My Version of Breast Cancer 101

Monday, October 28, 2013

I can't start without first thanking everyone for their amazing support after our first post about being diagnosed with breast cancer. Although this is an incredibly tough time for us, we feel so loved that it's hard to even describe in words how grateful we truly are. Between the phone calls and emails and texts and care packages, not just for us, but for Emma and Jack, the support has been amazing. I don't think that I'll ever be able to express what it all means to us. So truly, from the bottom of our hearts, Wes and I thank you so very much.

It has absolutely made a difference and will forever be in our minds.

Last week was really, really good. Up until Friday it seemed like any other normal week really. We were back to our same routine. Get the kids up, go to school/work, come home, cook dinner, bath time, snuggle time, bedtime, etc. It was back to all seeming like it was just a bad dream. I don't know what it was about Friday that made that day different, maybe I was just tired from the week, or maybe I was just run down from trying to go on with normal life, when it reality, it really wasn't normal. It was like being Eeyore for the week, but without all the sadness. We were feeling pretty positive (especially with all the love we were getting from friends and family). But there was just this gray, gloomy, raincloud following us around all week. On Friday, it just seemed to finally catch up to us, and rain.

Although we had heard about the final biopsy reports during our last set of appointments, I finally saw a copy come through early Friday morning. Right to my Inbox. Maybe it was just seeing all those words again. Those words that we had tried to forget about for a few days. Maybe it was just that it caught me off-guard and I just wasn't mentally prepared for it. Who knows. But for some reason it felt like getting the news all over again.

Infiltrating and In Situ Moderately Differentiated Ductal Carcinoma

It felt like I got hit by a truck. Again.

All day, I couldn't get those words out of my head. Here's the kicker. Even though the surgeon had explained most of it to us the previous week, I still didn't understand what most of it really meant. That made for a pretty rough Friday. I was pretty beat when I got home and just overall wasn't feeling so hot. Thank goodness for Wes. He has certainly carried the burden for the last couple of weeks and I don't know what I would do without him.

After getting that rough day out of my system though, I decided to use that biopsy report to learn a little more about what we were facing. To teach myself. I'm an engineer. I like data and I didn't understand the data I had so far. If I understand the data, I feel better about solving the problem. So, I figured since I didn't really know much about cancer at all, why not share what I learned so far too. I'm sure there is a lot more to come, and I know there is a lot more that I can learn. But here's my version of Breast Cancer 101...

Infiltrating and In Situ Moderately Differentiated Ductal Carcinoma

Sounds gnarly right?

Yeah, I thought so to. Here's how you break it down...start from the right, and move left....

Ductal Carcinoma: Simply put, it's a type of cancer that starts in the milk ducts of the breast. There are two different types, Ductal Carcinoma In Situ and Invasive Ductal Carcinoma.

I was diagnosed with both.

Ductal Carcinoma In Situ (DCIS) is the most common type of breast cancer. "In Situ" just means "in it's original place". So it's cancer that is noninvasive and has stayed put. It hasn't yet made it to the breast tissue and it's pretty much the earliest stage that breast cancer can be, Stage 0. This usually doesn't form a lump, but is found about 80% of the time through a mammogram, which will detect tiny bits of calcium that develop in dead cancer cells.

Typically, DCIS is treated with a lumpectomy and radiation. The risk of lymph node involvement is pretty small here, so the lymph nodes under the arm aren't usually removed.

Invasive Ductal Carcinoma usually develops in the same breast and around the same place where the DCIS first occurred. It's similar to DCIS in that it also begins in the milk ducts of the breast, but it doesn't stay contained there. Instead, it grows through the duct walls into the breast tissue. This is the kind that can more easily spread to other parts of the body. This is the type of cancer that causes a hard lump to form.

In addition to surgery, most doctors will recommend treating invasive ductal carcinoma with chemotherapy, hormone therapy, radiation therapy, or a combination of all of these treatments. Chemotherapy and endocrine therapy are systemic treatments, which targets cancer cells throughout your entire body, where radiation focuses on the specific area. The use of radiation depends on the type of surgery you have, the size of the tumor, whether it has spread, and the if the lymph nodes are involved.

So for me, I have one spot of invasive cancer (which is the lump I found) and then a more wide spread area of DCIS. My Invasive (or Infiltrating) Ductal Carcinoma was also given a grade assessment of Nuclear Grade 2 (which means moderately differentiated, or intermediate grade). Still trying to figure that part out though.

Estrogen and Progesterone Receptors: Estrogen and Progesterone receptor status tests show whether or not one or both of those hormones fuel a tumor. Cancer that is hormone-sensitive is slightly slower growing and has a better chance of responding to hormone-suppression treatment, than cancer that is hormone receptor negative.
My results showed that my cancer was Estrogen Receptor Positive (ER+), which means that estrogen is causing my tumor to grow, BUT the cancer should respond well to hormone suppression treatments.  
Ki-67 Proliferation Index: Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. This makes Ki-67 a good tumor marker. High levels of Ki-67 indicate an aggressive tumor. 
My Ki-67 Proliferation Index was 10%. which I think is a good thing! 

So there you have it. A very high level, probably boring, breast cancer 101. 
Our surgery date is currently set for Monday, November 18th. So until then, we are just going to keep filling up our weekends with family pictures in the park, princess practice and hot chocolate with rainbow marshmallows to warm our bellies.

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