Many of you have been asking the science-y questions about my cancer. Well, buckle up, but here is a science lesson you may not have know you ever wanted.
There are several types of breast cancer. The most common type of breast cancer is called Ductal Carcinoma In Situ (DCIS). In short, it means that the cancer cells are contained in a breast milk duct inside a woman’s breast. That’s a good thing – it means it hasn’t spread anywhere and is mostly self-contained inside the duct. This type of cancer is typically treated with a mastectomy and some hormone therapy (more to come on that in a minute). I have a spot of Ductal Carcinoma In Situ in the center of my right breast in a duct directly behind my nipple. DCIS is rated in three levels 1-3. 1 being new cell formation, not rapidly duplicating. Level 3 means its duplicating rapidly and on the verge of becoming Invasive or rather spreading outside the duct (bad). My DCIS is Level 3. DCIS no matter what level is considered stage 0 cancer.
My lump is in the outer lower quadrant of my right breast about 3-4 inches away from my cells behind my nipple. It is a type of breast cancer called Invasive Ductal Carcinoma (IDC), meaning it has spread outside of the duct and into the surrounding breast tissue (and in lots of cases to lymph nodes and other tissue beyond the breast). My IDC is stage 1B which means that I have both a mass measuring no more than 2mm and other small groupings of cancerous cells (behind my nipple), but that it hasn’t (thankfully) spread to lymph nodes or through my surrounding chest wall. Stage 2 would mean that it has spread to the first layer of lymph nodes beyond the breast tissue.
Breast cancer cells are also evaluated for hormone receptors: estrogen, progesterone, and a human growth protein called HER2. Every cancer starts out with both positive and negative receptors and as it grows the positive or negative receptor cells take over. Breast cancer cells that are positive for estrogen/progesterone/HER2 grow in the presence of those hormones and are often treated post chemotherapy with hormone therapy to prevent future growth. Negative cells are more difficult to treat because they grow in spite of hormones. Thats about as good as I can explain this stuff – needless to say it’s complicated, but makes treatment of breast cancer much more specified, and thankfully effective. My case, of course, is a unique one.
My DCIS (milk duct contained) is 29% positive for estrogen receptors, 26% positive for progesterone receptors, and negative for HER2. Those are particularly low levels for a hormone positive cancer and curious on their own, but my lump adds an additional curiosity. My lump is 9% positive for estrogen receptors, negative for progesterone, and negative for HER2. Its super uncommon to have two different types of primary cancer.
This is what my oncologist called “a shit pathology report”.
After my oncologist consulted with a friend a Dana Farber Cancer Hospital they concluded that we caught the pathology of my breast cancer so early that the negative cancer cells were in the process of taking over the positive receptor cells. They have effectively rated my breast cancer “triple negative” or negative for estrogen, progesterone, and HER2 receptors. This type of breast cancer is the most aggressive, fastest growing, and most likely to recur within a 5-year window. However I am SO LUCKY that we caught it early. The five-year recurrence rate for triple negative breast cancer for stage 1 is under 10%.
So, here we are. My oncologist, in consult with my breast surgeon, made the decision that we would start with chemo instead of the mastectomy. My case was right on the borderline of the protocol and they opted to attempt to stop the cancer growth and prevent spreading prior to surgery. I will require a full mastectomy (removal of the whole breast) because the two cancer spots are too far apart to effectively preserve my breast. I have opted for a double (or bilateral) mastectomy because of the cancer being triple-negative and attempting to avoid any recurrence (hang tight for the blog where I tell you all about talking to my plastic surgeon about reconstruction…full of laughs).
I have eight chemotherapy treatments (spaced every two weeks). The first four are Adriamycin and Cytoxan together. The adriamycin is called the “red devil” because it’s red in color, makes you pee red, and has some nasty side-effects. It’s the strongest chemotherapy there is – and it causes total hair loss, usually a few days after the second treatment (my second treatment is slated for April 5th). I’ll be rocking some sweet headgear…look out…but if anyone has suggestions for my eyebrows let me know (fake mustaches perhaps?). My second four treatments will be Taxol, which is allegedly easier, but can cause permanent neuropathy – and also total hair loss. Hopeful you all like the look of my bald head for awhile.
My chemotherapy treatments will take me through June, then I will recuperate for 4-6 weeks prior to my mastectomy, slated for sometime in August. If the pathology from my mastectomy comes back with “complete pathological remission” meaning zero cancer cells in the breast tissue, my treatment will be complete. If however, there is any trace of cancer still growing, I will require additional treatment.
There’s your science lesson for today. I probably screwed some things up – I’m not an oncologist and to be honest cancer and cancer treatment is so complex, it’s hard to keep it all straight. Until the next episode!