Medical Team, What Say You?

After a week of medical appointments, I am pleased to introduce my medical team and share what we have learned about Gwen, patient #123 (they told me I have a number assigned, I want to know what it is to see if it contains any of my lucky numbers):

1. Genetic counselor, Julie, to receive results from the blood test submitted last week to determine if I am a carrier of the BRCA1 and BRCA2 mutations (pronounced brack-a), which are human genes known to be linked to hereditary breast and ovarian cancer. I tested negative for these two genes. What Julie shared was that any family has a 10% chance of having this gene. If it is in the family, children have a 50% of getting the gene passed to them from either parent. If passed, that person has an 85% chance of getting breast cancer, and anywhere from 25-40% chance of getting ovarian cancer because of this gene. The average person has an 8-10% chance of getting cancer. There was a ton more information Julie shared, but in the interest of keeping 1.5 hours of conversation to a shorter story, I'll leave it to you to search the web.
2. Navigator Nurse, Mona, at St. Luke's, who gave me a great educational book on breast cancer and how to deal with every aspect of my life that it will affect, with areas specifically highlighted for my case. Oncology Associates has a Navigator Nurse also, so I will see what she has to offer at my next visit there.
3. Nutrionist, I don't remember her name, provided by the Cook Cancer Wellness Program, who will help me with suggestions and plans for meals and food that will help me while I am going through treatment and after. I will begin meeting with her next week. Oncology Associates also offers this service.
4. Personal trainer, Matt, also provided by the Cook Cancer Wellness Program. Rumor has it everybody adores him. I'll get to be like a Kardashian! Matt will work with me at whatever level I can manage before, during, and after treatment. I need this accountability to make sure I get healthier and stay that way. They also offer weekly workouts such as Zumba and Pilates. What is great about this program is I will be in it with other people who are in different stages of their cancer treatment. If Gwennie gets hots during a workout, I can throw off my wiggers and no one will think anything of it! Yay, me!! 
5. Social worker, Nancy, who will help get me and the kids set up with counselors who specialize in individual, child, and family counseling for people/families with cancer.
6. General surgeon, Dr. Renz, and nurse Brenda, who are leading the surgical efforts in my treatment to remove the tumor. The three options I have are lumpectomy with radiation, mastectomy, or bilateral (double) mastectomy, one being prophylactic. It sounds like radiation is a standard follow up to a lumpectomy. Did I  mention Dr. Renz is hot, hot, hot?! I want him to play 'Take Me Away' from The Ugly Truth while he is removing my breastuses.  Love, love the Kathryn Heigl girly dance.
7. Plastic surgeon, Dr. Emery, and nurse Bethany who advised me of the procedures and process for the reconstruction options I have. John and Mom said it was interesting to watch Dr. Emery and me interact, as we fed off of each other in conversation and changed topics about every two sentences! I was extremely impressed with the work he has done and so I am able to put that fear to rest.
8. Oncologist, Dr. Wilbur, and nurse Paula, who pretty much told me how it is - lol! She is my age and we bantered back and forth very well. She is the one to determine if my hormone receptors are going to be called triple negative or not (see blog that talks about this more). She is calling this triple negative, but will treat the 1% positive estrogen because, um, I can't remember why. I am sure John does. She calls my clinical diagnosis - Stage 2, ER weakly negative, PR negative, HER-2neu negative, grade III, invasive ductal carcinoma. The treatment she recommends is 1) local - surgery, with 2) system-wide - chemotherapy. Why chemotherapy? That is what I asked, over, and over, and over again. She explained by putting a number of my stats into a database, including my (young) age, and it showed that if I do not have chemotherapy, I have a 45% chance of this cancer reocurring somewhere else. This typically occurs by some cancer cell(s) getting into the bloodstream. Even though the genetic test result was negative, she is still concerned with the prominence breast cancer has in my family, and admits that we (science) only know about these two mutations now. There may be more. I will meet with her again for chemotherapy "training". As of right now, she is suggesting eight weeks of one chemo cocktail with a shot of another cocktail after each treatment. Then 12 weeks of another chemo cocktail, and followed up with five years of Tamoxifen, which she is recommending because of my 1% positive ER result.

Whew!

