On March 25, 2011, I met with my Oncologist and the breast surgeon and the radiation oncologist. I met with Dr. Diab first, my oncologist. He gave me the results from the PET Scan and the Breast MRI. The PET scan came back negative, the cancer hadn’t spread throughout the body. The breast MRI just showed the one tumor in the right breast. At least that was the good news. I would need chemo. The kind of cancer I have is estrogen negative, progesterone negative and HER2 negative. Dr. Diab explained to me that Invasive Ductal Carcinoma is an umbrella term. I have Triple Negative Breast Cancer – a very aggressive cancer. It would not respond to any adjunctive therapy (Tamoxifen or any other estrogen type pill). My only choice would be chemo. I would need 6 treatments over 3 weeks which would take about 4-6 months to complete. He said right then it looks like stage 1 but won’t know for sure until after I have surgery. He told me that the cancer cells were dividing at a very fast rate…65%.
I met with the Radiation Oncologist next. He said I would do chemo first after the surgery. If the lymph nodes come back positive for cancer seeds I would need 6 weeks of radiation, 5 days a week. If the lymph nodes come back negative I wouldn’t need radiation. He explained the side effects of radiation that I could experience….skin could itch, skin could become pink, possibly burn, possible prickly heat. Lotions and ointments would help with the side effects.
I saw the breast surgeon last. She explained to me that if the genetic test come back positive, most people opt for the double mastectomy. She said that if I chose to do a lumpectomy with sentinel node removal it would be done on an outpatient basis. I have the double mastectomy it would be done on an inpatient basis. If I have the double mastectomy I would have to meet with a plastic surgeon. She would call me with the genetic test results.
Here comes some scientific terms and words that might bore some of you. Some of you might find it fascinating and look up what it means I believe I explained that I tested negative for the BRAC-1 and BRAC-2 breast cancer gene. No one else in my family has had breast cancer. I am the first one to have it. The diagnosis from the core needle biopsy: Tumor Type: Infiltrating Ductal Carcinoma. Grade, Nottingham: Grade II (Tubules 3, Nuclei 2, Mitoses 1). Lymphatic/Vascular Invasion: Not Identified. In Situ Component: Ductal Carcinoma In Situ Present, Solid Pattern, Intermediate Nuclear Grade, Comprising less than 10% of the total tumor volume. Calcification: Not Identified. Lymph Node, Right Axilla Biopsy: Lymph Node, No tumor identified
Clinical history: Highly suspicious palpable mass, lateral right breast, consistent with invasive cancer. Mildly prominent right axillary lymph node, r/o mets. Surgery performed: Right breast and Axilla Biopsy.
Microscopic Description: Sections show cores of breast tissue extensively involved by an infiltrating carcinoma composed of small groups and single neoplastic cells. The groups in many areas infiltrate in a “Indian-file” pattern, but other groups hint at gland formation. The cells have a small amount of cytoplasm and enlarged nuclei showing mild to moderate atypia. Mitotic figures are difficult to appreciate. An in situ component is focally identified showing expansion of ducts/lobules by similar appearing cells. This component comprises less than 10% of the total tumor volume. Lymphatic/vascular invasion is not identified. Immunoperoxidase studies for E-cadherin and P-120 show staining consistent with a ductal carcinoma. Calcifications are not identified. Sections show core biopsies of a lymph node. Metastatic carcinoma is not identified on routine H&E-stained sections.
PET Scan: Indication: Breast cancer, initial staging examination. Findings: There is focal metabolic activity corresponding to 1.2 x 1.6 cm nodule in the lateral right breast, representing the biopsied lesion. No definite FDG avid axillary, internal mammary, or other mediastinal or hilar adenopathy is seen. Mild stranding is seen in the right axilla related to recent intervention. Impression: Focal fluorodeoxyglucose uptake corresponding to nodule in the lateral right breast, representing the known tumor. No distant fluorodeoxyglucose avid metastatic disease.
Bilateral Breast MRI Examination with and without contrast. Indication: 38-year-old woman with recent diagnosis of right breast invasive ductal carcinoma, grade II, with associated intermediate grade DCIS. Lymph node biopsy at that time was negative for malignancy. MRI is performed for extent of disease. Comparison: Mammograms of 4/6/05, 4/10/07, 3/15/11, 3/16/11. Ultrasounds of 4/6/05, 4/10/07, 3/15/11, 3/16/11. Findings: Background fibroglandular enhancement is mild. Right Breast: There is a malignant enhancing mass with associated biopsy clip artifact at its lateral margin at the 9 o’clock N5-6 position- measuring 1.6 x 2.2 x 2.4 cm. The mass is located 1.3 cm from the chest wall; however there is no abnormal pectoralis muscle enhancement to suggest chest wall invasion. No right axillary lymphadenopathy is appreciated. Left Breast: There is a non-mass-like area of enhancement with minimal associated persistent enhancement at the 5 o’clock N5 position, measuring 1.1 x 1.6 x 1.8 cm. There are two additional areas of non-masslike enhancement with associated persistent enhancement kinetics in the superior left breast – one at the 11:30 N4 position measuring 1 x 1.4 x 1.6 cm and the other at the 12:30 N5 position measuring 0.9 x 1 x 1 cm. Correlation with recent mammograms reveal these enhancing areas to be located within areas of dense fibroglandular tissue and may represent parenchymal response to hormonal stimuli in this young patient. No axillary lymphadenopathy is seen.
Impression: Unifocal right breast carcinoma, measuring 1.6 x 2.2 x 2.4 cm (1.3 x 1.9 x 2.4 cm on ultrasound of 3/15/11). The mass is 1.3 cm anterior to the chest wall and there is no MR evidence of chest wall involvement. Three areas of non-mass-like enhancement in the left breast at the 3 o’clock N5, 11:30 N4, and 12:30 N5 positions. These areas may represent enhancing fibroglandular tissue in this young patient and they do correspond to areas of fairly dense breast parnchyma when reference is made to recent diagnostic mammogram. Conclusion: Known Biopsy-Proven Malignancy – Bi-Rads 6. Recommendations: Left breast ultrasound correlation.
I decided to go ahead with the double mastectomy even though I tested negative for the BRAC-1 and BRAC-2 gene. The reason I made that decision was because of the aggressiveness of the Triple Negative Breast Cancer and I knew I would worry it would come back in my left breast. Dr. Clark, my breast surgeon said that was a good decision to make.
My next step was to meet with the plastic surgeon to go over my options for reconstructive surgery………