Surgery

The bottom line is that the surgery went well and there is no lymph node involvement.

The pre-surgery activities were quite a production.  Since the surgery was at Indian River Surgery Center, an outpatient facility, I had to go first to Vero Radiology to get wired.  Yep, wired.

Using ultrasound to locate the tumor, a Radiologist inserts a thin wire with a tiny hook at the end into tumor.  This makes it easier for the surgeon to precisely locate the tumor. The wire is inserted through a needle. In my case, my surgeon prefers to have the need left in place rather than removed.  The theory is that it will keep the wire in place.

With the wire inserted, the technician taped it down and sent me off for a mammogram.  Unfortunately, in manipulating the breast to get a good picture, the needle came out.

Back to ultrasound to have it re-inserted.  Then back for another mammogram. This time everything stayed in place

Then back to ultrasound to prepare for mapping.  This involves four injections of a radioactive dye. (These hurt like big bee stings.)  The dye will move to the primary lymph node.  The surgeon can then locate this node using a Geiger counter and it can be removed and sectioned for biopsy.

The wire is about 4 inches long and could be taped down easily if it were not for the base of the needle sticking out.  So I ended up with a Styrofoam coffee cup taped over it.  I’d worn one of Neal’s button front shirts, but I had to button it around the cup.  You can imagine the looks I got as I left through the Radiology waiting room.  If I’d had a cup taped to the other side I’d have looked like a aged Madonna.

Off to the surgery center.

Everything went smoothly at the surgery center. I woke up with a 3 inch incision on my breast, and another 3 inch incision under my arm where they removed 2 lymph nodes for biopsy.

No stitches.  No gauze dressings.  Both incisions were closed with N-butyl-cyanoacrylate.  Medical Superglue!  That means that I don’t have to worry about wound care (except for icing any swelling) and I can take showers.  Very nifty.

I was at home by 1:30 in the afternoon.  Spent a couple of hours sleeping off the anesthetic.   So next week I see the surgeon for a post-op exam and then have my first meeting with a Medical Oncologist.  That’s when the real “fun” begins, I guess

Karen and the Wild, Wild, Breast

This is my daughter, Karen’s, 10th year participating in the Susan G. Komen Walk for the Cure in the Twin Cities.  She alternates years walking and crewing.  This year she’s a member of the Tent & Gear crew. She gets to drive a truck this year in addition to handling everyone's gear and setting up tents.

The cowboy hat goes with the theme for this year’s crew.  Here’s the Tshirt

 

It’s a grueling event for the walkers – 60 miles in 3 days; and a lot of hard work for the crew hauling around everyone’s gear and setting up and organizing tents.

I’m proud of Karen for her 10 years of steady support for breast cancer research.  I’m proud of all of the participants for their efforts.

Biopsy Pathology Report

I got a copy of the pathology report from the biopsy.  It didn’t tell me much more than I already knew.

The triple-negative result led to additional testing which confirm a diagnosis of Basal like Breast Cancer.  After doing some online research about Basal like Breast Cancer, I don’t really know any more about it than I did before I started.

Apparently one school of thought equates TNBC (triple-negative breast cancer) and Basal like Breast Cancer.  Another set of researchers say that all TNBC is Basal like, but not all Basal like is TNBC.  These cancer subgroups have been identified only in the past several years, so there’s just not enough research yet to be definitive.  If you can explain it to me I’d be grateful.

I’m Grade 3 on the Nottingham histological score which means that it is a rapidly growing tumor.  I’d already figured that out just by feeling it over the past month or so.

The question that I’m most concerned about is whether there’s lymph node involvement; but that won’t be known until the surgery.

 

Waiting. Waiting……

The Cost of Cancer - Part I

Ok, so now I’m scared. Not about the disease – about the potential cost.

 In many cases breast cancer is treated with surgery followed by radiation therapy. Triple-negative breast cancer, however, generally calls for a cycle of chemotherapy followed by radiation.

Chemo drugs can be unbelievably expensive. I’ve read that drugs can be $3,000 to $9,000 per injection!  And in some states, insurance does NOT cover cancer drugs that are given in pill form; but covers that same drug if given by injection.

