The Cancer Offensive

Diagnosis and Treatment Decisions

(August-September 2014)

Sometime in mid-July 2014, I felt a small lump in my left breast. It was close to my chest wall and kind of hurt, so I thought it was a swollen pectoral muscle or something. I didn’t think much about it for a couple of weeks, but it never went away. In fact, it got bigger. I have two family members on my dad’s side that I know of who have had breast cancer, so I decided I’d better get it checked out. About two weeks of poking, prodding, and testing later, I found out the lump was malignant. Specifically, I was diagnosed with “triple negative” early Stage 2 ductile carcinoma. I had an MRI, which thankfully showed no evidence of spreading. On the same day I found out that my MRI was good, I found out my genes are bad. I am BRCA1 positive. The BRCA1 gene mutation is nasty business, so I made the decision to have a double mastectomy even though there is no evidence of disease on my right side at all. Everyone is different, but for me, this was an easy decision. I didn’t have to think about it at all. In fact, the doctor was still talking about the gene mutation when I interrupted him and said I wanted everything gone. That is the course he planned to recommend anyway, and my husband was totally on board. I have not doubted my decision for a minute since. Of course I was sad about losing parts of my body, but the trade-off of being cancer free was absolutely worth it.  I had a two-stage reconstruction, with the first stage occurring at the same time as my double mastectomy. The second stage involves exchanging temporary tissue expanders for more permanent implants, and occurs later.

Surgery and Chemotherapy

(September 2014 – January 2015)

I had my double mastectomy with partial reconstruction on September 13.  My doctors are AMAZING, so the surgery went very well.  My breast surgeon removed all the breast tissue, including the tumor and the cyst encapsulating it, while my plastic surgeon inserted saline tissue expanders and closed.  The first thing I remember after waking up is one of my surgeons telling me all my lymph nodes were negative.  This was confirmed with more detailed pathology a few days later, and the margins around the tissue they removed were clean.  Finding out for sure that the cancer had not spread was such a relief.  My recovery from the surgery was normal, and not too bad!  I was off the prescription pain meds within a week or so.  I did have to sleep in a semi-reclined position on my back for a few weeks, but then was able to sleep on my side like before.  I had some residual muscle soreness from the surgery, but nothing out of the ordinary.  It was so mild that I didn’t even need to take anything for it.

On October 9, I started a six-round course of “ACT” chemotherapy. The day I received my first treatment, I started out at the hospital radiology department for a procedure to get my mediport inserted under the skin on my chest. The mediport was a smallish device with a silicone injection port and a small catheter that went into a vein. Some people choose to receive chemo through a regular IV. That was not the best option for me because one of the drugs I was getting (colloquially called “the red devil” or “the red death” due to the color and the nasty side effects) is corrosive and would have damaged the veins in my arms. The port was totally the way to go. The procedure lasted about 30 minutes and I was awake the whole time. I did get a mild sedative to take the edge off. Once that was done, I went straight from the hospital to my oncologist’s office for my first infusion.

The chemo I got was preventative in my case, but pretty strong. Because I had triple negative breast cancer, a recurrence would be…not good. Aggressive chemotherapy was good insurance I was more than happy to have. Anyway, the chemo generally went fine considering I was being systematically poisoned.  I lost most of my hair about two weeks after my first treatment.  I retained my eyebrows and eyelashes for the most part. The day I got the chemo and the day after were pretty normal days. Days 3-6 were pretty cruddy, but fortunately, I did not struggle with nausea too much. Mainly, I was just achy and tired. I had trouble getting comfortable, which made the fatigue worse. It was kind of like being hung over, but more poison-y. Overall, though, the chemo was manageable.  As of November 20, I was half way done.  Woo hoo! The schedule for my final three chemotherapy treatments worked out so that I was able to enjoy both Thanksgiving and Christmas.  I did have a treatment on New Year’s Eve, however. My doctor walked by the infusion room while I was getting that one and said: “Way to ring in the New Year, huh?” I love her, but biggest eye roll ever.

All my doctors agreed that I was probably not a candidate for radiation. Just to be sure, they referred me to a great radiation oncologist for a consultation. That doctor spent a lot of time examining me, discussing my treatment, and explaining her opinion that radiation was not indicated for me. I was relieved, mainly because I was ready to be done, but also because radiation can make a plastic surgeon’s job more difficult if it causes skin damage.

Cured

(Post-Treatment)

By the end of my last treatment, on January 22, I still had a little bit of hair on my head. Oddly, that started to fall out about two months later, around the time my new hair really began growing in. I was expecting my hair to grow back pretty quickly, which did not happen. My eyebrows and eyelashes also thinned out quite a bit in the weeks following the end of chemotherapy. I’d read about that, but wasn’t really prepared for it. Fortunately, because my hair is so light anyway, you have to look REALLY close to tell. I started taking a vitamin for hair, skin, and nails that contains a huge amount of biotin. I also started thinking about cute pixie cuts for the summer!

The most important thing that’s happened since the end of active treatment is my oncologist pronouncing me cured. That’s another thing I wasn’t expecting. I thought there would be a lot of talk about remission, and not being officially cured for five years, etc. Nope. According to my oncologist, since my disease was not advanced and my surgery was so successful, I am considered cured now. She is a very serious and experienced doctor, so I know she is not using that term casually. Although being cured is definitely positive, I still struggle with it a little bit. The fear of recurrence is still there big time. I think as I get some distance from the whole experience, I will start to see myself as cured, too.

I went back to work six weeks after my last chemo. The fatigue stuck around a little bit, but overall, it was pretty manageable. Food started tasting good again, and some of the chemo-related weight started coming off. Weight loss remains a work in progress.

In terms of my ongoing care, as my doctor says, I have no mammo to gram. As a result, I will not be getting mammograms going forward. Because my breast tissue was so dense, the mammograms I got before didn’t detect my cancer, anyway. Instead, I will see my oncologist for a physical exam and blood test every three months for the next year, and then every six months for four years after that. I will see my breast surgeon every six months, too. In addition to those appointments, I will see my regular gynecologist every six months for the foreseeable future so he can also give me a physical exam and continue to monitor my ovaries for any problems via regular ultrasounds. I have already had the first ultrasound, which came back normal. I plan to have my ovaries removed at some point, but my medical team agrees that we should wait a few years if possible so that I continue to get the benefit of my natural hormones.

I still have tissue expanders in, so will need another plastic surgery to switch those out for implants. That procedure is done outpatient, and can be scheduled whenever it is convenient for me. I hope to have that done in the next month or two, depending on my work schedule.

As I’m writing this, it is almost exactly seven months since my diagnosis. It is hard to absorb how much has happened. I am so glad the worst is behind me, and am looking forward to a long, healthy life.