Becca's Blog

Prologue:

Five years ago, Mom was referred by her OB/GYN to start having her annual mammograms. At the time, I was a bit young to fully understand what was going on, only aware that it was another doctor’s appointment she had to go to. We received an urgent phone call the next day, telling Mom to come back immediately, because they'd found something in her left breast. We rushed back in, and after several targeted images were taken, we were informed that the anomaly was calcifications, which, in most cases, are benign. It was recommended that Mom come back every six months, however, just to monitor it and make sure it wasn’t harmful in any way. After about two years of this, the calcifications were determined stable, and Mom was switched back to annual screenings.

August 2016

Our family went back to the breast center for Mom’s yearly mammogram. As we checked in, she was presented with the options of taking the 2-D mammogram, or the most current technology, 3-D mammography. However, the newer test wasn’t covered by our insurance company. Better safe than sorry, she decided, paying the extra $81 it would take.

Two days later, Mom received a call, in which she was told to come back in to take some more targeted images, this time of the right breast. The nurses, techs, and doctors weren't allowed to say anything, though, which resulted in some scary waiting.

We returned a couple days later for targeted images and an ultrasound of the area they were scanning. My dad, brothers, and I waited outside while Mom went in the back for the testing. This time, the techs and nurses were unnaturally quiet as they screened her. “Are you okay?” and, “You’ll know everything that we know at the end of the day,” were phrases repeated to Mom, multiple times. It dawned on her that something was wrong, that perhaps the small anomaly they were looking at was something different. At the end of the appointment, Mom was told that they didn’t know exactly what it was, and this was something that would need more testing.

Once again, we returned to the doctor’s office to have the anomaly biopsied and tested. This time, the doctor, an interventional radiologist, was more forthcoming. "You need to prepare yourself," he said gently, but firmly. "It's ugly enough that what I'm mostly doing today is confirming what we already suspect." He told us that, against the back of her breast, was a small patch of cancer.

Tears stung my eyes as I was told the news. It was hard not to worry, but Mom reassured us that the doctor had told her that they’d caught it early, probably at Stage 1, and it would be very easy to treat and remove. In the process, however, we'd have to go through the long wait for this to be over.

September 2016

A few days later, Mom received a phone call from her primary care physician. She was diagnosed with two different types of breast cancer: invasive ductal cancer in situ, the most common type of breast cancer; and lobular carcinoma, the second most common. The first kind would be easy to treat, because it hadn't spread. The second kind, however, can sometimes spread. More testing would be needed to determine what steps would be taken next.

My brothers and I went out on the back porch with Dad to take some photos for this blog. We were dressed up in pink outfits, and sported awareness gear, getting into power poses to show we were going to beat the cancer. Mom had to stay indoors, and we were able to see her less and less. My brothers tend to get sick often, and Mom's doctors said that her immune system was very compromised. Mom also had to start taking a bunch of different medicines to kick out a stubborn respiratory infection she'd been fighting for a couple months.

The following week, Mom and Dad met with a panel of four oncologists, with whom they discussed her entire medical history and planned her treatment. The first doctor, a medical oncologist, revealed that Mom's biopsy samples had grown larger in the lab when exposed to the hormones estrogen and progesterone. He discussed medicines that Mom would take after surgery. The second doctor, a surgical oncologist, did a breast examination, and wanted to make sure that the lobular cancer hadn't grown, because there was a lot of inflammation. She believed if the mass was not any bigger, that Mom would only need a lumpectomy. The third doctor, a genetic oncologist, ordered bloodwork to determine if the cancer was genetic, and if any of the other members of the family were at risk of getting it. The last doctor, an interventional radiologist, discussed ways to prevent the cancer from coming back. It was a very, very long day.

A few days later, in a different part of the hospital, Mom had an MRI. After a long wait, she came back out, saying that it was super noisy, but the techs were great. Later in the week, a phone call confirmed that the inflammation was just from the biopsy, and that the mass had not grown. The MRI also strongly suggested that the cancer had not yet spread to the lymph nodes, which was a big relief. The lymph nodes are the immune system's filters, and are usually the first place where cancers can spread. With this information, the doctors confirmed that a lumpectomy should be sufficient, and added her to the surgical schedule.

