Get out those notebooks!

Or, if you were like me in my classes in college- go grab the paper, US Magazine, or hell, just ditch this entry. It's time to learn a little bit about breast cancer. First of all, let me preface by saying the only science class I've taken was "Diversity of Life"- otherwise known as the easiest class at Northwestern. Seriously- even easier than Breathing for Credit. I write soap operas, so what I write here is like Cliff Notes- if you want the full story, please read an actual book. If you are ever interested in learning more about Breast Cancer, a great website is, funny enough,
http://www.breastcancer.org


There are many different types of breast cancer and how you treat it is just as varied. So here's a primer for you. That way, when I talk about pathology reports, treatment options, etc, you'll be at least sort of prepared.

Let's start with the basics. Boobs are not just for wet t-shirt contests. Their primary function is for milk making. (Insert Udder joke here). The first breast cancer distinction is here. There is ductal breast cancer (Originating in the ducts that carry the milk) and lobular cancer (the lobules are where milk is actually made.) Ductal is much more common and lobular is actually a bit more scary. Lobular is a sneaky little bitch- hard to find and has a higher chance of showing up in the other breast. So, if you're going to have breast cancer, ductal= good and lobular=bad.

Right now, without taking Maria out, I have ductal with "lobular characteristics". We won't know what that means until Maria's in a jar and on some slides. I do know, if I have lobular, many argue I should have a double mastectomy because my chance of recurrence in the other breast is a lot higher.

Okay, next thing to worry about- how big is the sucker? Mine's about 1.7 cm. This is still stage 1, although if they find cancer in my lymph nodes, I will then be stage 2. My cancer is big enough to feel and big enough to worry about, but not so big to panic. (Okay, maybe still panic, but you get it.) The bummer about Maria's size is that any tumor over 1 cm, especially with my age, makes me candidate for chemo. Lucky me.

My cancer is invasive, meaning it's broken out of its little cancer shell and started to move. This is obvious by my star pattern on my mammogram. Cancer that hasn't yet broken out is "In Situ". Usually you don't have chemo with that one because it hasn't gotten into your body.

Okay, so to keep score, so far I am stage 1 (pending lymph node biopsy), IDC- invasive ductal carcinoma.

Another thing to note is the pending results of my BRCA test. (Are you falling asleep yet?) There is a very small portion of the population that has this gene mutation that makes them like 60% (some say almost 80%) likely to get breast cancer (as opposed to about 14% normally%). Even though I don't have family history, my young age makes it a possibility. A very small fraction of breast cancers are a result of this gene, but it's still something I'd like to rule out. Plus, there is anecdotal evidence of a link between BRCA and colon and prostate cancer- both of which I have been lucky enough to have in my family. I should be getting the results of this very expensive test that insurance only covers a fraction of in about 2 weeks. If I were to test positive, that is another reason for the double mastectomy. There's also an argument for taking out the ovaries, but we'll cross out that bridge when we come to it.

Finally, another big question right now is my hormone receptor status. I could be estrogen positive (er+) or progesterone positive (pr+). This is actually a positive you want to be, because it means the cancer is susecptible to hormone therapy. So after chemo, I'd take a drug called tamoxifen for 5 years. I've been told the likelihood of being er/pr+ is smaller in younger women, so we'll see. Another funny (by funny I mean Alanis Morrisette fucked up ironic) this is if I'm er+, it makes it much more complicated to get preggers eventually, due to the crazy estrogen being pregnant causes. And you definitely cannot get pregnant while taking tamoxifen- unless you want a kid with 5 arms and 3 eyes.

Round up time! Lobular- bad = mastectomy (as least for me)
Lymph nodes positive= stage 2 and more drama
BRCA- bad= mastectomy
ER/PR+ = good for cancer fighting, bad for baby making

The final thing is my her2neu status. I could go into this long song and dance (what rhymes with proteins?) but the point is, if I'm positive for this, it's bad. It's a sign that the cancer is aggressive and needs more chemo- in fact, there's a chemo style drug called herceptin that I'd need for ONE YEAR. Yep, chemo for a year. That's hot. Apparently, I will be too- in flashes.

I think that's it for now. Please email or comment if you have questions. I will know the answers to these questions after the pathology report comes back after my surgery. The answers will tell me if I need a mastectomy, what kind of chemo, etc. etc.

It's a real pain in the ass.