Second verse, same as the first...

It's been a long time since I've been here.  My last post was almost three years ago!!!  I haven't even been by to read or check for comments in over a year.  I'd started this blog to document my journey with breast cancer, and after treatment (and some scares), every day became another day of living without cancer.  In fact, life became beautiful and busy, filled with love and laughter and fun and excitement.  Weddings!!  Grandchildren!!  New jobs!!  Home improvements!!  Half marathon training!!  Travel!!  Yoga teaching!!  Hubby and family and friends...

You know - the stuff of normal life.

A couple of weeks ago was the fourth anniversary of my first chemo.  I was so busy Livin' that I actually forgot.  I remembered the next day, felt mildly nostalgic (and just a little naseous), and then the moment was over.  Move along...nothing to see here...

I had an appointment with my surgeon that Friday; I found another lump near the first area of cancer, but I'd had a cyst there a couple of years ago and we removed it and all was well.  My surgeon and oncologist continue to remind me - early stage, lots of tough treatment, go live your life and don't worry about recurrence, you'll be fine.  So I wasn't worried about the appointment with the surgeon, almost forgot, in fact, because I was so busy Livin'.

"So it's a cyst," I said to the surgeon (because I've been to medical school and I know these things).  "Let's poke it with a needle and be done with it."  He pushes it around, tries to pick it up, calls in another doctor.  They talk.  He shakes his head, sends me over to the hospital for an ultrasound.  The tech there takes her time and let's me watch the US screen; she's young and sweet and we talk about the weather and my daughter's recent wedding and what the HELL is that thing on the screen?  It looks like Jabba the Hut except a little uglier, all fat and jagged and dark and mean.  *click* there's one picture and *click* there's another and *blip* now we've got measurements of Jabba.  She wipes the gooey gel off Lucy and announces she'll "be right back."  

I lay there and think about my next long run - do I brave the cold and ice or just run the hamster-wheel track at the Y again (where 5 miles is 80 revolutions...oy...)  The tech returns with the radiologist in tow.  They whisper (by the way - that's just plain rude.  Secrets don't make friends...) and the doctor plops gooey gel on Lucy and does his own rolling search for Jabba......riiiiiight there.  And there.  And here's another view.  *click*  *measure*  And he announces he'll "be right back."

I'm a little slow sometimes, and just as it begins to dawn on me that perhaps this isn't just another cyst, the radiologist returns.  I hear words like, "solid mass" and "irregular borders" and "taller than wide" and "echogenic" and "shadowing", and he'd gone out to call my surgeon but the surgeon is in surgery so he calls the surgical suite to discuss this, and 

*boom*  There's that sinky, swaying feeling where all the air leaves your lungs and your head spins and your vision tunnels down to the lightswitch on the wall and words don't have meaning anymore and you can't really hear what's being said but the conversation goes on without you and the only thing that comes out of your mouth is

Fuck

Oops.  He smiles a sad sort of half-smile.  I tell him I've been down this road before so I ask, "Is it a 4 or a 5?"  He hesitates briefly, realizing I'm an edumacated cancer survivor and says, "I can't give it a 5 because that's a slam-dunk and I need a tissue sample, so I'm going to say 4c."

These numbers refer to the Birads rating system (Breast Imaging Reporting and Data System), which assigns numbers 0-6 to mammograms and ultrasounds as a means of standardizing reports and describing risk of breast cancer.  Anyone who's had a mammogram and received that letter in the mail may have seen the number, but it goes something like this:

0 = incomplete, more imaging needed

1 = negative findings

2 = benign findings

3 = probably benign (less than 2% chance of malignancy)

4 = suspicious (overall 20% - 35% chance of cancer, range of 2% - 95%)

In the 4 category are three sub-categories:

4a = low suspicion of malignancy (>2% - <10%)

4b = intermediate suspicion of malignancy (>10% - <50%)

4c = moderate concern, but not classic for malignancy (>50% - <95%)

5 = Highly suggestive of malignancy (95% chance of cancer)

6 = Known malignancy

He tells me he'll write the US report that weekend and fax it over to the surgeon so he has it first thing Monday morning.

And so the Long Weekend Wait begins (cue the violins...)

Ken and I - we Know, with that capital K of Knowing.  Been here before, Knowing before being told.  It's not reactionary, it's not catastrophizing - it's simply Knowing.  So we let it go for the weekend.  We run, have fun, go shopping, keep busy Livin'.

First thing Monday morning the phone rings - and doesn't stop.  The oncology NP calls to say they've seen the US report and wants to schedule a "planning meeting" with the Oncologist.  "But I don't have a diagnosis yet, what are we planning?"  She says they want to get the scans on the books, talk about next steps...  "But I don't have a diagnosis YET," I say again...  I leave her with the promise to call when I schedule my biopsy.  

The Oncologist's assistant calls to schedule an appointment (can't dodge that bullet apparently).

The surgeon's office calls to schedule the biopsy for Wednesday.  Then the hospital calls to pre-register for the biopsy.  Then another hospital staff calls to go over the biopsy procedure and pre-requirements.  "No bloodthinners for five days before the procedure...well, nevermind since we've only got two days.  Just don't take any Tylenol or aspirin or anything before then, okay?"

Okay.

The biopsy is an ultrasound-guided vacuum-assisted biopsy.  Let's just say that Lucy is numb from stem to stern; a small incision is made and a very large needle is inserted to take core tissue samples of the tumor, four in all.  They allow Ken to stay in the room and he watches (in fascination, of course) from the corner.  When it's over they insert a small titanium marker and then send me for a mammogram to ensure they can see the marker.

The oncology nurse navigator comes to visit before the mammogram.  We have a few minutes to talk about what all this means.  She lets me know they're level of concern is "up there".  We laughingly agree this sucks.  She tells us that it'll take at least two days for results - which likely means another Long Weekend Wait.  But since Ken and I already Know, we just get back to Livin'.

Ken reminds me later, however, that our GP has Saturday office hours, and so we pop in for a quick visit on Saturday morning.  And sure enough, the results are in.  No one smiles as they print and copy and stamp the report.  Oh well - we had a little bit of hope.

So all of these words, the telling of this super-long story, is to let you know that the biopsy is positive for breast cancer.  Not only is is positive, but it's also negative - as in, no estrogen receptors, no progesterone receptors, so it looks like this:

ER-, PR-

Okay, so now we freak out just a little.  This is not a recurrence of my previous cancer, which had estrogen receptors (ER+).  This is a new, completely different breast cancer.  But it's a new cancer exactly next to the place of my previous cancer.  It's been in there for a while - maybe through previous chemo and radiation (including targeted boosts to that very area).  WTF?

We're still waiting on another piece of important information - the results of the Her2neu testing.  That is the last of the three hormone receptors that completes the picture and tells us what treatment is necessary.  If the Her2 is negative, then I have Triple Negative (TN) breast cancer.  Being ER- means my cancer is not being driven or affected by estrogen, so Tamoxifen or other Aromatase inhibitors, which are significant and valuable treatment options in breast cancer, will not benefit me.  If the Her2 is positive, then I will need to add Herceptin and possibly Perjeta to my chemo regimine.  TN is often associated with a BRCA1 or BRCA 2 mutation, so I may finally get the genetic testing I'd asked for four years ago.

So there it is.  It really does kind of suck.  We don't have a treatment plan in place just yet.  Chemo, surgery, reconstruction - it'll all come together soon enough.

But for now, we take a few moments to absorb all this new, different, interesting and (yes) scary information.  And we keep on Livin'.

It's what I know how to do best now.  And I'll do it again soon, real soon.