How in the heck did I get here today? (the non-emotional scientific explanation)

Most of you know that last July, I was diagnosed with breast cancer - specifically - DCIS (ductile carcinoma in-situ). This type of cancer typically does not spread - it is contained in the breast tissue. I had a left-breast mastectomy in September, to ensure that all the DCIS was removed. There was no evidence of lymph cancer (or any invasive cancer) at the time, based on: 1) results of my sentinel node biopsy; and 2) the tissue samples tested after my mastectomy. I was sent on my way with a five-year prescription of tamoxifin, which is an estrogen suppressor, meant to slow or prevent any recurring cancer in my right breast.

I had reconstructive surgery in early February 2009, which included a silicon implant. This surgery was successful and again, there was no evidence of lymph swelling at the or invasive cancer at that time

Sometime in April, I noticed that I had small, painful lumps in my left armpit. I just assumed it was swelling related to the reconstructive surgery, and it would eventually go away. I mean, all signs indicated that I had a textbook DCIS case, and the mastectomy took care of it all. I was not too concerned.

A month later (May 2009), the swelling did not go away. I told myself that I would have the lumps examined in early June when it was time for my mammogram and MRI. Sure enough, those test results showed multiple swollen lymph nodes, so clearly that the radiologist suggested I get a biopsy.

A few days later, in my surgeon’s office (Dr. Shawna Willey, Georgetown), I received a fine needle biopsy. A few days after that (mid June) she called me to say that the lymph sample revealed breast cancer cells. She explained that unfortunately, there must have been some invasive carcinoma cells lurking in my breast that went undetected. These cancer cells spread to my left lymph nodes. Dr. Willey immediately scheduled me for surgery to remove my lymph nodes, and also scheduled me for a PET/CT scan just to make sure there were no other tumors outside of the lymph nodes.

After my PET/CT scan, my oncologist (Dr. Mary Wilkenson, Fairfax) called me into her office to share the results. Not only were there tumors in my lymph nodes, but there were distinct tumors in my liver. I saw the scans myself – and there was no mistaking it – the cancer had spread to my liver.

Dr. Wilkensen needed to get a larger sample of lymph tissue to determine what kind of cancer they were dealing with – what type of receptor cells were there – so she could recommend a treatment plan. The test results were revealed to me today (July 20, 2009) and it showed that my invasive carcinoma originated from breast cancer, and the cells were HER-2 positive. I may or may not have this correct -- but from what she explained, this type of cancer is aggressive, and does not grow or respond to hormone changes. The medicine most effective in treating these type of cells is Herceptin. She assured me that this is relatively good news – as they have seen many positive results in shrinking this type of cancer with herceptin.

In addition to a weekly shot of herceptin, every three weeks, I am going to receive chemotherapy which consists of the drugs carboplatin and taxotere. Possible side effects are infection (due to decreased white blood cell count), nausea, hair loss, fatigue, joint aches and perhaps weakening of the heart muscles. After two to three months, I will get another PET/CT scan to see if the tumors have changed, and my treatment will be adjusted after that. If it is working, chemotherapy will be reduced, and eventually eliminated, and I will be on a herceptin maintenance plan. If it is not working, or there are side-effects that are unexpected, then she will make changes to the medicine, chemotherapy schedule, and do whatever it takes to get better results.

On Monday, July 27, I will have a Single-lumen mediport placed in my chest for easier administration of intravenous medicine. I will probably have my second dose of chemotherapy in the second week of August. I will lose my hair – most likely in the next 2-3 weeks.

There you have it, medical geeks. That’s the unemotional story of how I got to be where I am today! Stay tuned for more cancer adventures!