Diagnosis

I had my appointment to find out the results of the biopsy on Tuesday, October 18. Seth came with me. They put us in a room with a few lounge chairs and a clock that audibly made ticking noises. Seriously. We waited for 25 minutes while this clock made tick tock sounds.

Finally, a radiologist whom I had never met before and someone described as my "patient navigator" sat down with me and told me I had cancer. The doctor went through the biopsy report but I cannot remember anything that she said other than one thing. She said that the person who did the reading called her to discuss how strange my tumor was and that they couldn't figure out whether it started in my breast or was from another area of my body. Hence, the 25 minute delay. I guess this was clinically fascinating. The comment on my report says: "The tumor is poorly differentiated with a solid architecture. The cells are large with foamy or histiocytoid cytoplasm. This is an usual appearance for breast carcinoma, however it has been described. ... Although we favor that this represents a primary breast carcinoma (ductal), the possibility of metastatic tumor cannot be excluded. We considered the possibility of other carcinomas with "foamy" cytoplasm such as salivary gland acinar carcinoma. Please correlate clinically."

The patient navigator then informed me that because my cancer was serious that they had "held open" a few appointments for me. One appointment was for an MRI and the other was with a doctor. Seth grabbed my hand at this point. I knew he was trying to comfort me but I did not want to be comforted.

They ushered us out of the room. And on the way to getting my next appointments scheduled, the patient navigator asked me how I was doing. Before I could stop myself, with as much sarcasm as I could muster, I said super awesome. She apologized right away for asking. I did not mean to be nasty and I immediately felt bad for lashing out like that. Mental note to keep my sarcasm in check but warning that it is my main coping mechanism.

My next appointments were set but I was unable to keep times and dates in my head. I kept asking the scheduler to repeat things. It didn't help. I asked her to write them down, finally. MRI on Thursday, doctor the following week. The doctor squeezed me in on Friday, and that was really the first appointment where I felt like I had a clue what was going on. (Further on the "clinically fascinating" front, my doctor said that they called her to discuss my case because it was so interesting and she decided that it made no sense to make me wait longer for my appointment.)

Calling my family and friends was awful. Seth told me that I couldn't do it via group text message, though. I had a few beers and then started dialing. Having five siblings is daunting at a time like this.

I was so clueless that I had no idea of the specialty area of the doctor I would see. My doctor (who turned out to be my surgeon) is Colleen Coleman of Hoag Memorial Hospital. She sat me down with the reports and helped me make sense of them. And then she mapped out a game plan for my treatment. It was such a relief to start to figure this stuff out.

Diagnosis:
Stage 3a, grade 3, triple negative breast cancer. (Triple negative means that there are no Estrogen, Progesterone or HER2 receptors.) There are likely three tumors in my right breast. Total volume of involvement is 10.4 cm AP x 6 cm TR x 6.8 cm SI. (If you can believe this, the one I felt was the smallest one.)  This is really aggressive cancer. SBR score of 9/9. Cancer has metastasized to three right axillary lymph nodes.

Game plan:
- Pet scan/additional testing
- Chemo
- Genetic Testing
- Mastectomy and lymph node removal (possibly Sentinel Lymph Node Biopsy)
- Radiation