Quote for Today:
"Okay, so the shit hit the fan. Take a deep breath, get grounded, and center yourself. Like Alice in Cancerland, you're falling down a dark and creepy rabbit hole. Doctors are spewing lots of information, most of which probably goes in one ear and out the other. Why? Because when you are newly diagnosed with cancer, this is what you hear: "Blah, blah, CANCER, blah blah, ... CANCER, blah blah blah." ~ Kris Carr, Crazy Sexy Cancer Tips 

I am overwhelmed with information right now. While I have lots of things ahead, I find I am only able to focus on the next step in front of me. ~ Gwen

This is a song that has helped me through the last three years of my life, when I was hoping I could save my marriage, when I was starting my life over at age 37, and now when I am facing a monster I have no control over:
While I'm Waiting ~ John Waller

I have no idea where this journey of cancer will take me. But... I am strong, I am faithful, and I am at peace. Because of this, albeit emotionally exhausted, I am able to make it through every day. ~ Gwen

And Then There Was Cancer

The radiologist said, "It looks like you have a little bit of cancer." Really? Just a little bit?!

Beside manner, beware. Not so fond of this gal.

I was set to have a hysterectomy tomorrow (sidenote - I think it is extremely hilarious that I got my period today!). When I went in for my pre-op physical, I also had my annual mammogram. When my gynecologist (Dr. Rozeboom) came into the exam room, he quickly talked about the hysterectomy surgery, and then said he wanted to talk about the lump he saw on the films. We talked briefly about the lump, said that regardless of what it is, he would want it out. He scheduled an appointment with my surgeon (Dr. Renz - hot, hot, hot!) a few days later, saying it would be helpful if we could group the two surgeries together. He suggested the surgeon may want to do a biopsy. The next day, the radiologist (at RCI) called to schedule an appointment for a more specific mammogram and an ultrasound. At that appointment the next day we talked about my upcoming appointment with the surgeon, and how he may want to do a biopsy. The radiologist called the surgeon and they agreed doing the biopsy sooner would be best. A few minutes later, they had a time slot open that afternoon, so I came back and hour later for an ultrasound biopsy.

It just plain sucked. I went straight to Dairy Queen after and got a Peanut Butter Bash. If you've never had one, STOP reading this blog NOW and go get one!

The day I met with the surgeon and was expecting the biopsy results, I woke up with a bad feeling in my gut. Early in the morning, the radiologist called and asked me to make an appointment to discuss my biopsy results. Yeah, the two other times I have had a breast biopsy, they have told me 'benign' over the phone. I told her I was going to come to her office right then. This is when she told me I have cancer. The tumor is clinically diagnosed as Stage II cancer, 2.5 cm in size, and grade 3 in appearance. I say clinical because until I have surgery and they can test the slices of the tumor, we won't know the true pathology of this thing. My receptor test results were: 

• Estrogen Receptor (ER): Positive (+) 1%, Allred score: 2
• Progesteron Receptor (PR): Negative (-), Allred score: 0
• HER-2-, score 1+
• Ki-67 Proliferation Index: High 60%

In lay terms, the best I understand this clinical diagnosis is:

• Stage 2 (on a scale of 4) because of the size of the tumor (20 x 19 x 26 cm)
• Grade 3 (on a scale of 1-3) because it is most abnormal in appearance and considered to be aggressive
• These three results help the oncologist determine the best treatment for me:
• ER+ (1%), Allred score of 2 (on a scale of 1-8)
• PR-, Allred score of 0 (on a scale of 1-8)
• Both indicate the tumor is most likely not stimulated by estrogen or progesterone, and may mean that it will not respond well to hormone therapy 
• HER-2 negative, score 1+ (on a scale of 0-3+), which indicates this is a mildly agressive, fast growing cancer
• Ki-67, high at 60% indicates that my cells are dividing rapidly, another aggressive cancer indication; lower than 10% is a preferred result

All of these statistics define my personal cancer, which therefore helps the doctors determine the best course of treatment. There are so many factors involved that make up my particular case that differentiates it from other's. This is why there is no set treatment for cancer in general, but so many treatment options depending on a specific diagnosis.


Quote for today:
"We learned more about cancer in two hours than I learned about anything in four years of college." ~ Sheryl Crow, from the Foreword of Crazy Sexy Cancer Tips (a gift from John)

One of my most favorite songs, based on Psalm 119:105, Thy Word, by Amy Grant:
Thy Word is a lamp unto my feet
And a light unto my path.
When I feel afraid
And think I lost my way,
Still, you're there right beside me.
Nothing will I fear
As long as you are near;
Please be near me to the end.
Thy Word is a lamp unto my feet
And a light unto my path.