On
Tuesday afternoon, we got the histopathology report on Amanda's tumor
back from the lab. The surgeon, Dr. A, handed it to us and didn't explain
anything. I don't remember if i posted the results of her surgery
before, but the one thing she had really been hoping for was that she
would get to keep most of her lymph nodes. After surgery we were told
they had taken all of them. She was upset by this, wondered if it was
necessary, wished it hadn't happened, of course.
The lab report revealed that of 26 lymph nodes tested, 21 were still positive for cancer.
That's a huge number, obviously. That's all of the sentinel lymph nodes and 3/4 of the axillary ones.
Furthermore,
at diagnosis, she had one 35mm lump in her breast. What they ended up
extracting in surgery was one 75mm invasive ductal carcinoma, plus an
additional 70mm ductal carcinoma in situ (a pre-cancerous tumor). Her
margins were clean but there are a lot of other little things in that
lab report that sound nasty or discouraging.
She
wasn't scheduled to see her oncologist for another week, but as we
walked out of the surgeon's office, she called them immediately and was
fortunately able to move the oncologist appointment up to yesterday
morning, so she could explain the lab report to us.
The
main takeaway here is that the chemo was not effective. It may have
helped contain the cancer a little but it certainly did not kill the
tumor, like it was supposed to. She felt like the tumor was shrinking
during chemo, but during the four-month wait between the end of chemo
and surgery, she started to complain that it was hurting again and felt
bigger again. The doctors brushed this off as normal. They still can't
tell us definitively if the longer wait contributed to these
complications, but what is certain is that if the chemo had done its
job, that tumor should have been dead and inactive regardless. Given all
of the information we have currently, she would be considered Stage 3
now, up from Stage 2 at diagnosis.
The
biggest concern right now is that cancer most easily spreads through
the lymph system, so the number of infected lymph nodes is not a good
sign. It's more encouraging that not all of them tested positive though,
so it's possible the lymph nodes did their job and prevented it from
getting any further.
They've
ordered a new PET scan to find out for sure if it's been contained to
the breast and the removed lymph nodes. We are still waiting for
insurance to approve the PET scan so we can get it scheduled but we
certainly hope that happens soon. If we don't hear anything today,
Amanda's going to call them tomorrow morning and check in on it, and
probably every day after that until they get their shit together and
authorize the damn thing.
Setting
the PET scan aside for the moment, this report still changes the way
we're approaching her treatment going forward. She was originally
expecting to get radiation after healing from surgery. Once they took
the lymph nodes out, it was suggested she might not need radiation; now
it has become definite that she will. The oncologist is optimistic that
radiation will take care of any lingering cancer in her body. However,
they have decided to be more aggressive with her hormone treatments. She
was already expecting to be on hormone treatments for the next 5-10
years, but the stuff they were going to give her is not the strongest
stuff available. However, to get stronger hormone treatments, she needs
to be in menopause. They are going to be giving her regular injections
to trigger an artificial menopause, which she will continue to receive
until she goes into natural menopause. Given how young she is, that
might be quite a while. But it will allow them to hit her with the most
effective treatment they have.
This
is all assuming that the PET scan comes back negative. If we find that
the cancer has spread to other organs...that's a terminal diagnosis.
Stage 4. At that point, further treatment switches from aggressively
combating cancer to just making her comfortable and trying to prolong
her life. We're trying not to think about that right now but it's a
possibility that looms heavy over us.
By
this point it should go without saying that we're scared. From where we
started, this should have been an easily treatable, routine breast
cancer case. And somehow it has become this fucking mess. In hindsight,
yeah, we probably should have done surgery first and chemo after, which
was what the oncologist recommended in the first place but the surgeon
talked us into doing chemo first; if the chemo had been effective, he
would have been right, and would have saved all but one of her lymph
nodes. We had no way of knowing the chemo wouldn't work. It's useless to
second guess the past at this point, so we're just focusing on moving
forward. But yeah, we're scared.
There's
still a couple things working in her favor, at least. The lab report
shows that the cancer is still receptive to the hormone treatments, and
her HER-2/neu status is still negative, which is good; those are the
bright spots we're clinging to. Given everything in the lab report, the
oncologist thinks there's about a 30-40% chance the cancer has spread.
So the odds are still in her favor, but that margin is shrinking.
On
top of that, we learned late last night that a friend and former
coworker of hers died by suicide this week. That's been difficult for
her to process, on top of the shock from everything else.
I don't have a good way to wrap this up.
---
UPDATE March 5, 2021 3:32 pm pdt
The PET scan is approved. We can call back in one hour to get it scheduled.
UPDATE March 5, 2021 4:28 pm pdt
Wednesday, 3:30 pm
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