A happy mothers day to you if you are one (of both human or loved furry critter type) and happy mother's day to your mothers if you ain't.
We went to the surgeon (Anita) on Friday just past, to find out where to from here, now that all the pathology, testing and histopathology report was complete. I am saddened to report that it was less than optimal and obviously not what we were expecting nor what we would have liked to hear.
It seems that despite going back into the left breast tumour site a second time to surgically "clear the margins", the team found more of the little buggers skulking around the parameters of the new margins. Although these are baby cancer cells, if left unattended they would develop. So I will need surgery again.
They have also found isolated tumour cells albeit in only two of twelve nodes under my arm, but it demonstrates that the type of cancer tumour that I had was reasonably aggressive so this fact, to a large degree has pretty much determined that I am headed for chemotherapy toot sweet! Although the tumour was small (1.6cm), it was classed as a Grade 3 because it had already made its way under my arm - in short , what the Surgeon referred to as a reasonably high turnover rate of cells - I presume she meant that it has quite a quick conversion capability. So its chemo instead of chrysanthemums for me this year.
According to the surgeon, the debate apparently between the clincial team was, which need be first - surgery or chemo. If I was to opt for the surgery, then the type of surgery that I could have (and more of that a bit latter), would postpone the commencement of chemo as time would be required for sufficient healing. From her "surgeon's hat point of view" she said she can see the relative merits of getting the breast and underarm sorted, and thereby closing off that specific chapter. However, the infancy stage of these lurking cells means that we have time and to that end she agrees with her colleagues in this instance that chemo should commence as soon as possible. I will come back to my surgeon in a minute.
The oncologists and pathologists were barracking for chemo first and surgery latter. The reason is that the relative aggressiveness of the tumour was making them inclined to get the chemo through my system to flush out and kill any other cells that may have already broken away and headed into my blood stream and possibly lodged elsewhere. They wanted to be able to do this ASAP.
Now folks, all of that makes perfect logical and rational sense but when you are absorbing it in one go it makes for one industrial sized head spin. I was conscious of the effect of the news on Siobhan and on me and I was fighting really hard to stay in the moment and not lose the thread of what was being told to me. I was conscious of the almost physical effort I was making to remain focused.
Many things were going through my head at that moment - The team obviously think that the cancer is relatively aggressive, that I could already have cancer cells cruising around my body looking for a nuturing place to lock and load, that I am going to have to wear a bloody wig, that I have a bloody big head and what if I can't find one to fit, that I will need to learn to draw on eyebrows, (but I need to be wearing my glasses to be able to do it properly and not look like a tragic drag queen) and finally \what if I go through all of this and it comes back or a new one starts in the other boob.
Oh and "fuck" I kept thinking "Fuck"................
So I asked Anita. I said that someone had told me early on that having had breast cancer in one breast there was a high probability of it either a) spreading to the other breast or b) a new cancer occurring in the right breast. She confirmed that this was the case particularly in relation to the latter. So I said leaving the chemo question to one side for the moment, what were my surgery options. It was at this juncture that she floated the relative merits of going again and revisiting the margins and scraping more out, versus a bi-lateral mastectomy, versus a double mastectomy. But that should I elect for chemo first, then this would allow me to explore reasearch and determine which surgical solution was the best option for me. A bi-lateral or double mastectomy would require longer healing times that if I went for that procedure now, would delay my starting chemo.
Radical stuff folks to take in in one go.
But it did show me how they gently steer you towards the optimum clinical solution in their collective opinions that they prefer. Although they were at constant pains to ensure that I was aware it was my choice as to how I proceed, the manner of how they queued the information led you to the path of obvious inevitability that chemo first was the only real option here.
I do think that perhaps they were expecting me to be a bit bolshie and likely to be seeking hard facts as they also advised that we were to meet with the medical oncologist immediately post this meeting which we hadn't been advised of prior. I had asked about survival rates, my own survival rate given these new developments, the percentages of re-occurence, more radical intervention to mitigate future risks etc, so I guess they figured I wasnt the crying and staring-into-the-distance-in-shock kind of gal..........
Before we left the meeting with my surgeon and breast nurse one good thing happened. The drainage bag was removed (a big yay for me!!) but Anita also advised something that totally spun me out. If all things being equal, the chemo works and mops up any cancer squatters taking up residence in my body and I have either a genetic predisposition or a strong family history that would warrant a double mastectomy (and bless her and her wonderful honesty, she said that if she was in my shoes, she would be opting for a double mastectomy with reconstructive surgery), she said that if I elect to go down that path - guess where they rebuild your boobs from folks??? From the fat in your tummy - so you end up with new boobs AND a tummy tuck ! Stay tuned because if we get to that stage folks the stories and the pics will be totally wild!
I will now not see Anita for about three months but she has arranged a referral to Plastics, the familial centre for genetic testing and an ultra sound as they have identified a "mass" from my CT Scan .......but recorded it as an ovary !! D'oh.....so she is seeking clarification.
So then we meet the medical oncologist. A total cocky Irish wise-arse smart-mouth who I take to immediately. He can do the genetic logirthythm in his head based on family history of breast and other cancers, ages and pre and post menopausal factors and in his view I probably am not likely to be a gene carrier but will get it confirmed through testing. He also provides me with an interesting sheet of data as to what the odds are for a woman of my age, type of cancer and story thus far, of survival if electing to use available of therapies (chemo, radiotherapy and hormonal ) versus those who dont.
He then proceeds with an almost wickedand delighted expression on his face to say he intends to thoroughly and totally poison me as soon as I agree commencing with FEC which is fluorouracil, epirubicin and cyclophosphamide. I will be given three cycles of this (one every three weeks for nine weeks in total). Followed by three cycles of docetaxel. (one every three weeks for nine weeks in total). A combined six cycles occurring over 18 weeks folks. Oh, and I will lose my hair in the second cycle of FEC .....just in time for the start of winter!!!
He tells me to seriously reduce alcohol intake (what sort of Irishman is this bloke) as the connection between breast cancer and alcohol is well established. In the interests of full disclosure peoples, I intend to do so, save for one notional glass at any important occassion but that this change to lifestyle will only commence when chemo does. So now we wait about three weeks and I will start chemo.
Siobhan and I left and walked across the road to the Fitzroy Gardens. The leaves have turned and have started to fall away. As we both digest the news, we look at the trees on this beautiful Melbourne autumnal day and I say to Siobhan that I want to come back to this specific tree with her in spring, when new green shiny leaves have totally covered all its branches. I tell myself that this tree wil provide a metaphor for my own renewal.
To Joy and John D and to Pauline and Rob a very special thank you from us.
Kxxxx
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