I Have Breast Cancer

I am sorry that some of you are going to find out this way, but I am a little overwhelmed with telling everyone. I figured this way everyone will know what is going on without leaving anyone out.

On October 13, 2009, I went in for my semi-annual checkup with my gynecologist and she found a lump in my left breast. She advised me to get a mammogram and a sonogram. I had done a self exam a few months before and didn’t feel anything, but when I left her office I felt a pea sized lump that was not there before.

On October 28^th, I went in for my mammogram and sonogram. They immediately advised me to schedule a biopsy on not only the one mass that my doctor had found, but on 3 masses (7mm, 8mm and 2.1cm). I was able to schedule the biopsy for the next day.

On October 29^th, I had my core needle biopsy on my left breast. It was not bad at all. They numbed me up pretty well. They biopsied the 3 masses and put a titanium marker in each one so we would know which ones were biopsied already. After the biopsy, I had another mammogram to make sure they got the areas.

On November 1^st, 3 days after my 39^th birthday, I received my positive diagnosis for Infiltrating Well-Differentiated Ductal Carcinoma on all 3 masses. After reading the pathology report, we realized that if you were going to get breast cancer, I had a good one to get. I have a very good outcome of beating it. The pathology report showed that it is:

1. Well-differentiated (Looks the most like normal cells and tends to be slow-growing and less likely to spread to the lymph nodes).

2. All 3 sites showed similar architecture with well formed tubules and focal cribriform architecture with a grade of 1/3

3. Intermediate grade of 2/3

4. Low mitotic rate of 1/4

The combined histologic score is 4/9, which means again that it is slow-growing Grade 1 cancer. I am also estrogen positive, progesterone positive and HER-2/neu negative. This means that they can cut off my estrogen and progesterone to make it stop growing.

On November 2^nd, I had a MRI with dye done on both breasts. They found 2 more masses (5mm and 2.6cm) near the chest wall in the left breast. The right breast was still clear.

On November 19^th, I finally got in to a doctor at Sloan Kettering Cancer Center. I am not mentioning this doctors name since we decided not to go with them. The doctor offered me a lumpectomy with would take out 2 1/2 inches from the top of my left breast. There would be a noticeable dip in the top and smaller size. She said a mastectomy of the left breast would change my chance of a reoccurrence from 5-10% for the lumpectomy or a 5% chance for the mastectomy over 10-15 years. I would only have a .7% per year over 10-15 years for the right one. To me, that is still a chance of getting it again. So I wasn’t sure what I was going to do.

We decided with the Sloan doctor to do a MRI biopsy of the 2 spots on the left breast that had not been biopsied yet, since she did not think I needed a mastectomy. At the time, I couldn’t understand why with the lumpectomy, she was emphasizing the deformity so much. I figured I would get a reconstruction. I was also given an appointment to get tested for the BRCA gene, since I am an Ashkenazi Jew and the defect gene is prevalent in this lineage. I also had an appointment for the MRI on Dec 7 and an appt with the plastic surgeon on Dec 9.

On November 24^th, I had a second with Dr. Axelrod at the NYU Cancer Center. She took one look at me and said that if we did a lumpectomy that I would not have any breast left on the left side. Since I was so young and they do not do reconstructions on lumpectomies, she did not want to leave me so deformed. At the time at the appointment at Sloan, I didn’t understand why the doctor kept emphasizing the deformity. Dr. Axelrod said it is a general practice that reconstruction is not done on lumpectomies. After talking with Dr. Axelrod, she advised us to think about everything over the weekend and to let her know on Monday what we would decide. She wanted to know whatever we decided that she would like an update on me if we didn’t use NYU. She did tell me that she wanted me to speak to another plastic surgeon, Dr. Sloan, for another consultation.

On November 30^th, I had my consultation with Dr. Sloan. He gave me 3 options for reconstruction: implant, LatFlap (back muscle transplanted with implant) or Tram Flap (tummy tuck with transplanting belly fat into a new breast). We decided to go with the TRAM procedure since it was the most real looking and a get a tummy tuck out of the deal. Not too bad.

On December 1^st, we got in to see Dr. Axelrod and made our decision to go with NYU Cancer Center. Overall, we felt more comfortable there. I also cancelled my appointment for the MRI biopsy since I was having the breast removed; I would not need it biopsied prior to the mastectomy.

I had an appointment later that day with the Genetics counselor to test me for the BRCA gene. She explained to me the percentages of reoccurrence of the breast cancer if I was BRCA positive. Rob and I decided that if I was positive that I would have both breasts removed as well as a possibility of my ovaries, since BRCA positive also increases your risk of ovarian cancer by at least 50%.

So here is where I stand now. I am waiting for the BRCA test to come in to decide if it is one or two breats.

My Upcoming appointments:
Dec 15^th - Preop testing at 10am
Dec 15^th - CTScan of the Belly at 1pm to make sure the belly is viable since I had a c-section and 3 laps through my belly button
Dec 16^th – BRCA Gene test results
Dec 21^st - Radioactive dye injected into my lymph nodes to see if the cancer has spread there
Dec 22^nd - SURGERY

The surgery will be 6-8 hours. I will be in the hospital for 5-6 days. (Yes, I will be in the hospital for Christmas. At this point, none of us wanted to wait until January. Both doctors were going on vacation.) This procedure is the longest one both for surgery time, hospitalization and recovery at home because I am using my own tissue for the reconstruction.

I will try to keep this updated, but recovery might get in the way. I will probably be getting chemo and if the lymph nodes are positive, radiation as well. I am still deciding when I will get a short haircut, before the surgery or before the chemo.