Breast Cancer, Chemotherapy, Lymphovascular Invasion, mastectomy, Oncotype, reconstructive surgery, Tamoxifen

I’ve Lost My Marbles

These days breast cancer treatment is like going to In N Out Burger. You can get it tailor-made if you use the secret language. Those in the ‘know’ sound like this:

“I am HER neg, PR/ER positive”

“I found out mine is triple negative”

“What are your staging numbers?”

“PT2CN0.”

“BRACA neg, which is good”

You thought that was confusing? Try navigating through the treatment plan options. If your lymph node biopsy is positive then you do not pass go nor do you collect $200 dollars. That will get you a pass straight to Chemotown. Since I was diagnosed as “node negative” (layman interpretation: the cancer cells enjoyed my ladies so much that they didn’t want to leave), the next step was Oncotype testing. The doctors used this test to decide the rate of exchange between breast cancer recurrence and chemotherapy. Pick a door. Any door.

Door #1-17 Oncotype Score:  “Get Out of Town” free pass.

Door #32-100 Oncotype Score: Welcome  to Chemotown! Sit back and relax. You’ll be here for a while.

door 1-17               door 32-100

Door #18 – 31 Oncotype Score: Painted an ambiguous gray, behind this door you’ll find a “Complimentary Stay” gift card and a “Get Out of Town” free pass.
door 18-31

I chose the excitement and ambiguity of the gray door and was offered the “Free Stay”  and the “Get Outta Town” Pass. Decisions, decisions… what’s a girl to do?

ER/PR POSITIVE: Out of 100 cells tested for cancer, 97 of mine were found to be an unorganized mess of estrogen and progesterone. The cells love me so much instead of dying off and growing, they just wanted to stick around.

       NORMAL CELL                                                                       INVASIVE CARCINOMA              NORMAL DUCT -NO CANCER                          invasive ductal cancer

GRADE (0 – 3): The higher the grade, the more disorganized and irregular the cells and quicker they divide. Because there was a party happening, we (me and the ladies!) were given the clear cut “High-Grade, grades 2 and 3”.

STAGE (0 – 4): The higher the number, the bigger the showmanship. Being completely disorganized but enjoying each other’s company, we decided to that moving was too much of a hassle.  I had one tumor that was  1.5 centimeters. But because news of the party spread, there was a total of 6.5 centimeters of cancer growth around the initial tumor.  My lymph nodes tested negative, but I did have lymphovascular invasion, so I earned a Stage 2.

LVI (Lymphovascular Invasion): These guys know how to do it right! They turn their house party into a block party by making their own network of blood vessels. Just like the game of telephone, my blood vessels created a system of disorganized communication. The good news is that the police came and broke up the party before the phone line reached my lymph nodes. The less good news is that like any good house party, a few quick ones always escape the fun police.

lVI PARTY

ONCOTYPE DX (1 – 100): As the winners of a score from 18 to 31, the treatment is more of a “go with your gut”. The advice I got was “Your score is pretty low. But it is in the intermediate level. But your lymph nodes are negative. But you do have lymphovascular invasion. But Tamoxifen is a very effective hormone therapy. But it is very harsh on the system. But chemo is even harsher. But it might give you a peace of mind.”  Armed with all this helpful information, I was sent home to think about starting chemo or Tamoxifen.

Ever play roulette? Imagine you have a jar with 100 green marbles:green marbles

Option 1- Tamoxifen: Now, take 15 out and replace them with red marbles. Next ask a friend, spouse, neighbor or dog to blindfold you. No peeking! Reach your hand into the jar and grab a marble. It’s like the game Operation… careful not to pick red marble or you lose your turn!

Option 2: Chemo and Tamoxifen: Take out three of those little red guys to replace with the green ones. Blindfold. Rinse. Repeat. marbles

I understand we’re not talking about your mother’s chemo. This chemo is a kinder, gentler chemo.  But is it worth three extra balls to destroy my entire immune system? Is it worth postponing the ER/PR receptor condom (i.e. Tamoxifen) to first destroy all my cells? Are three more worth the possibility of permanent heart damage? For me it was a no-brainer. Didn’t even have to think about it. Decided right there, with my cancer-buddy in tow. “Thank you very much but no thank you. I’ll pass.” We left Oncology with three lucky green marbles rolling around in my pocket.

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