not entirely unexpected

Expect the unexpected

It's been a rough week. The Oncologist got definitive pathology results that prompted her to do an online appointment and initiate a new treatment plan for chemotherapy. It was never off the table as an option but not what we were all hoping for. I am still processing and feeling mostly overwhelmed with intermittent moments of acceptance and grief. 

Pathology Results

The Short Version 

Testing for HER2 is definitively positive. HER2 cells are problematic because this type of tumor cell grows at an accelerated rate, which makes them more dangerous for spread and recurrence. Recommended treatment plan is chemotherapy, endocrine therapy, and radiation treatment.

Oncologist's treatment recommendation is based on three things:  

1. HER2 positive results;
2. identification of lymphovascular invasion (cancer cells identified outside of the tumor but not yet in the lymph nodes); 
3. the final size of the tumor that reflects growth from 16 mm to 21 mm between March 13 and May 16. 

The Technical Data

Process: FISH, Solid Tumor Interpretation, left breast, lumpectomy: Invasive carcinoma

Results: HER2 GENE STATUS: POSITIVE

HER2: CEP17 Ratio: 2.0

Number of nuclei counted: 60

HER2: 4.33 mean signals per nucleus

CEP17: 2.12 mean signals per nucleus

Tester's Comments: HER2:CEP17 ratio greater or equal to 2 with an average HER2 copy number per tumor cell of greater or equal to 4 places this tumor in Group 1 (Positive) as defined by the 2018 ASCO-CAP Guidelines for breast HER2 testing. Breast cancers in this category are considered HER2 positive without further testing required. 

Treatment Plan

Chemotherapy

• 2 chemo medications for 6 cycles with treatment once every 3 weeks for 18 weeks
• 2 secondary agents (I'll ask more questions about what these are at my next appointment) are injected at the time of each chemo dose for 18 weeks, continuing after chemo is concluded for a total of 12 months
• Labs are required the day before each chemo treatment
• Echocardiogram are required between treatments to monitor for potential side effects to the heart from one of the agents

Endocrine therapy

• Estrogen blocker will be prescribed as a pill after chemotherapy is concluded since the tumor needs estrogen to grow. I think this is kind of like cutting off its food supply to prevent recurrence. This treatment continues for 5 years with the potential to be extended to 10 years as new data is starting to show the benefits of the longer treatment. 

Radiation treatment

• Targeted radiation treatments will start after chemotherapy is concluded on a schedule of 4-5 days per week for 6 weeks for a total of 20 treatments.  

Next Steps

1. Medical port placement under my right collarbone as the receiver for the chemotherapy drugs. This will save my veins from having to take a new needle injection each time, which stresses them and makes them unusable after awhile. This is an Outpatient surgery set for this Saturday, 6/10. The same surgeon who did my first surgery will do this placement.
2. Echocardiogram baseline needs to be done for comparison to the later ones in order to track progress. This is scheduled for Monday, 6/12.
3. Oncology appointment Thursday, 6/15 to confirm details of the chemotherapy process and prepare for the first round of treatment. 
4. Waiting for insurance approval of the plan 
5. First round of chemo treatment will start the week of 6/19 or 6/26. TBD.

Thanks for the Hug

So many of you have offered encouragement and offers to help, and I don't yet know exactly what I need. As I figure it out, I'll let you know. 

Again, so many of you have also sent such loving and supportive notes, cards, texts, wishes, prayers, hats, food, coffee, leaf fossil, warm blanket, journals, smoothie maker, cancer survival tools, flowers, an original painting, and an illustrated book manuscript about scientifically impossible river rapids. And while I appreciated the thought, I did turn down a batch of kittens. Every kindness is appreciated.

Sending love out to each of you taking the time to read this and for your ongoing support of me and my family. I feel your collective embrace, and it was much needed in the moment. 

Sherri