December 17, 2005

I decided that it would make sense (particularly in my hyper-organized mind) to keep all of you up to date through email. A lot of this may be re-cap for you, but I figure if I missed some details, I can catch you up now. Feel free to pass this email or any future ones to whomever you'd like. Part of my objective is to share my cancer education with you to remove some of the mystery and make it all less frightening for all of us. The media in the US has a way of exaggerating and playing on people's fears; I'd like to counteract that effect.

My breast cancer adventure started on November 17th with a normal screening mammogram. On December 1st, I was back for high-magnification mammograms of both breasts. On December 6th, I had a stereotactic core needle biopsy of a spot in my right breast and on December 12th, I received the news that the spot was cancer. Whew.

On December 15th, Todd and I spent 5-1/2 hours at Henry Ford Hospital in Detroit where we met with 3 different specialists and an oncology nurse. It was a great morning; both Todd and I feel more comfortable that I've made good decisions so far and that the group of physicians that I'm working with are the right ones. We spent more than 45 minutes with each of the specialists: a surgeon, a medical oncologist and a radiation oncologist. We were able to ask lots of questions and walked out with piles of information.

My diagnosis is "ductal carcinoma in situ" and "invasive." "Ductal" means that the cancer's origin is in a milk duct (which carries milk) as opposed to a lobule (which creates milk). "Carcinoma" is the type of cancer (about which I don't know much). "In situ" means that it is confined within a duct and "invasive" means that it has spread beyond the wall of the duct. Because the cancerous tumor cannot be felt or seen in the mammogram, the professionals believe that it is less than 1 centimeter in size and therefore has probably not spread to anywhere else. So, they believe that this cancer is Stage I (on a scale of Stage 0 for pre-cancer to Stage IV of metastasized cancer). Stage I and Stage II cancer is very treatable and I expect to recover fully.

The next step is to remove the cancerous tumor and to evaluate whether the cancer has spread at all. So, I have two choices: mastectomy with lymph node removal or lumpectomy with sentinel lymph node removal and radiation. Either of these choices has been proven to have the same rate of survival so they are truly alternatives of one another. I have chosen lumpectomy with sentinel lymph node removal and radiation. My surgery is scheduled for next Tuesday, December 20th. It is outpatient surgery under general anesthetic and I should be back to work in a couple of days.

With the lumpectomy, the surgeon will remove the tumor and a margin of healthy tissue about 1 centimeter around the edge of the tumor. A mystery to me was how the surgeon would find a tumor that can't be felt or seen. The answer is pretty interesting. When the core biopsy was completed, they placed a clip of titanium about the size and shape of a sesame seed at the site of the biopsy. So, when I go in for surgery, a radiologist will insert a wire touching the clip. Then, the surgeon will follow the wire to find the tumor.

The sentinel lymph node removal is interesting too. The sentinel lymph node is the first node to which the lymph travels from the tumor site (like the sentinel at the gate). To find it, the surgeon injects the tumor site with blue dye and watches where the dye goes. Then, he removes the node that it reaches first. There is a false negative possibility with sentinel node removal: the surgeon could remove the wrong node or he could fail to find the node at all. Internationally, the false negative rate is 7 – 8%. The false negative rate among the surgeons of Henry Ford is a mere 1%. I definitely feel that I'm with the right doctors!

The last certain piece of my treatment will be radiation. In my case, radiation will be delivered from a special x-ray machine. I will receive treatment 5 days per week for 6-1/2 continuous weeks. Radiation does not cause hair loss. I have been told to expect the first few weeks to be uneventful. During the last weeks, I can expect the skin over my right breast to appear sunburned, to feel occasional sharp pains in my breast and to feel tired. Radiation will not start until at least 6 weeks after surgery and after other therapies that may be recommended.

A pathologist will examine the tumor and the healthy margin of tissue to make sure that there are no cancerous cells at the outer edge. That way, they can be certain that enough tissue was removed. If there are cancerous cells at the edges, then I'll undergo additional surgery. This is not a very likely outcome. He or she will also test the tumor to determine if it grows when exposed to hormones and/or HER-2/neu (a protein). If the tumor is hormone responsive, then the medical oncologist will recommend 5 years of hormone therapy. If it is HER-2/neu responsive, then the medical oncologist will likely recommend antibody therapy. If the tumor is larger than 1 centimeter or if the lymph node has cancerous cells, the medical oncologist will be likely to recommend chemo-therapy. Chemo-therapy for breast cancer will cause hair loss as well as fatigue.

Even though I have cancer, I have not lost my human ability to make choices. I chose to make an appointment for my regular mammogram rather than wait another day. I chose to have the biopsy rather than not. I chose to continue to use doctors from the Henry Ford Medical group rather than another. I am choosing to write to all of you; I am choosing to share everything I know. I choose to be happy and optimistic. And, I choose not to worry.

I would encourage you to remember that you make choices every moment of every day too. There are many things in life you cannot control, but you can control your choices. Make them wisely.