What's With All the Negativity?!?

Monday's surgery is behind us, and the girls are being a little cranky.  Lucy's ego is a little inflated, thinking she's all that and a bag of chips.  Actually, Lucy's swollen after all the poking and prodding and tissue removal, and now sporting a seroma (a collection of fluid) in the cavity left after the lumpectomy.  There's also a seroma under my arm where the lymph nodes were removed, so she's still tender and swollen.  On a funny note, when I scratch the skin over the seroma it sounds hollow and almost drum-like.  The fluid will eventually be reabsorbed by my body, so no In-A-Gadda-Da-Vida drum solos anytime soon.

Ethel's not particularly happy to share her space (again) with Portia, but they're nestled all together in their little corner of the world.  Portia's still a little tender, too - moreso than I remember from before - but she'll settle down eventually.

"Is she talking about us?"                   "No way, we're breast friends!"

Our surgeon called on Friday with the new pathology report.  There was good information to share, primarily that the size of the cancer itself was smaller than we originally expected.  Dr. F removed 2.5 cms of tissue from the site; within that area was about 1 cm of cancer.  The rest was scar tissue from previous surgery and radiation therapy.  We got clean margins, so instead of doing an excisional biopsy (where some cancer might have been left behind in "dirty" margins), we achieved a true lumpectomy.  

Jabba has left the boobie...er, building.

Additionally, lymph nodes are clear.  There were cancer cells in the lymph nodes, but not enough for them to be considered "node positive" or to have "micromets".  This is good - very good.  Finding a few cancer cells, or Isolated Tumor Cells (ITCs), means my lypmh nodes were doing what they're supposed to do - catching the bad guys and throwing them in Lymph Node jail to keep them from travelling to somewhere else in my body.  This happened our first time around as well, and so we're pleased with this additional piece of good news.

On the other hand, we now know the Her2 status of the cancer, and it's negative.  My estrogen (ER) and progesterone (PR) receptors were also re-tested, and they, too, are negative.  This means my cancer is triple negative, or TN.  This is not necessarily good news, but it's good news to have so we know what we're dealing with.  

The challenge with TN is there are no targeted treatments to prevent metastatic recurrence.  ER+ breast cancer (as I had the first time) has powerful targeted treatments in Tamoxifen and aromatase inhibitors like Aromasin and Arimidex.  In fact, Tamoxifen is considered almost as important (if not perhaps just as important) in treating ER+ BC as chemo and radiation, and can be one of the first treatments prescribed for those whose BC metastasizes.  Typically, Tamoxifen and AIs are taken for five years post-treatment, although there are new studies that support the use of these treatments for 10 years.  

Her2+ BC also has targeted therapy in the form of Herceptin (an infusion typically given with chemo initially, then every three weeks for a full year).  There is also Perjeta, another Her2 inhibitor therapy given neoadjuvantly (prior to lumpectomy or mastectomy).  Both of these can have serious side effects including heart problems, but they are remarkable effective at helping decrease the incidence of metastatic recurrence.

TN, on the other hand, has none of these targeted treatments.  Chemotherapy is a given (except in cases of very, very small tumors), and the preferred course is Adriamycin, Cytoxan and Taxol - the chemo I had during my first dance with this devil.  Unfortunately, Adriamycin has a lifetime maximum due to the chance of heart failure, and I've already had my lifetime max.  So - we look to another chemotherapy regimen, which will be Cytoxan and Taxotere.  Cytoxan will cause my hair to fall out, and Taxotere can case permanent neuropathy and has the potential for permanent hair loss.

Good thing I'm a hot bald chick.

But these treatments are what I have available, and as much as they suck, they also rock.  

In addition to learning of my TN status, our surgeon also shared that the cancer is grade 3, which is the highest grade for breast cancer.  This means the cells are poorly differentiated (they look very different than normal cells) and are aggressive (the cells are dividing and growing rapidly).  While this isn't necessarily good, there is a silver lining:  chemo loves fast-growing cancer, and gobbles it up like a toddler with a 3-lb. tub of gummy worms.  Hopefully, this means that any rogue cells floating around in my body will be attacked unmercilessly by the upcoming chemo treatments.

TN has an early metastatic recurrence period - typically within the first three to five years - and it's a higher incidence of recurrence than for ER+ BC.  The positive side of this is that, unlike ER+ BC, I won't be waiting around 20 years for the other shoe to drop.  

Well, except that I will, because on top of now watching and waiting for TN recurrence, I'm still watching and waiting for my first ER+ recurrence.

I'm not gonna lie.  I'm kinda scared.  Triple negative doesn't have positive outcomes (no pun intended...oh fuckit, yeah, I meant it.  Gotta take my humor where I can find it).  Of all the varieties of BC, TN pretty much sucks the ocean floor of outcomes.  Even with a smaller sized tumor, the chance for recurrence is greater than what I worried about before.  No one's patting me on the back and saying, "Hey, small size, early stage, you'll be cured here shortly."  

Tomorrow (another Epic Monday), Ken and I meet with the University of Michigan Breast Cancer Center for a second opinion.  They're already reviewing my first pathology slides from four years ago, as well as my current slides.  They're re-reading all of my scans and reports.  I'll have more scans and tests when I first arrive, after which we'll meet with an interdisciplinary team to discuss their findings and their recommendations for treatment.  We'll be able to ask the questions that seemingly have no answers, like How did this happen and What does this mean long term and How much do I really need to worry?  Maybe they'll have answers (I'm keeping my fingers crossed) and maybe they won't.

That's the beauty of breast cancer - it's pretty much a fucking crapshoot.

I still find positivity in all of this negativity, however.  Finding joy in those little moments in between the mundane, like a surprise visit with Michael and Vaeh, and sweet hugs from Miles and Tori.  Feeling wrapped in love by the beautiful, artistic socks from Stephanie and Josh, and dropping little texts with "I love you's" and floating hearts.  Watching Mary wield the reciprocating saw like the basement-killing ninja I know her to be. Ken and I hiking MacCready Reserve today, climbing over the ancient pine trees fallen by the recent wind storm, marvelling at the sap-art created on the forest floor.  

With this new diagnostic news I am reminded about what's truly important in my life.  Everything else, we just take one day at a time.

(thanks, sweetie!)