The Biopsy Results

After what seemed like the longest four days of my life, I got the pathology result at the breast clinic.

From Friday to Tuesday, I armed myself with all the information I could gather about breast cancer. Even though at the back of my mind, i still cannot embrace it, I did not want to be caught off guard again and not be able to ask questions IF EVER the result came back positive of cancer.

I remember when I went in for the ultrasound, I was quite confident it would just be plugged milk ducts so I didn't prepare myself with questions to ask. This time around, I had questions written down like a news reporter.

As I was called by the nurse to take my vital signs, I wasn't aware that I was nervous until she told me that my heart rate was very fast, 119 per minute.

Jim was at home to take care of baby James so we agreed I will call him on speakerphone so he can hear everything the doctor has to say and ask questions too. I was very composed, I say. I psyched myself up that I cannot cry or breakdown because I need all the details I can get.

Melissa, the breast cancer nurse practitioner came in and started examining me again. She sat down and gave me the news: I have breast cancer, approximate stage 2B invasive ductal carcinoma with focal necrosis.

Okay. I was still calm. I started asking questions while jotting down the details.

1. How big is it: one was about 4cm in the 11 o'clock position. The other one was 1.5cm near the areola.

2. Is there lymph node involvement: yes. Based on the ultrasound and clinical exam, there is palpable gross lymph node involved. They will know more when they do lymph node dissection operation.

When lymph nodes are involved, it means cancer cells have spread outside of the breast and have possibly spread to other parts of the body.

3. What stage is it: stage 2B with the possibility to go higher depending on the results of the next series of tests.

Based on breastcancer.org, There are 5 stages of breast cancer:
Stage 0: used to describe non-invasive breast cancers such as ductal carcinoma in situ (in place) and Lobular Carcinoma in situ. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal cells.

Stage 1: describes invasive breast cancer with tumor measuring up to 2cm AND no lymph nodes involved.

Stage 2:
2A: no tumor in breast but cancer cells are in axillary lymph nodes OR tumor up to 2cm and has spread to lymph nodes OR tumor 2 to 5 cm and has not spread to lymph nodes.

2B: tumor is larger than 2cm up to 5 cm and has spread to lymph nodes OR
tumor is larger than 5cm but has not spread to lymph nodes

Stage 3:
3A: no tumor is found in the breast but cancer is found in axillary lymph nodes clumped together or sticking to other structures, or spread to lymph nodes near breastbone OR

Tumor is 5cm or smaller, spread to lymph nodes clumped together or sticking to other structures OR

tumor is larger than 5cm , spread to lymph nodes clumped together or sticking to other structures.

3B: tumor may be any size , spread to the chest wall and/or skin of the breast AND
may have spread to axillary lymph nodes clumped together or sticking to other structures. Cancer may have spread to lymph nodes near breastbone.

Inflammatory breast cancer is stage 3B

3C : No sign of cancer in breast or if there is a tumor of any size, it may have spread to the chest wall and/or skin of the breast AND
cancer has spread above or below the collarbone AND
cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone.

Stage 4:
Invasive breast cancer that has spread to other organs usually lungs, liver, bone or brain.

4. What do we do next: I need to get blood tests to check for tumor markers which will detect cancer activity in the body. Circulating tumor cells are cells that break off from the cancer and move into the blood stream.

Chest X-ray to check cancer in lungs.

Bone scan to check cancer invasion in bones.

MUGA (Multi gated acquisition scan) scan to test the condition of the heart, to withstand chemotherapy. One of the drugs used in chemotherapy, Adriamycin , can be toxic to the heart and can lead to heart failure.

Other tests to follow are estrogen-receptor, progesterone-receptor and HER2 tests to define the breast cancer further. These tests are crucial in treatment because being positive to these receptor means the cancer can be treated by not "feeding" it with these hormones.

I am also a candidate for the expensive genetic testing to find out if I have the BRCA 1 or 2 gene mutation (Breast Cancer Susceptibility gene) known as tumor suppressors.
Deleterious or harmful mutation of these genes greatly increases a woman's lifetime risk of developing breast and/or ovarian cancer.
This discovery, in case, will affect my treatment and will enable other family members to get tested too.

5. What do you do next for treatment:
I would need to be in neoadjuvant chemotherapy as soon as possible. We are looking at within 2-3 weeks.

Mastectomy. The whole breast needs to be taken out because the size of the lumps and the locations do not make me qualified for a lumpectomy anymore. Removal of both masses leaves the breast basically gone.

Radiation therapy. After mastectomy, I will be treated with radiation on the site of surgery. This will destroy cancer cells in te breast that may stick around after surgery. It decreases the risk of recurrence.

Hormone therapy. If the cancer cells is shown to be positive to estrogen, progesterone or HER2, I will be given hormones for at least 5 years.

She said they are pulling the big guns on my treatments because I'm young. I thought being young with breast cancer has an advantage. But it was otherwise. According to youngsurvival.org, compared to older women, young women generally face more aggressive cancers and lower survival rates. More and more evidence shows that breast cancer before age 40 differs biologically from the cancer faced by older women. A lot of startling facts can be found in this site that helped me learn more.

Despite the prevailing belief that young women cannot have breast cancer, we can and I did. I am even breastfeeding at the time of diagnosis. Even though breastfeeding has been known to decrease breast cancer occurrence.

Ok. These were a lot of information to digest. I was still composed and hoping Jim was still listening over the phone. We can hear James playing in the background so it was a good breather for me.

Finally she told me I can get dressed and wait for her to schedule these tests asap.

As I was getting dressed, it started dawning on me, I'm in for a big fight. A very big and long one.

It was comforting to know that I have a life long partner to go through this challenge with. I also have a son to push me to fight for my life. They are my source of strength.

But then I still cried. I cried hard than I can ever imagine. I cried to Jim over the phone for a good ten minutes or so. I was crying because I was sad he has to go through this too. I know it will be tough for the caregiver as much as the patient. Emotionally, physically psychologically. I was sad for baby James, although he still doesn't understand it, he may see me sad or weak at times. I'm his primary playmate and I love that. I'm sad that I might not be anymore at times.

But I had to console myself, bring my self together to drive home. The journey will start.

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