Resting

All went well today. After a long day of sitting in some of the least comfortable hospital chairs we’ve experienced (and that’s saying something!), Husband and I are home. 

I’m tired and still a little groggy, but feeling fine. Dr. D said the surgery went very well, and she was able to extract just a single node. 

Now we wait. It will take as much as 2 weeks to get the pathology back. For now, I’ll focus on healing. Sadly, this precludes beach time and swimming, but at least I’ll have some forced down time. My friend C already offered to send along some good fiction. 

At this point, I’m ready to settle in and shut off my brain for awhile. Good night!

Waiting room selfie
Resting

Commuter Surgery

Tomorrow’s the day! Actually, it’s so late that today is the day…Regardless, Brigham & Women’s Faulkner Hospital, here we come!

This will be a long day. Husband and I will arrive at 8:30am to check in. We then walk outside and across the street to the Belkin House, where I will get a wire localization. (More on this in a moment.) We will then walk outside again, across the street, back to the main hospital building, where I will head to nuclear medicine. This led my friend W to refer to the process as commuter surgery.

This should all take about 2 hours at most. Then we get to sit and wait until 2pm, when the lumpectomy is scheduled. The surgery itself should take about 2 hours, and then I’ll just need to come out of the general anesthesia. Alas, I’m not a big fan of anesthesia, as I tend to feel pretty lousy afterward. (Admittedly, I DO like anesthesia inasmuch as it keeps you from feeling scalpels cutting into your flesh.) All told, I expect we’ll spend about 12-13 hours, door to door.

Now, back to the wire localization, or “wire loc” (sounds like “loke”), as the nice coordinator lady called it. This wire loc is done under local anesthesia, and is essentially a long, thin wire that is injected via a needle into my breast. As I understand it, the wire leads to that handy titanium marker they placed during the stereotactic biopsy. The surgeon will use the wire to help guide her as she removes tissue during the lumpectomy. I’m imagining this wire as a plumb line, around which she’ll extract an approximately equidistant amount of tissue on all sides. This might be a ridiculous analogy, but I’m going with it.

Apparently I’ll be left with a piece of this wire hanging out of my body between the wire loc and the surgery…so for about four hours I’ll have an antenna. (OK, not really. They will bandage it up so it’s not dangling out for all the world to see. But I do wonder if this could start a new trend in the Ham radio circuit.)

Radio Free Wire Loc
Radio Free Wire Loc
And then: nuclear medicine! At this point in my tour of Faulkner Hospital, I’ll have a radioactive tracer injected into the breast to identify the nearest underarm (axillary)  lymph node, which is called the “sentinel node.” Once I go to surgery, Dr. D. will remove this sentinel node (identified in the operating room by a gamma probe) and ship it off to pathology to be sure there are no signs of cancer in the lymph system.

And that’s about it. Now you can share all this sweet lingo with your pals.

Hey, let’s go to nuclear medicine to see what the gamma probe says about my nodes!

Sure, thing, let me just put away my wire loc first. I’ve been picking up Peruvian Landó music on this thing all day.

I’ll send an update in a few days. For now, thanks to all of you for your texts and calls and emails and love.

Commuter Surgery

Dreams of GCTA

BRCA1 doesn’t look like such a big whoop.

Protein BRCA1 PDB 1jm7.png
Not the kind of pretty ribbons you want to have.

Protein BRCA1 PDB 1jm7” by EmwOwn work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

In fact, the BRCA1 and BRCA2 proteins actually *repair* DNA when they function correctly. The problems occur if you happen to have mutations in the BRCA1 or BRCA2 genes, when some of the DNA base pairs get mixed up. (Remember when you made that poster of DNA using different colored Tums? No? Then you’d better thank your lucky stars that Al Gore invented the Internet.)

As a result, these normally helpful bits of our genetic programming stop doing their job. They don’t become malevolent havoc-wreakers, but more like one of those useless office morons in a Dilbert cartoon. The mutated BRCA1 or 2 genes can’t fix damaged DNA, which means they can’t prevent other mutations, which means those mutations might allow cells to grow uncontrollably, which means a person carrying a mutation in their BRCA1 or 2 genes might end up with a tumor. Specifically, a tumor related to breast, ovarian, fallopian tube, or prostate cancer.

BRCA mutations are not so much this guy...
BRCA mutations are not so much this guy…
...but more like these guys (with apologies to Scott Adams).
…but more like these guys (with apologies to Scott Adams).

All of this is to say that I have found myself thinking a lot about G, C, T, and A lately. Tomorrow is the day when we get the results of my genetic tests. As I’ve previously noted, these results alone will not change my planned course of action. Still, I can’t help fearing the tests will show that I’m positive for one of the many known BRCA mutations. And then I get to wonder about if…when…the next little cancerous jerk will pop up.

My sister visited me this past week, along with her wonderful family. In addition to providing a truly wonderful break from reality, it was also a chance to talk about what my latest diagnosis means to her and the rest of my family. She compared having a close family member with cancer to having a close family member with a difficult addiction, like alcoholism. No matter how well that person is doing, no matter how many years with no sign of cancer, you always have that little nagging worry in the back of your mind.

“Is today the day the cancer comes back?”

I’ve thought A LOT about this, though I never thought of it in exactly these terms. Her analogy seems an apt one. From my perspective, the worry never quite makes it to the back of my mind. It’s at least in the middle of my mind, whatever that is, and often right up front. I’m sure it’s the same for my husband, though we don’t talk about this very often.

