The oncologist came in to tell my family and I that the results of the pathology report were back on the tissue removed during the mastectomy.
Unfortunately, the more detailed pathology report revealed that the cancer was not contained in situ, and was larger than expected and had spread to other parts of the right breast. Also, upon further testing, one of the lymph nodes contained a very small amount of cancer (micrometastasis).
So, although the original diagnosis was ductal carcinoma in situ (considered stage 0), the pathology report indicated invasive carcinoma, with grade 3 (aggressive) tumors and what is considered stage 2B cancer. Video about Stage 2A & 2B Cancer.
Stage 2 means the breast cancer is growing, but it is still contained in the breast or growth has only extended to the nearby lymph nodes. The stage is divided into groups: Stage 2A and Stage 2B. The difference is determined by the size of the tumor and whether the breast cancer has spread to the lymph nodes.
For this to qualify as Stage 2B Cancer:
EITHER
The tumor is between the 2 and 5 centimeters and has spread to less than four axillary lymph nodes (my case).
OR
The tumor is larger than five centimeters, but has not spread to any axillary lymph nodes.
One of the margins of the tissue removed was also not entirely clear. The tissue from the left (unaffected) breast did not show any signs of cancer.
What this meant for my treatment is that based on the size of the tumor, the grade (aggressiveness), and the fact that it has spread to a lymph node that I will need chemotherapy. I may also need radiation or some additional surgery (there was a group of doctors at Moffitt who met to discuss my case called "The Tumor Board" to determine the recommended course of treatment).
Chemotherapy would start as soon as my drains were out and my incisions had healed - a few weeks.
Because the pathology results were such a surprise, the 4 weeks following surgery were filled with lots and lots of doctors appointments as all the different specialists decided how best to move forward. It was also necessary to wait for the incisions from the mastectomy to heal enough for treatment to begin.
1. The detailed pathology report indicated that my tumor was estrogen receptor positive and progesterone receptor positive (ER+ and PR+). These results are a major component of deciding the types of treatment and the medicines used.
2. I would be receiving 20 weeks of chemotherapy. The course of treatment I would be receiving is commonly called AC + T (these acronyms standing for the drugs that are being given: Adriamycin and Cytoxan, given together, followed by Taxol). The AC therapy will last 8 weeks, with treatment being administered every other week.
After the first 8 weeks of AC therapy, there will be 12 weeks of Taxol, given every week.
I would first need a procedure to have a port placed in my chest so that the chemotherapy can begin. The port will make administering the chemotherapy drugs possible without having to place an IV for each treatment.
I was originally scheduled to start the first round of chemotherapy September 28, 2016, however my oncologist wanted to run one more test, the Oncotype DX Test, to make sure that the type and duration of chemotherapy they planned on administering was the most appropriate for me.
The Oncotype DX Test is a type of genomic test that will allow the doctors to better understand how likely an estrogen receptive cancer is to come back (recurrence) and how it will respond to different types of chemotherapy medicines.
Once these results are back, the oncologist may decide to alter the treatment plan (shorter duration of treatment - 3 months - and fewer chemo meds administered), or he/she may decide to move forward with the original chemotherapy schedule (20 weeks of AC + T).
For More on Genetic Testing See Blog Post: Oncotype DX & BRCA Testing
