Happy Birthday! You might have cancer…

Every year on June 2nd I celebrate my birthday (and usually enjoy some cake with my dog).

In the weeks surrounding my birthday, I head to Dana-Farber for tests and appointments. I have a mammogram, MRI, ultrasound, chest x-ray, pulmonary function test, ECHO, and a whole bunch of blood tests with the primary goal being two-fold – 1) to ensure that the long-term side effects of my cancer treatment haven’t reached a level that requires intervention 2) to ensure that no new cancers have cropped up as a result of the chemo and radiation.

This year’s battery of tests started out just like the prior year’s… I had a mammogram. Unlike last year, the mammogram came back without any red flags, which meant that I could avoid another biopsy. However, the decision was made after last year’s events to throw in an annual breast MRI. MRIs and Mammograms are very different and show different things.

Fortunately, the world we live in is AWESOME and I got hooked up with a pair of noise cancelling headphones during the MRI. The MRI team put on my request for the Jack Johnson Pandora station and I got to lay down for about 30-45 minutes… for a mom of three kiddos under 5, this is more or less like going to the spa.

The Ultrasound  

On May 9, my oncologist relayed the news that ‘three things popped up’ on my MRI and I needed to head to ultrasound. “Ultrasound? Great!” I thought, “This beats another biopsy.” 
Due to my ‘high risk’ status, I was tag-teamed during the ultrasound by two doctors with a great sense of humor given the circumstances. Maybe they’re always used to people being really stressed but I wasn’t. Based on their commentary, there was one lump that looked like nothing, one that probably was nothing, and one that they couldn’t find on ultrasound despite me twisting into crazy positions.  After repeated ‘looks’ at the lumps, the physicians said “they are probably nothing but we should biopsy them given your medical history.” So I was headed back to the breast biopsy clinic…

More or less what my lump looks like on ultrasound.
The Biopsy
I was very excited to learn that this biopsy was going to be much less of an experience than last time. It just involved an ultrasound machine, some lidocaine (obviously), and the ridiculous contraption that more or less sucks part of the lumps out. In true clinical research coordinator fashion, I agreed to give some extra sample for research – fortunately, I got more than just personal satisfaction and some good karma out of this – the doctor running the trial visited and proceeded to do an awesome dance due to their overwhelming excitement.

In order to mark where the lumps were located for the next round of imaging, I ended up with two more titanium markers placed in me. These markers show up on imaging and let the radiologists know that we’ve already checked out that spot. It also lets the surgical team know where the lump is located if they have to head in for a resection.

  

My Birthday
On the day before my birthday, I woke up knowing that the pathology results from my biopsy were taking longer than expected. This was because my lump samples were sent out for additional immunohistochemistry tests – I will save you a complicated biology lesson and just say that usually this is needed when things are not super clear cut or when something, like cancer, is going on and they need to further identify it. I was fairly confident that I would have results by the end of that day but alas, that afternoon I still had nothing. My work colleagues are awesome and laughed with me as I said, in a weak moment, ‘I’m going to be annoyed if they tell me I have cancer on my birthday!’ I wouldn’t go as far as to say that I was losing sleep over it but there was small feeling of concern now growing.

Fortunately, cancer has a way of helping me refocus on enjoying the moment. Thus, my partner in crime (Donny) and I agreed that cancer or no cancer – we needed to make the most of the present. So, naturally, we went to a couple of shows! On Monday we saw The Old 97s and on Tuesday, we saw Ingrid Michaelson and A Great Big World. While Ingrid, A Great Big World, and a whole bunch of their friends crowded on stage for the tour finale, we crept into the midnight hour and I knew my 31st birthday was coming to a close. The lyrics to the finale song seemed particularly relevant and I soaked up every glorious minute. 

Surgery
I made it through my birthday without facing the words, ‘you have cancer,’ but I wasn’t in the clear. The morning after the Ingrid concert, I received word from my oncologist that one of the lumps was indeed benign as we expected but the other wasn’t. Based on the number of sketchy cells in the small samples that were pulled out, it appeared to be ‘pre-cancerous’ but, as my surgeon verified, the entire lump was coming out. As I’ve learned throughout my complicated 18 year relationship with cancer, it’s not always black and white – sometimes a cancer diagnosis can fall into the grey area. In my case, the pathologists need to look at the whole lump to determine if there are enough atypical lobular cells to call this thing cancer. Even if it my lump does not earn the official title of cancer, which I’m hoping it doesn’t, we still may not be able to close the book on this case. Depending on the breast oncologist, some folks still end up getting treatment, such as mastectomies, due to the high probability of one day developing cancer.

So, as I officially say goodbye to food for the next 18-20 hours and prepare for the surgery by washing one last time with my special soap, I can’t help but wonder what road we will be heading down. In thinking about this unknown future I continue to be a bit frustrated with myself… a couple days ago when I was discussing the surgery with my surgeon, I learned that we could keep my nipple… “Keep my nipple? Are you kidding!? That’s the good news!?!” But I keep having flash backs to that time when I thought that losing my hair from chemo was going to be devastating… A little perspective certainly goes a long way.

It goes without saying that I will post a surgery update within the next few days; however, we won’t have a path report back for a little while. I promise to keep everyone abreast of the situation (sorry, I had to use that pun at least once)!

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