Month: December 2017

Making it Work > 2017 > December

Word of the Day: Receptor

Posted on December 29, 2017 by pioneerintrees

Before my breast cancer journey began, I might have guessed that a receptor is a mechanical part of a TV tower. Or something like that. Perhaps I wasn’t paying attention in Biology classes. (Sorry Mr. Bailey! But thanks for the quilt!)

What are Receptors?

Turns out receptors are a big deal when it comes to breast cancer. There are three types of receptors on a breast cancer cell:

estrogen receptors
progesterone receptors
HER2 receptors (human epidural growth factor receptor 2)

What does it mean?

When you have breast tissue removed and sent to the lab, they identify whether or not the 3 receptors are positive or negative:

POSITIVE: This means that the cancer cell IS receiving signals from that hormone or protein, telling the cell to grow.

NEGATIVE: The cancer cell IS NOT receiving signals from that hormone or protein to grow.

Why is this important?

It determines your treatment. If any of the receptors come back Positive, then you are a candidate for “targeted therapy” – treatments that target specific characteristics of cancer cells. Good thing. Because other therapies like chemotherapy is a systemic therapy that targets all quickly growing cells … such as those that are in your gut, mouth, vagina, and that grow hair and nails. Yes, vagina.

So, for example, if you test positive for one of the two hormone receptors, then you can use hormone therapy to cut off the supply of estrogen and / or progesterone to the cells. These are called targeted therapies. Boom! Dead cancer cells without the need to throw a ton of chemotherapy at your body. (Note: This is when a positive result is actually positive … not like my last post when a Negative is a Positive.)

With that in mind, a triple negative pathology is NASTY … since only chemotherapy can be used.

What’s my pathology?

Let’s take a look (this is the 2nd path report btw):

My hormone receptors are both negative – so no hormone therapy for me. Move on to the HER2 receptors. Positive. WOOT WOOT!

What’s HER2?

HER2 are proteins that control how a healthy breast cell grows – until they stop working properly, get out of control and replicate in a crazy ass way.

This is the first thing I read about HER2, from the American Cancer Society website:

“For about 1 in 5 women with breast cancer, the cancer cells have too much of a growth-promoting protein known as HER2/neu (or just HER2) on their surface. These cancers, known as HER2-positive breast cancers, tend to grow and spread more aggressively. ”

Oh great. That doesn’t sound so positive…

So what’s next?

So to be sure that there there are no rogue cells journeying around my body, we have to hit those HER2 positive cancer cells with some drugs. And the best treatment is to combine some of the targeted therapy (good) with some of the systemic therapy (not as good). This is what my oncologist has recommended:

1. Herceptin (this is the brand name – the medical name, trastuzumab, is hard to say):

This is a monoclonal antibody (a man-made immune system protein).
It blocks the ability of the cancer cells to receive chemical signals that tell the cells to grow.
Sometimes it is given alone and sometimes accompanied with chemotherapy.
Causes flu like side effects (fever, chills, nausea, muscle aches).
Oh, and it can cause congestive heart failure … more on that in another blog post…

2. Taxol (chemical name Paclitaxel)

One of the taxane chemotherapies that interfere with the cell’s ability to divide.
In order for it to find the cancer cells it needs to hitch a ride on herceptin, which incredibly knows where to go (because it’s targeted …. remember?).
It uses solvents to dissolve paclitaxel, the main ingredient, so the medicine can enter the bloodstream. I will have to take pre-medications to minimize reactions to the solvents. Oh can’t wait for that.

So that’s where we’re at folks!! I know what’s coming … just have to firm up a few dates and get myself fitted with a portacath!

Oh so many more stories to come… like what I’m going to do with this stunning hair before I lose it all!!

When Negative is a Positive

Posted on December 10, 2017 by pioneerintrees

When looking for signs of malignancy in a pathology report, a negative result is a good thing. A positive result is a bad thing. My biopsy was positive for cancer. Bad. Treatment? Take it out. Done.

This week I received the first pathology report that gave data on 3 things that were removed during surgery: Lymph Nodes, Right Breast and Left Breast. Since I knew that the Right Breast contained cancer cells, it wasn’t expecting any huge surprises, just more details. The Left Breast was removed prophylactically (for my convenience) so I wasn’t expecting anything there. But the Lymph Nodes? Now that data was going to be important.

Such great news! Negative! Woot Woot!

Before we go too far along, let me explain a bit about the lymphatic system – that will give you an idea of why this is such a big fucking deal.

The lymphatic system carries lymph – a clear fluid (from Latin lympha, meaning water). Lymph works in conjunction with the circulatory system (which carries blood). It travels along and filters through lymph nodes (we have between 500 and 600 in our bodies). Here’s a look at the area of interest to me:

Lymph nodes and the lymphatic system are very important in the cancer world, because when you have cancer, the lymphatic system acts as a highway (to hell). It carries cancer cells all over the body where it can take root, grow and kill you. That process is called metastasis. I’m sure you’ve heard of metastatic cancer. Sucks.