Two weeks later, the whole family got up at 4:00 in the morning. My brothers and I went to stay at my best friend Josie's house while Dad took Mom to the hospital. The reason Mom had to go so early was because she also needed a lymph node biopsy to finally confirm what the MRI suggested: that the cancer had not spread beyond the original mass in the breast. The nurses at the hospital applied a numbing cream to Mom's breast, and had to wait for two hours for it to take full effect. Then, she received four injections of blue dye that would reveal the lymph nodes that were most likely to be affected by the cancerous breast. A special camera tracked the path of the dye, and revealed to the surgeon which lymph nodes to biopsy. There are 20 lymph nodes under each arm; only two of Mom's were indicated by the dye.

During the surgery itself, the doctor removed the mass and the two lymph nodes. Everything she removed was then sent to a lab for testing to determine if they'd gotten everything out, to confirm the cancer's properties, and to make sure that the lymph nodes were indeed clear.

Mom had very little pain after the surgery, which brought great relief to our family, and despite being a little tired, she was very positive about everything.

October 2016
Two days after the surgery, the results of an important test came back: Mom's cancer was not genetic. We cheered and celebrated by making chocolate cupcakes decorated with pink ribbon frosting.

Mom and Dad went to a follow-up visit with the surgeon ten days post-op. The surgeon came into the room with a large smile, presenting good news and not-so-good news. The good news was that the biopsied lymph nodes were 100% clear of cancer. The bad news was that there was still a small margin, in the anterior, that didn't come back clean. Mom would have to have a second surgery to remove the small sliver that was left. The surgeon saw no reason to wait, and scheduled Mom for the next available appointment. This second, smaller surgery, was quickly performed with just a local anesthetic. Mom was home, and comfortable, within a few hours.

Two days later, the surgeon called back with the wonderful news that they'd been successful this time, and that everything was out. Mom is tired and bruised, and she's lost a bit of weight, due to the cancer and stress inhibiting her appetite. But today, she's cancer-free, and our whole family is very grateful that we've had such wonderful friends, and a crackerjack team of doctors, helping us.

October 2016, Part II

Mom and Dad went to see her medical oncologist this week to discuss next steps.  He confirmed that the doctors received an “all clear” report on the surgery margin after the second procedure.

Her pathology report, which was prepared after an analysis of the removed cancer in a laboratory, was kind of discouraging.  After cancer patients have surgery, specially trained technicians examine the excised cancer itself.  They add what they learn to other factors, including patient age and health.  Then they assign a “score” to determine what happens next.  It’s called the Oncotype DX test, and it scores 1 to 100.  Lower than 18 is low risk, 18 to 30 is moderate risk, and 31 and up is high risk.  Mom’s score is 31, just inside the high risk category, meaning she has a 25% chance of this cancer coming back in the next 10 years.  Because of this, her doctors are recommending chemotherapy.

Chemotherapy is a medicine that weakens and destroys cancer cells, and can be especially helpful targeting cells that have escaped from an original cancer into other parts of the body.  While my mom’s chance is very small that that happened, it’s an added safeguard.  Her doctors say that in combination with radiation and hormone therapy, which would be scheduled as the steps after chemotherapy, she could reduce her higher risk for getting this cancer down to 9% for the next 10 years.  Chemo can be a life-saving therapy, but it has some challenging side effects, including nausea, possible hair loss, and a weakened immune system.  The doctor says it can feel like getting the flu.

Mom admits she’s worried more about the chemo than the surgery, but she’s trying to learn as much as she can so that she can stay positive.  She’s been talking with her best friend – my Aunt Lisa, a former oncology nurse – and other friends and family members, for support.  She got a short pixie haircut, and has ordered some soft and warm pink hats to wear in case she loses her hair during the cold winter they’ve predicted for our area.