tumors were HER2/neu Negative.  This also is good.  This is where Dr Sirridge got really excited!  HER2/neu is human epidermal growth factor receptor 2.  This is a gene that sometimes overproduces the HER2 protein, thus making the breast cancer cells divide and grow at a very rapid rate.  Mine being negative means it is NOT an aggressive form of breast cancer and I will NOT need Herceptin treatment.  Little cheers here!

So my full diagnosis is Multicentric Invasive Ductal Carcinoma grade 2, ER/PR+, HER2/neu negative.  And with these types of cancers, the survival rate at 10 years is 85-90%!  Again-little cheers here!

Now is where it gets tricky.  As if all of  that above wasn't, right???
How do we get started?
~Lumpectomy vs. Mastectomy.  Means take part of boob with tumors or all of the boob in laymen's terms.  Lumpectomy in my case (because of two separate areas-pretty far apart) would mean taking about 1/3 of the right breast and radiation therapy, but still keep boob on body.  Mastectomy means taking all of the right breast, leaving tissue on the chest wall to heal. 
Many of you don't know I went to Radiation Therapy school a long, long time ago-though I never have worked in the field.  And I saw lots of radiated boobs, post lumpectomy.  In 1993 I knew I would NEVER opt for lumpectomy and radiation having seen what I did-and I still feel that way.  Add on top of that the risk of recurrence and then dealing with a mastectomy and breast reconstruction to a radiated chest wall.  YES, I am an X-Ray Tech, and yes, I LOVE Radiation.  Diagnostic-not Therapeutic.  So as you can probably guess-lumpectomy is out.  Mastectomy is in. 

~Right only (unilateral) or both (bilateral)?  Well, since I am going to be getting a new boob on the right for sure someday-I may look kinda funny with a gorgeous, perky DD next to my tiny, little, nursing destroyed,  barely a B.  Just kidding.  For safety's sake against recurrence-they both gotta go. 

~Part of the mastectomy will entail a Sentinel Node Biopsy.  This occurs during the surgery where they check to see if any of the lymph nodes in my right axilla (arm pit) are affected.  This is where the staging will come from, and thus help determine the need (or not) for chemotherapy after surgery. 
With  a bilateral mastectomy-they take both breasts, but only do the node biopsy on the affected side-or the right.  If the nodes are positive for cancer, the Surgeon will do a node dissection and take them out.  Surgery takes about 2 hours-but most of this time is spent waiting on the Pathologist to let the Surgeon know whether or not the nodes are affected.  Then I spend one night in the hospital and go home the next day.  Yep, you read that right-ONE NIGHT. This is the standard of care in the industry, I'm not being cheap :)    Not sure how I feel about that yet, I will let you know post-op day one.....

In talking to Dr Sirridge today, we talked about testing me for BRCA1, and BRCA2, or the human genes known as tumor suppressors.  If I carry either of these genes AND if there is a mutation on
it, it can mean an increased risk of cancer.  And also mean a greater risk for recurrence.    This is not necessary for treatment, but for me, and my daughter and my sisters and all my female cousins-it is.  A positive BRCA1 or 2 can mean an increased risk of cancer for those considered my 'first degree relatives'-all those gals I just mentioned whom I love so much.  Now me being positive would not mean automatically that they have it, and would be up to them to decide if they wanted the testing.  Catch?  It's expensive as hell.  About $3500.  Most insurances pay all but about $400.  I guess we will find out Monday if it's ramen noodles in the Rawley house next week or not!?!!?   JK-they are kind enough to set us up on a payment plan....of course you are!  Gee, thanks.  With all that's going on with our insurance right now, kinda makes me nervous-my PD and FD friends will get that-but it's a whole 'nother post and one that I get pretty pissy about.
 Dr Sirridge talked to Dr Maureen Sheehan in regards to the genetic testing because he says she is the 'gene guru'.  He wanted her opinion as to
1-we do the testing at all (yes-blood drawn and being sent out)
2-we wait for results to do surgery and type of surgery if positive (yes)

#2 is a yes because even though I am opting for a bilateral mastectomy-you are asking what the hell else could he do to me in surgery?  Well, if positive, I could need a port-a-cath placed for subsequent chemotherapy, and I would rather get the most bang for my buck-meaning one surgery, get it all done.  So, we are waiting for those results. 

Now for the best news, or silver lining, if there ever could be in a cancer diagnosis.
With my hair color, eye color and body habitus, my chances for a rockin' fabulous breast reconstruction are awesome!!  In a nutshell (these are Dr S's words-not mine) the bone thin skinny, blond haired, blue-eyed women do not fare as well in chest wall healing and future reconstruction as my 'type'. 
Basically, because I have a little extra cushion on my butt and thighs, the plastic surgeon can suck it out and put it where my new boobs will go with or w/o an implant!  Rock the freak on!  Doesn't mean fat is good, or that I have no intention of taking off all this excess weight I have been trying to for years.  BUT, since we all know as women that in losing weight the last places to go are always the butt and thighs, and towards the end of this journey I'm sure there will still be a little there-and it can go right on up top to help out the new sisters!  woo-hoo!

As it stands, I will have a bilateral mastectomy with right side sentinel node biopsy on Friday March 2nd.  Everything else will be determined from there according to the plan outlined above.  I like a plan, I need a plan, and I am happy with this plan.   Please know that these choices were made by me and Brian, and are what work best for our life.  I support any decision a person facing cancer makes that works for them.  Just because I have chosen this particular route of treatment does not make it better or more curable than any that others have chosen.   

 Don't get me wrong, if I could go to Seattle Grace Mercy West and have the expertise of Dr's Bailey, Yang, Grey, Hunt, McDreamy and McSteamy, Avery and Karev, I'd be on the first plane.  Then off to Oceanside Wellness group for some 'whole body healing' from Dr's Bennett, Wilder, Turner, King and Wallace, then sip some wine on Addison Montgomery's Malibu beach front property with her and Amelia Shepherd,  I would be there.  But since that is TV, and this is REAL, I'll be happy with with the fantastic care from my friends at NKCH-who have already taken such amazing care of me, and my new friends at the KC Cancer Center!  (I'm kind of a Grey's/Private Practice freak in case you couldn't tell)

Ugh, did I leave anything out?  I have no idea.  This is all so surreal.  One minute I think I can handle this and the next I want to crawl under my covers and go to bed, hoping to wake up and realize this is just a bad dream. 

But it's not a bad dream, and waking up tomorrow means I have another day to fight this terrible disease that kills 40,000 women annually. 
And it means that I won't be one of those 40,000. 

Not if I can help it. 

And I sure can.