When cancer cells travel in lymph, they will get caught up in the lymph nodes. This is why, when looking for any spread of cancer, the surgeon first figures out which nodes the cancer tumor drains to, and then does a biopsy of those nodes. With breast cancer the surgeon takes out one or more axillary lymph nodes. They are in the armpit as you see in the diagram above. In an earlier post I told you a bit about how I was prepped for the sentinel node biopsy. I found out later that only one node “lit up”, which was a good thing since the surgeon only had to take one out.

sentinel node biopsy — *This is what they do to figure out where the “hot” node is.*

Of course, since it’s deep in the armpit, the surgery involves digging and scraping through the pectoral muscle so it’s a bit tender. But I digress. My “hot” node was negative, and that’s what’s important. No cancer in my lymphatic system. Phew!

The second set of results were details about the cancer in the right breast – which we knew a bit about already, mainly that it was Ductal Carcinoma in Situ (DCIS) with microinvasions. That means that there was cancer in the duct with some invading out of the duct. Details from the pathology report:

the cells are Stage 3 invasive ductal carcinoma
there were multiple foci of microinvasion in the 4cm x 3.6cm area (as shown in the MRI … so mastectomy was the right call). 🙂
the two foci were 2.5mm and 2.1 mm
there were clear margins around the larger area
It is named “high grade comedonecrosis” or “Grade 3”, positive for EIC (extensive intraductal component) Which translates roughly to “really fucking bad”, as my surgeon pretty nearly said, but without the swearing.

The data revealed that it was bloody good that they did a mastectomy, rather than a partial mastectomy (otherwise known as a lumpectomy). It was a bit of a crap shoot to do it since MRI results can often be a “false positive”. I decided to err on the side of caution and had both breasts removed. Glad I did.

Next step is to meet my oncologist. He / she will read the next pathology report that identifies my cancer cells’ receptors. These receptors indicate what makes my cancer cells grow, and so from that, they determine the treatment plan. But that’s for another blog post.

Thanks for hanging in!

Coming Unglued

Posted on December 5, 2017 by pioneerintrees

I’m coming up to 3 weeks since having my breasts removed. Since I left the hospital I have subconsciously been measuring my progress by the amount of gluey bits that I’ve been able to remove from my body. I know this because now that it’s almost all gone, I’m still not healed. And I’m appalled. But I’m getting ahead of myself.

glue in the armpit — *Just kidding – these are bruises from where they taped me to the table. (OMG, really? Yes.) But note the tape going WAY up into my armpit!! Seriously excessive.*

I came home a few hours after surgery. I was hopped up on oxycodon and therefore didn’t care that the tape attaching the bandages to my body came high up my chest, straight around under my armpits and across my back. The next day, when I realized that the tape was preventing me from moving freely, I pulled back a few centimetres along the perimeter and tucked it in on itself, like a rebel. Thus began my journey into tape removal, and in my mind, recovery.

big ass bandages — *This first bandage was more like a halter top. Note my work on the edges to make a nicer finish.*

I guess that my tape removal = healing theory came from the premise that this healing thing was going to continue on a predictable trajectory. Tubes out, big pad of bandages off, staples out, smaller bandages off, steri-strips on, steri-strips falling off, … no tape. Done! HA! How easy was that??

Look at how the glue turns black – even on the edges of the steri-strips! Yeech.

Now, as I have gone off all drugs except for the odd extra strength ibuprophen, I’m ALMOST glue free, and yet … what’s that I hear? Oh. It’s nerve endings yelling at me! Wearing a shirt hurts. Wearing anything hurts. That is, unless it’s really tight. I feel like a deep pressure junkie. I stand around pressing my hands flat against my chest to make the sensation go away. It’s not quite pain, it’s more like a humming, or the feeling when you’ve had frostbite and then you come into the heat. Burning. Pins and needles. It’s very distracting. Driving with an ice pack under the seat belt is distracting (but feels so great!).

It’s actually fascinating to probe around the scar tissue and feel the edema in some areas (soft and pillowy) and scar tissue (?) in others (hard and unrelenting). I don’t know exactly where the surgeon dug and scraped to get at the sentinel lymph node, but I can guess.

So ya, I’m almost 3 weeks from surgery and still unable to do basic stuff without wincing, such as:

wipe the table
pull open the cutlery drawer
drive standard
braid my hair
take off a shirt (how come it’s easy to put it on?? makes no sense)
sleep on my side
push myself up from a seated position

At my last appointment my surgeon drew me a diagram to explain it. There are nerves that run up through the breast tissue from the chest wall to the skin on top of the breast. He’s cut all of that tissue out, and in the process cut the nerves. So now I like to think that they are talking to each other. “Hey!! Where are you??” Not sure how long it takes for the nerve endings to chill out and the swelling to subside so that the skin can meld with the chest.

chest diagram. — *This is my version of the doc’s drawing. Lou can weigh in on how well I did.*

In the meantime, tomorrow I will work on removing the last few bits of glue.