The Beginning of Treatment

June 2, 2016 – I met with my cancer surgeon – Dr Lisa Torp.  7:45 am . . . my world changes in an instant.  Dr Torp is extremely intelligent, very compassionate and gave us every detail possible. 

She started by showing us the mammogram films.  She said my breasts are not dense at all and that helps with finding anything.  The cancer is in the inner part of the breast.  She showed the areas in the ducts that they believe the carcinoma insitu is. 

The carcinoma is less than ¼ of my breast -  not too small but not overly large.

There is a lymph node that looks abnormal – (this is not the sentinel node)

Ductal cancer – most cancers start within the milk ducts.

DCIS – I have one area of invasive cancer 9mm or (slightly less than 1 cm) (1/3 of an inch) – this is possibly the largest area of invasion.  We will not know for sure until after surgery.

Right Now I am considered Stage I.

They look at additional information – they look at the cells and the pathologist assigns a score= grade on how cells look, if they are organized or aggressive.

High grade means they are more aggressive cells and they are more disorganized

They look at breast panel or markers such as estrogen receptors.  If there is no estrogen positivity (not estrogen sensitive) this is a poor indicator and it is a more aggressive cancer. Pills would not be used for this invasive cancer.

The DCIS in the ducts showed a 5% positivity – not a strong factor – we could use pills such as tamoxifen.  This will be retested after surgery.

I have HER2 neu positivity with ER negative and PR Negative.

The cancer is considered High Grade

Although pills would not be used for the HER2 portion – there are targeted therapies for HER2 cancer.  Chemotherapy is recommended using Herceptin and possibly perjeta if the invasive portion is more than 2cm.   There are situations where HER2 is improved if chemo is before surgery.  1)  Status of the lymph node 2) abnormal ultrasound 3)  breast biopsy

We need to establish the status of the suspicious lymph node.

The lymph biopsy will show if cancer is in the body -we would treat the body first

If the lymph node comes back good then Lumpectomy with radiation – lumpectomy and radiation are linked together.

If I would get a mastectomy I may or may not need radiation

              There are situations where radiation is still needed

              2, 3, 4 cm involvement of cancer

Lymph node involvement

Aggressive types of cancer

The doctor said I am a candidate for lumpectomy right now.

From a letter sent to my PCP:

“Clinical stage I hormone receptor negative her 2 positive left breast cancer .

She may actually be stage two as she has a palpable left axillary mass and clinically suspicious axillary lymph node on ultrasound. Staging significantly impacts decision making about neoadjuvant chemotherapy versus surgery as her first intervention”

So a battery of tests begins to help with my treatment plan:

Ldex screening – helps monitor lymphedema risks

http://www.breastcanceranswers.com/ldex-score-how-it-helps-to-monitor-lymphedema-risks/#.V2qJcrgrKCg

Chest Xray EKG and Blood work.

June 6^th – Breast MRI

June 8^th – Genetics Appointment

June 9^th – Lymph Node biopsy for the suspicious lymph node (not the Sentinel)

June 10^th – CT Scans, Bone Scans

June 13^th – Echocardiogram

June 15^th – First Oncologist appointment

June 17^th – Port placement.