Thank you for visiting my Caring Bridge site. I am hoping it helps me to share information with those who would like to keep up to date on my care. I am on a path that is likely going to be full of lots of twists and turns but I look forward to getting started. I want to say in advance I am already so grateful for the love and support we’ve all received, and realize we are fortunate to have such great people in our lives. I really hope this to be a bridge to communication (ha hence the name caring bridge) and not a replacement for connecting with you personally.
Best,
Sally
P.S. I apologize for the length of this. Skip ahead if you don’t want all the details!☺️
Bad News Comes
Some time in January of this year I noticed a lump in my right breast. I had a history of fibrous breast issues before that had shown up on mammogram or were felt on exam. These had always turned out to be nothing, so I tried not to be too concerned. Also, most of January we were battling a nasty cold virus in our house, and this got put onto back burner. This lump WAS larger and more noticeable than others before, so when we were all well in our house I scheduled a mammogram.
But, when I showed up for my mammogram on February 14th I was told that because I had a known lump I needed to reschedule for a different type of mammogram. On Monday, February 19th I returned to have a diagnostic mammogram and ultrasound. It was just after these tests the radiologist performing them said he thought it looked like a cancer although we needed to do a biopsy to be sure. Wednesday the biopsy was done, and Friday, February 23rd I got the call with the bad news that it was indeed cancer. Even though I had been preparing myself for this news it was really shocking to hear it was absolutely true. You see I had not been a high risk candidate with a strong family history, and before this year had been faithfully getting my mammograms. It now was an unbelievable truth we now had to manage.
The Details (for those interested)
My cancer is called Invasive Ductal Carcinoma, grade 3, ER/PR positive, HER2 positive, T2, N0, M0. This means it is located in the milk duct, and being invasive it has broken through the wall of the duct to infiltrate the tissue outside, increasing the risk of spreading to the lymph nodes and the rest of the body. It is 3.1 cm in size, and as according to all the tests done so far has NOT spread to the lymph nodes (N0) or elsewhere (M0) — making it a Stage 2 tumor (T2). Another trait of my tumor is the cells are considered Grade 3 (based on a grading of 1-3). This is different than staging, and just refers to the nature of the actual cancer cells having an irregular shape and being more aggressive in growth.
My tumor is also considered triple positive. My cancer cells have hormone receptors for Estrogen and Progesterone, meaning hormones help these cancer cells grow. The third positive refers to HER2 (human epidermal growth factor receptor 2). HER2 positive cancers are more aggressive because the cancer cells make too much HER2 protein. The oncologist explained it is like the gas pedal is stuck all the way to the floor. The good news is that given these features there are more ways to attack the cancer. I will be getting hormone therapy which will block the action of estrogen and progesterone hormones on the cancer cells. In addition, HER2 positive cancers now have a really effective targeted treatment (Herceptin) which attaches to the HER2 receptors and blocks their action and stops the growth of HER2 positive cancer cells.
The Choice of Care
After I was diagnosed here in Northfield we decided to make the hour trip down to Rochester to get evaluated at the Mayo Clinic. Erik’s brother, Paul and his wife Rebecca are both doctors at Mayo and it was nice to have their inside knowledge and guidance. I will say before we made the final decision it was a bit difficult. Being halfway between the Twin Cities and Rochester, we had so many good options. Being faced with this obstacle I didn’t want to make the “wrong” choice. I finally decided after talking to many friends who have gone through breast cancer treatment before me (all at different locations) that everyone seems quite happy with their care no matter where they have gone. How lucky we are to have such great care and so many choices! That being said I have been pleased with all the care I have received so far at Mayo — two thumbs up!
The Testing
When we went down to Mayo, we first needed to get some high resolution images of the tumor to see if there was anything else to be concerned about in either breast or the lymph nodes adjacent to the affected breast. They did a mammogram, ultrasound, and a MRI to evaluate further. A very small area of cells was found that were of concern — in fact they were so small they could not be found on an ultrasound. So, the following week they did another MRI with a biopsy of the site to see what it was. It could be another tumor or ? Fortunately, it was found to be normal, hooray! Also on the first MRI they saw one lymph node that was a little thicker than the others. They reassured me they weren’t too worried about this because lymph nodes sometimes react this way to the biopsies or even possibly the flu shot I had this fall. However, just to cover the bases they did a needle biopsy of that lymph node. It also came back normal, also good news! Even though these tests don’t guarantee the cancer has not spread, they are really good indications. In addition, there was also a blood test done to determine if I was a carrier of the genetic gene mutations BRCA1 and BRCA2, this came back negative. This means I don’t have genetic predisposition to developing breast cancer and practically speaking there isn’t an increased risk of my siblings or children developing breast cancer- very good news! Other tests were done to evaluate my heart function since chemo can affect this and they wanted a baseline to compare to after I started treatment. I had an echocardiogram and an EKG, the results found my heart to be normal and in very good shape. Ok, check...testing done and ready to go forward.
The Plan
Wednesday, March 14th (one month from my first mammogram appointment) we met with the whole “team” of doctors at Mayo I would be seeing, this included the oncologist- Dr. Ferre, surgeon- Dr. Hieken and radiation oncologist- Dr. Corbin. These 3 doctors had met that morning (without me) to discuss the plan together and then we met with each of them individually.
The plan is to start chemotherapy first. In my case, they know I will be receiving chemo for sure (since I am HER2 positive) and starting chemo first has it’s advantages. By watching the response the tumor has to the chemo they get an indication of how well this treatment is working and if they need to modify the treatment regimen going forward. Another benefit is that it will make the surgery easier since the expectation is the tumor will shrink. Dr. Ferre said that in 30% of women the tumor disappears completely! [I’m not permitting myself to have unrealistic expectations, but this is certainly nice to hear!] I will receive chemo (Docetaxel and Carboplatin) once every three weeks for 6 treatments done here in Northfield for 16 weeks total. I meet with the oncologist here in Northfield- Dr. Kratz who will be overseeing my chemo on Monday. Likely, I will start the treatment next week (maybe Thursday) possibly finishing around the first week of July. In addition to the chemo, I will be starting the IV drug Herceptin (every three weeks) I need because of my HER2 positive status. This will be done with the chemo initially and then start up again after surgery until I have received a year’s worth of doses.
After chemo, there will be a period of rest (4-6 weeks) to build back my immune system before surgery. The plan right now is to have a lumpectomy. Dr. Hieken feels I am a very good candidate for this type and location of breast cancer. A surprising statistic is the cure rate for a lumpectomy with radiation therapy vs. a mastectomy are equal. They will also remove and examine the sentinel lymph nodes for any presence of cancer cells. After surgery I will have another break to heal (4-6 weeks) before starting radiation for a period of time. I will finish the IV Herceptin (after 1 year) and start the oral hormone therapy which will last for another 5 years. Well that is the plan as it stands now. We know it isn’t set in stone and may change, but it feels great to have a starting point and get going! Wish me luck!🍀
