6/20/19: The Nurse Called Me with Appointments and Receptor Results

While we were at the genetic counseling appointment, the nurse called and left a message. I called her back and was able to speak with her.

She said she spoke with my NP and had some information for me.

First, I got an appointment with the plastic surgeon. Unfortunately, it conflicted with the appointment with the breast surgeon, so she was trying to see if my breast surgeon appointment could be changed. I told her the NP had said I could always decide about breast reconstruction later, and that I'm not sure yet how I feel about breast reconstruction, so right now I am more concerned about meeting with the breast surgeon as soon as possible. I wouldn't mind delaying the appointment with the plastic surgeon. The nurse agreed to keep my breast surgeon appointment as scheduled, she would cancel the plastic surgeon appointment, and look to re-schedule the plastic surgeon for a later date.

Second, I got an appointment for the MRI with biopsy. The date is about 1 1/2 weeks after my appointment with the breast surgeon, so we won't have the biopsy results in time for the breast surgeon appointment. I am wondering how soon we could schedule the surgery... Having both genetic testing and MRI biopsy results before the surgery would be ideal. But I'm also wondering if, after all this anxiety and stress, would I rather just get the double mastectomy no matter what, and save myself the future trouble of having to worry about cancer in my left breast? I need to think about this. The NP had said we can cancel the MRI with biopsy if I opt for the double mastectomy regardless of test results. 

Third, they got partial receptor testing results. I am positive for both estrogen and progesterone receptors. This is good news. This means hormone therapy drugs could be used in my treatment. (I can't help but think how my many years of taking birth control pills may have affected the breast cancer growth... I took a combination birth control pill that contained estrogen and progestin, a synthetic form of progesterone.) They are still waiting on the HER2 testing results.

The nurse said the first step right now is surgery. Then I would meet with a medical oncologist, who would handle my treatment after surgery. 

6/19/19: My NP Called Me

My NP called this morning, as promised.

Every time someone from the Breast Center calls, it's a different number. But now I know to pick up just in case.

I had prepared a list of questions in advance. The NP had me ask my questions first, but in this post, I think it makes more sense to describe important information first.

I have my appointment with the breast surgeon next Friday. I'll have my husband go with me to that appointment.

The NP said the surgeon would likely recommend a mastectomy.

She said she spoke with the surgeon about my case. The cancer being in 2 locations, in 2 quadrants of the breast, is complicating. Usually, when the cancer is in one location, they surgically remove the tumor, then treat the location with radiation to reduce the chances of recurrence. I guess the radiation is targeted to the specific location of the cancer, and it's not an option if there are 2 locations. I wasn't clear on why not, but I found this site that lists radiation as an option if the cancer is "located in one site."

Additionally, the second lump being so close to the nipple is also complicating. She said because of this location, breast-conserving surgery doesn't provide a good option cosmetically. 

She said she would also make an appointment for me with a plastic surgeon to discuss breast reconstruction surgery. We will have to drive to the main hospital in the city for that appointment. At this point, I'm not sure how I feel about breast reconstruction surgery, but I figure it makes sense to meet with the plastic surgeon to learn about the process and what my options are.

Other things we talked about during the phone call:

I asked for clarification regarding the first lump. She said the lump itself is a sebaceous cyst, and the cancer is behind it. The cancer showed up as a "shadow" on the ultrasound, so it looked like maybe the cyst had ruptured, but it turned out to be "not related." I'm still not fully clear on it, but it seems like it's just a coincidence that the cyst happened to appear in front of the cancer.

And the second lump? It's a cancerous tumor. She called my case "multifocal" because there is more than one lump, but when I Googled it, I think maybe she meant "multicentric" because she was clear that my 2 lumps are in different quadrants. I'm not sure if having multicentric cancer is automatically worse than having unifocal cancer, but it can't be better. (In Googling "multicentric breast cancer", it does appear that a mastectomy is the typical course of action.)

The NP said that when there are multiple tumors, they evaluate the cancer based on individual tumor size; they don't add up all the tumors for a total size. She referred to my tumors as "small," and she said having the 2 locations doesn't necessarily mean the cancer is more advanced. I guess that's reassuring. 

I asked if they could tell what type of cancer it is, and what stage? She said they are still waiting on the receptor testing. And they will have a much clearer picture after surgery. During surgery they will look at the lymph nodes (something about a dye, and a biopsy) because apparently if breast cancer spreads, it will spread to the lymph nodes first. She did say that my lymph nodes "looked okay" on the MRI, so that's a "good sign."

Finally, I told my NP that I had read online that it takes about 2-5 years for breast cancer to grow big enough to be palpable. So understanding that my body has already hosted this cancer for a while, is there anything I can or should be doing now that I've been diagnosed? She said the only lifestyle recommendations are regular exercise and a healthy diet.