And so it is with these front-loaded thoughts that I’ll finally go to bed tonight, hoping visions of G, C, T, and A won’t dance in my head. And definitely not the Lord of Darkness, pictured above. But who am I kidding? Most likely it will be that damn Bananaphone song by Raffi that became implanted in my head during the visit with my nieces.

Dreams of GCTA

The sitch

Hey Ladies: go get a mammogram.

I put mine off for a while this year, actually. But I finally went in a couple months ago, and it’s a good thing. The mammogram showed a small area of microcalcifications. These microcalcifications aren’t necessarily a problem, but they can be indicative of cancer, so this led to another mammogram and an ultrasound, and then to a stereotactic biopsy.

In short, this is a needle biopsy guided by real-time imaging, to make it easier to find the target area. Sounds ok, right? So you lie down on your stomach on what looks very much like a massage table. Except instead of the “donut” where you would place your head on a massage table, there is a much larger hole around your torso through which you place your, ahem, part to be biopsied. Of course these parts come in all shapes and sizes, so it’s actually a fairly large hole.

“Just move around until you find a spot where you’ll be most comfortable,” the technician offered.

I can assure you that there is no such spot on this contraption, but I found a tolerable position and nestled in. The whole procedure took about 45 minutes, during which time they collected a sample of the tissue with microcalcifications and inserted a teeny tiny titanium marker. This marker makes it easier to find the area in future mammograms. Plus, I now get to answer affirmatively when asked if I have any metal in my body.

I left the office feeling pretty good. I mean, what are the odds that I would have cancer again? I was so confident that this couldn’t possibly be cancer, in fact, that a couple weeks later, I went into the follow up consultation with a surgeon from Rhode Island Hospital without much concern.

But as soon as I saw the nurse come out to the waiting room to call me back, I knew. And if I had any doubt from that split-second look that crossed her face as she called my name, I was even more positive after her exceptionally bland small talk. As I waited for the surgeon to come in, I became more and more nervous. And then she came in and told me that I have breast cancer.

Needless to say, this was a shock, and a horror, and colossally unfair. Still, it’s not the worst situation. In fact, as one of my docs recently told me,

“If you’re going to get cancer, this is the one to pick.”

Ha! Cancer humor.

He was right, though. I have Ductal Carcinoma in Situ (DCIS), which is, unfortunately, a very common diagnosis. The area of malignant tissue is about 1cm wide, and a very small portion of that centimeter (<0.1cm) is a “microinvasion.” DCIS is described as pre-cancer, or Stage 0, but the presence of the microinvasion tips my case to Stage 1.

Image from breastcancer.org
Image from breastcancer.org

The graphic on the right compares DCIS (with cancerous cells entirely contained within the duct) with DCIS-micro, showing a few of the cells breaking free of the duct. Thankfully, this is a very well studied form of cancer, and the research indicates that patients with DCIS and DCIS-micro often have a very good prognosis.

The wild card here is the genetics. Most breast cancers are not hereditary, but there are some genetic mutations that are known to increase a person’s risk of having breast cancer during their lifetime. The most well known of these mutations are carried on the BRCA1 and BRCA2 genes. I’ve been tested for these mutations and we’re (anxiously) awaiting the results.

The genetic results are important because they help determine the course of treatment. In my case, I’ve pretty much decided already that I will not get a preventive mastectomy, even if I’m BRCA1 or BRCA2 positive. I will go ahead with a lumpectomy later this month, to get a better handle on the true scope of the cancer and to get clear margins all around the malignant tissue. Hopefully there’s no spread, and that tiny little area they found in the biopsy was all of it. This would be the best case scenario. Then, I will likely do a 6-week course of radiation, starting 4 weeks after the lumpectomy.

Another wrinkle, though not a huge one, is the fact that, at 41 years old, I’m on the young side for breast cancer. This matters because there is not as much research conducted on “younger” women like me, which makes for a little more uncertainty with regard to some aspects of treatment. Still, compared to my previous cancer, uterine leiomyosarcoma (ULMS), there are GOBS of data, so I’m still feeling far more informed this time around.

There’s a possibility of hormone therapy after radiation, but that will depend on the various test results, too. Clearly, there are several big decisions yet to be made, but we can’t deal with them until there is more information. The best news is that all the docs I’ve seen (I got a second opinion at Dana Farber Cancer Institute, where I received all my treatment for ULMS) have agreed that I will not need chemotherapy.

So there you have it. Miles to go before we sleep, but with the support of my amazing husband and steadfast family and friends, I’m ready to beat this thing. Thanks for joining us on this journey.

The sitch

Cancer, Take 2.

You know that moment when you’re three and a half years cancer-free and you think to yourself: wow…I think I might have beat this thing?

And then, like a perverse comedian with an exquisite sense of timing, your traitorous body delivers a second cancer nearly 4 years to the day after your first diagnosis.

I hope you don’t know that moment, but it just so happens that I do. Thus, the title of my new blog.

The plus side (?) of having cancer twice is that you learn a few things regarding the logistics of the beast that you can apply on the second round. I learned, for instance, that it would be far easier to manage a blog than to send regular emails to my amazing support network. So, join me as I take a step into the 21st century and share the ups and downs of surviving one cancer two cancers.

More soon.

Cancer, Take 2.