My Breast Cancer Story Part 10: Treatment Plan

Cancer treatment plans are very much tailored to each individual patient, so before I get to my personal plan (which follows the lumpectomy surgery I had in early December), I want to share some details about my cancer with you.

First, let me introduce you to my tumour: invasive ductal carcinoma (80% of breast cancers are this type, which starts in the milk duct and then invades tissue outside the duct) along with DCIS (ductal carcinoma in situ, cells inside the milk duct have become cancerous but have not left the duct so it’s considered non-invasive). While having two different types seemed worrisome to me, I came across a study entitled “Overall survival is improved when DCIS accompanies invasive breast cancer” so you just never know.

Once removed and measured, the tumour came in at 1.1 x 1.0 x 0.8 cm, so definitely a small one, considered Stage 1A (because of size and the fact that it hadn’t spread outside the breast to the lymph nodes). Pathology indicated that it is Grade 2 (out of 3; referring to how abnormal the cells look compared to healthy cells). It tested positive for progesterone and estrogen hormone receptors, which means it can be fed by female hormones (more on that later) and has a low mitotic rate (referring to the speed that the cancer cells are dividing and growing).

The tumour also tested negative for HER2 (a protein that promotes the growth of cancer cells). This was a really important piece of information to have (and because the first test came back equivocal it had to be tested again – I waited 8 weeks after the biposy for the final results) because certain drugs can target HER2, and chemotherapy is often used for HER2-positive patients. (Random note: I know I’ve heard the works “unequivocal” and “unequivocally” many times, but I don’t know if I’ve ever heard the opposite. It took me a minute to flip the meaning in my head to figure it out when I first heard the original test was “equivocal” – uncertain, ambiguous.)

The fact that I don’t have a family history is also a consideration when it comes to treatment. I’ve been asked whether I’ve been tested for mutations in the BRCA1 or BRCA2 genes but I was told by my doctor that I didn’t meet the criteria for testing, as I didn’t have a first-degree relative with breast or ovarian cancer – therefore my disease isn’t believed to be genetic.

I’ve known all along that after choosing lumpectomy, radiation would be a required step in my treatment, and based on all of the above information my medical oncologist feels that chemotherapy will not be beneficial enough to me to be worthwhile. I won’t lie: this was a huge relief. Not only does chemo add months of time to the treatment and varying side effects (again, each person is different), losing your hair is pretty much a guarantee, and I was really struggling with that idea. That said, I was struggling a lot more with the idea of my cancer returning so I would have done whatever was necessary.

For peace of mind, my medical oncologist is going to order an Oncotype DX test, which analyzes a piece of cancer tissue and uses a number of factors to assign a “Recurrence Score” – the higher your number, the more likely your cancer is to return, and the more you could benefit from chemotherapy. (“I know your number will be low,” he said, “but at least you won’t second-guess the decision.”)

The Oncotype DX results can take a couple of weeks to come back, but in the meantime my radio oncologist will get the ball rolling for my radiation. In the next week or so I will go to Oshawa for my planning appointment (which will by far be the longest one): they will locate the area to be targeted, and do whatever measurements and technical setups are needed so that when my first session arrives (two weeks later) they’re ready for me to walk in, get zapped, and leave. (I will be driving an hour each way to these appointments which will only last minutes, but again – not complaining. Cancer, be gone!)

I will do 20 consecutive sessions of radiation (they run Monday to Friday, closed on stat holidays and once a month for maintenance) and I can assure you a full post on radiation will be forthcoming.

If the Oncotype DX results are shockingly high, we will have to adjust the plan to do chemo first, but my oncologist was very confident that wouldn’t happen and therefore I am too. (The oncology nurse who is my CAREpath case manager presented my case to the oncologist she works with, who indicated he also would have said no to chemo in this situation, so I felt even better having that unofficial second opinion.)

After radiation is complete, hormonal treatment will be the next step. Because my tumour is fed by female hormones, I will take the drug Tamoxifen for five years, which will block the estrogen receptors on any breast cancer cells, again with the hope of preventing recurrence. I’ve heard lots of {switch to sarcasm font} super fun things about Tamoxifen (not really looking forward to menopausal effects at age 43) so that will be a future post too!

While it was nice not to have to worry about appointments and decisions over the holidays (though I did keep busy with post-surgery physio at home and am proud to say I can now hold the phone between ear and shoulder again), I’m raring to go right now and finding it hard to be patient with all the waiting – I just want to be healthy and back at school! But the morning reflection I read yesterday encouraged the phrase, “I trust you, Jesus” and I’m using that one over and over to keep me grounded and focused.

Sending so much love and appreciation for all of your messages, thoughts and prayers.