Why does chemotherapy that costs $70,000 in the US cost only $2,500 in India?

http://www.theatlantic.com/health/archive/2013/04/why-chemotherapy-that-costs-70-000-in-the-us-costs-2-500-in-india/274847/

 Why do chemotherapy drugs cost so much?

http://www.takepart.com/article/2013/05/09/cost-of-chemotherapy

From the above article on takepart.com:

“But research is not even the biggest expense. The U.S. pharmaceutical industry spent 24.4 percent of each dollar of sales on promoting the drug, as compared to 13.4 percent spent on research and development, according to a 2008 study in PLOS Medicine by York University researchers who collected data from the pharmaceutical industry and physicians.”

I don’t know about you, but I could certainly do without so many (none would be good) TV ads for Viagra and Cialis.  Given the huge revenues of the drug companies, even moving 1 or 2 percent of every dollar to R&D would make a big difference.

But I really don’t know what to expect.  I guess that’s what scares me. Until the surgery I don’t know what stage it’s in or whether there’s any lymph node involvement. 

Today’s the 20^th.  8 more days to surgery and some answers.

Preparation Begins

My Primary Care Physician apparently must clear me for surgery – verify that I’m healthy enough to slice into.  So today I went in for blood work and a chest x-ray.  Can’t remember the last time I had a chest x-ray

I’ve also started a spreadsheet to track all expenses associated with this process. I want to be sure that I’m aware of when I reach that magic “out of pocket” maximum; and make sure that my insurance also knows exactly when I reach that number.  It’s something I’ve never had to consider before.

Research and reading leads me to believe that chemo is VERY expensive; and I suspect that radiation therapy isn’t exactly cheap.  Now that we’re retired and living on a fixed income, cost is much more of a concern that it was when we were both gainfully employed. It may very well be the most frightening aspect of this whole thing.

So I have cancer

This blog will follow my experience dealing with triple-negative breast cancer.  I am a 70 year old (71 in November) white woman which seems to put me in the minority of women who get this – most are younger women – and it strikes more black women than white women.  Typical.  I’ve always been a little out of the mainstream.

According to www.breastcancer.org

 “Triple-negative breast cancer does not respond to hormonal therapy (such as tamoxifen or aromatase inhibitors) or therapies that target HER2 receptors, such as Herceptin (chemical name: trastuzumab). However, other medicines can be used to treat triple-negative breast cancer."

About 10-20% of breast cancers — more than one out of every 10 — are found to be triple-negative. For doctors and researchers, there is intense interest in finding new medications that can treat this kind of breast cancer. “

 When I first found this lump, I was expecting to have a lumpectomy followed by radiation therapy – and then be done with it. No big deal.  The triple-negative diagnosis means that I’m now looking at a round of chemotherapy, too. This is starting to become a bigger deal.

I’m not frightened.  I’m not worried.  Everyone thinks I should be both.  I’ve had one previous bout with cancer – cervical cancer – that was caught early and quickly eradicated by surgery. Piece of cake.  I’m accustomed to knowing people who get cancer.  Aunts, uncles, cousins, parents, brother.  It seems to be a fact of life in my family so I don’t think of it as some remote, obscure monster.

I also seem to have not outgrown my feeling of invincibility.  Whatever trouble may have befallen me, or was self-induced, (99% of it) I’ve always landed on my feet.  I expect to land on my feet after this, too.

I am anxious.  I don’t wait well.  As I write this, my surgery is still 11 days away. It’s making me crazy.  I want it NOW. And that is affecting my frame of mind.  I’m antsy – have trouble concentrating – can’t sit still for very long.  I hate waiting.  Let’s get this show on the road!!!!!

In the meantime I’m trying to prepare.  My daughter found a wonderful newly published book:

Surviving Triple-Negative Breast Cancer by Patricia Prijatel. 

Patricia is a survivor who produced this book as a result of her experience and extensive research into this somewhat unusual disease.  She provides insights and an extraordinary amount of practical information.

This entry is just an introduction.  In a later post, I’ll include a list of web links for those who want more information about TNBC (Triple- Negative Breast Cancer).