^^^ From my Instagram stories (@fancyladydoctor)
Yesterday was a banner day: I ventured outside.
My friend H. was kind enough to drive me to my post-op appointment with my (wonderful) plastic surgeon, plus she braved seeing my Franken-chest (complete with drains coming out of the sides) AND witnessed all of this being photographed for comparison photos as the reconstruction progresses.
I’m 50/50 on whether her lawyer will soon deliver a restraining order due to the unsolicited nudity.
(Kidding! She is great and would be the near the front of the line to witness something akin to reality TV playing out in front of her eyes).
Something else happened: I saw the pathology report from my surgery for the first time.
It’s detailed, and I pored over it, line by line.
There were a few surprises.
The tumor is 1.3 cm (not a surprise). The four lymph nodes that were removed were all negative (a relief). The tumor is estrogen and progesterone receptor positive and Her2 negative (also known from the pre-operative biopsy). There is an associated area of something called Ductal Carcinoma in Situ (DCIS), a kind of localized cancer. This is likely what first showed up as abnormal on the mammogram. The right breast was completely normal (relief).
The parts that I did not like:
- My tumor grade is 3/3. This is not a scale where you want to be at the top. “Grade” refers to how abnormal the tumor cells are, or how aggressive. The scale goes from 1-3, with 3 being the most aggressive (i.e. worst actors). My biopsy had previously called the tumor grade 2/3, and the final result of 3/3 is now worse.
- The other area of DCIS is also 3/3. This was consistent with the biopsy report, so not a surprise but I still didn’t like it.
- The margin (cut edge between tumor and normal tissue) was only 1.5 mm for the area with DCIS. This means that there was a paper-thin line between the abnormal tissue and normal tissue. BUT – at least the margin was “clean,” meaning that the cancer cells did not spread all the way to the edge (or beyond).
What I am taking away from this: I seem to have an ugly, aggressive tumor but it seems that maybe it came upon me quickly. The findings on the mammogram that triggered the additional testing were also NOT due to this aggressive tumor, rather they were from the adjacent area of localized cancer that is something entirely different.
In other words, if I wouldn’t have had the lesser area of localized cancer (DCIS) that showed up as the microcalcifications on the first mammogram, this could have ended up a lot worse.
Please, if you are reading this, let me advocate for being on time with cancer screenings!
Thank you for coming to my TED talk.
After digesting the report, I started the deep Google into my condition.
My tumor is T1c, N0, M0. My stage – I think – is 1A, but barely.
I used an online calculator to input facts about my cancer and predict recurrence. The risk was low – 4.1% – but later I found out that this calculator applies only to women who are older than I am and who are already 5 years past diagnosis and treatment.
I found another calculator to predict my 15 year survival.
Funny-not-funny: I just about went into full cardiac arrest when the calculator spit out that my risk of dying from breast cancer within 15 years was 75%.
I quickly realized that I had typed my tumor size as 13 cm, not 1.3 cm, and with the correct information (and a tumor 1/10 of the size), the result looked different:
What the above says: this has nearly a 10% chance of killing me over the next 15 years.
What is not seen: There is an option for adding traditional chemotherapy to the above (I have left this as “None” in the graphic). With chemotherapy, it looks like the risk of dying can be cut in half, to about 4.5%.
Is this worth it? Will I be offered or advised to have chemotherapy?
I don’t know this yet.
My first appointment with the oncologist is Monday, so I will have to wait for more answers until at least then.
It’s going to be a long weekend.