Intro to Oncology

May 18

Less than 24 hours earlier, I was given a vague but life-changing breast cancer diagnosis of Invasive Ductal Carcinoma in the right breast by my gynecologist. This level of information about my diagnosis noted mostly the location of the cancer. For me, cancer originated in one of my breast ducts. It was “invasive” because it had grown beyond the confines of the milk duct and was now invading other breast tissue. Cancer of the breast can originate in other parts of the breast structure so Invasive Ductal Carcinoma is just one of a few different types. 

I didn’t know it at the time but having that level of specificity was pretty much useless in my Google searches that first day. The location and origination of my cancer was not particularly relevant in how it would be treated. I found out much more when I was introduced to oncology and that’s when things got serious. 

My situation was unique in that I somehow managed to magically secure a diagnostic appointment with an oncologist and a breast surgeon in the same cancer organization the very next day after I got the news the biopsy was positive for cancer. I’ve heard of people waiting weeks, chewing their nails to nothing and weeping over WebMD, before they get a chance to learn more about the specifics of their type of cancer and the potential treatment from an oncologist. That would have most certainly put me over the edge and I’m so grateful I didn’t have to wait. However, that day was one of the most overwhelming on records. 

Biopsy had first been the worst day ever. Then, diagnosis took the top spot. But, there were more worst days coming and today was one of them.  

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8am Dr. Allison Gorrebeeck

Dr. G is kind and mildly distracted. She’s tall and very doctorly in a fitted white coat. She goes through the motions of listening to my heart with her stethoscope, though I think that is just a medical way to initiate intimacy because the next thing she does is feel up my tits. 

She flips through the biopsy paperwork and begins to lay the framework for a comprehensive year-long nightmare. 

“Chemo,” she said. It was probably more complicated than that but that’s all I was able to retain. I’m pretty sure I was oxygen-deprived from holding my breath to keep from crying. Cindy was busy scribbling notes and nodding thoughtfully. Cindy may be a very sophisticated and lifelike robot. 

The trouble with Dr. G’s delivery was that she seemed incredibly confident. There didn’t seem to be many cracks in her theory that I could argue and use later to deny this was happening. I learned something new: my cancer was triple positive. 

Breast cancer, in addition to being identified by where it originated in the breast, is also tested for three characteristics that determine aggressiveness and most importantly, recommended treatment. Basically, these fine-tuned characteristics of the tumor help doctors know it better, what it thrives on and what might kill it. These are its hormone receptivity (estrogen and progesterone) and the presence of a protein called HER2. 

I won’t get into the complexity of all the many, many ways breast cancers are categorized because that is best done by a doctor. Frankly, the diversity would probably blow your mind. Also, new stuff is discovered all the time so the landscape of diagnosis is (gratefully) changing frequently. My cancer was receptive for estrogen (meaning it thrives when estrogen is present), receptive for progesterone, and HER2 positive. This is called “triple positive” in the breast cancer world. This definition, far above its first name of Invasive Ductal Carcinoma, was more important I found out from Dr. G in determining my treatment plan. 

Unlike some other types of breast cancer, triple positive breast cancer has a (relatively recently) statistically proven plan that doctors recommend with very little variation. Sure, definitely get a second opinion. Haul your ass to the Mayo clinic if you want but the recommended treatment protocol will probably be the same (at the time of my diagnosis, at least):  Chemo, followed by surgery, followed by more targeted therapy and hormone therapy and probably radiation. 

This little lump needs ALL THAT?! This is clearly a cruel joke. But, seriously, we caught it early, right? But, there are other things to try first? But, chemo is totally different from what I’ve heard about and doesn’t cause hair loss or even an upset tummy? But, this doctor doesn’t even have a medical degree and is an imposter in a white coat? Back me up already!

Dr. G decides to focus our attention on the chemo part since that needs to happen first. I think she realized that was a big enough hurdle for one appointment.  She says the protocol is 6 rounds of chemo called TCHP, every 3 weeks. “About six months,” she concludes. 

I had found a flaw! This lady can’t even do math! I gently offer that 18 weeks is actually 4 ½ months. She sort of mildly agreed that yes, it was a little less than 6 months. But, the look she gave me should have been an indicator of what I would feel like after 6 rounds of chemo. As tiny as I was trying to shrink this situation, I was having a hard time convincing myself that it wasn’t a whopper. As closely as I searched for imperfections in her plan, the more it became rock solid. 

Dr. G gave me a hug goodbye. I am so used to impersonal interactions with strangers, even doctors, that I knew I had just advanced to a new level of medical familiarity, one in which I was in no way comfortable.

Next up, Breast Surgery.

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