Sunday, December 22, 2013

Prognosis Factors

There's one questions that I can not bring myself to ask any doctor that we've met with so far.

I can't muster the courage to ask how long I have to live. 

First, I would feel like I was being super dramatic if I did. Other reasons include: 1) it is so cliché, 2) I don't feel it's fair that I have to contemplate this, 3) the information would likely haunt and overwhelm me, and so....4) I don't want to know.

Thinking about it too much is what leads to a lot of the conflict I feel about my future and my long-term plans. Everyone will die...eventually, but my eventually seems like it might be sooner than originally anticipated. When I was first diagnosed and sharing the news with those around me, one of the things that reassured me most was that no doctor told me I had "x" number of years to live. In light of such devastating news, this was a real relief.

I don't believe that any doctor can be extremely certain when they attempt to predict survival - and everyone has heard stories where doctors predicted incorrectly. Instead, my oncologist went through a set of prognosis factors* with us to give us an idea of what's working for me...and what's working against me in this sitch:


1. Size: My original breast tumor was approximately 4.5cm in length. That's pretty big. It's the tumor that prompted me to schedule an appointment to see a doctor. This tumor and it's location in my left breast make me a candidate for a mastectomy rather than a lumpectomy. If tamoxifen shrinks my tumors down a little, it will make surgery easier. When breast surgeons remove a breast tumor, they have to remove a clean margin around the tumor to make sure they get it all...so my 4.5cm tumor and a clean margin would be a large chunk of boob. Verdict: Size, not working in my favor.

2. Lymph Node Status: Breast cancer will often spread to the surrounding lymph nodes first. Cancer can spread once it's gone to the lymph nodes, and pathology reports will include results from the biopsy to see if there is lymphovascular invasion, which means that cancer cells are found in the lymphovascular system. I have multiple (numerous) affected lymph nodes. I tested negative for lymphovascular invasion, but false negatives for this are very common. Verdict: Lymph nodes, not working in my favor. 

3. Grade: Grade is different from stage, but is also categorized with numbers, so it can be confusing. There are three grades, and cancer grade does not factor into staging. Grade is an indication of the aggressiveness of the cancer. The pathologists will look at samples from the tumor(s) and see how similar they look. The more similar they look, the better, this means that they are not multiplying, growing, evolving very quickly. Most patients my age have very aggressive, fast-growing cancer. My tumors, however, have been categorized as grade I. Samples from all three sites (breast, lymph nodes, and spine) look the same. So....that's weird. Verdict: Grade, totally working in my favor. Yay!  

4. Hormone Receptor Status: Tumors are made up of all sorts of things. For real, Google it. When doctors test a tumor, they check for proteins that are hormone receptors. A hormone receptor is a protein that feeds on estrogen or progesterone. Tumors are categorized as hormone receptor positive or hormone receptor negative depending on the presence of these proteins.  My tumors are very hormone receptor positive, the tumor in my breast is 99% positive for estrogen receptors and 90% positive for progesterone receptors. This is a good thing because it gives us endocrine therapy as an option. Verdict: Hormone Receptor Status, working in my favor.

5. HER2: If a tumor is HER2 positive, it contains proteins known as human epidermal growth factor receptor 2 (HER2). HER2 positive breast cancer is typically more aggressive, but with it comes other drugs and treatments that may work (like Herceptin). What's really tough is when someone tests negative for HER2 and hormone receptors, that can really limit treatment options. Verdict: HER2 status, working in my favor - go me!

6. Metastases: Metastatic cancer is when cancer spreads beyond it's original location. It's different than having two different types of cancer (ex: breast cancer and lung cancer at the same time) and doctors check the pathology of the tumors to learn if they originated from the original cancer, or if they are distinct. Metastatic cancer is bad, as I'm sure you've heard. I am grappling with why...but basically (from what I understand), once it's in your system just moving about, it's there...so...that sucks. As I mentioned before, metastases means Stage IV cancer, which is not considered curable, which is why I can't get aggressive treatment, put this all behind me, and have some babies (Bitter? Yes, thank you for noticing). Here's the good thing though, metastatic cancer to the bone is not as bad as metastatic cancer to a visceral (vital) organ. So...yay? Verdict: Metastases, NOT working in my favor. Bone metastases, working in my favor...considering...

This is a long boring post, I know this, but I think it answers a lot of questions that people have. After going through this with my oncologist, the primary factor that I choose to focus on is the grade. I am so grateful every-single-day that I have a slow growing cancer. It's like my little security blanket and I will take it with me everywhere as long as I can. Considering that my cancer has already spread, knowing that it can't really go anywhere fast is very comforting.

*These are just a handful of prognostic factors that my oncologist decided to go through with me. This article lists more prognosis factors. Relevant prognosis factors are uncovered throughout the diagnosis and treatment process. Please note, that this is the first article I found, it is from 2007, and some things may have changed.

Monday, December 16, 2013

All the Best...and All the Worst.

In October of 2012, I heard a snippet of a comedy set from comedienne Tig Notaro. They used an excerpt from a show she did in LA on This American Life (one of my favorite things ever). I love so much of the material they use for This American Life, but I've never purchased anything extra - no books, no dvds, etc. I haven't even seen Mike Birbiglia's movie (ha!). This set though, called Tig Notaro - Live!, I went home and purchased immediately.

Tig was diagnosed with breast cancer and just hours after finding out, she went onstage and did a live comedy set. I can't imagine why I was so drawn to it, but since last October, I've listened to it over and over again. I am a person who LOVES to feel feelings. The intersection of comedy and grief in this recording was so poignant - I never got tired of it.


I have listened to Live! a couple of times in the last few months. What struck me the hardest this time around is a section where Tig says that - as she gets diagnosed - she is experiencing all of the best and all of the worst times in her life. I hate to say it, but I feel like I'm in the same boat. Luckily, I don't have as much on my plate as she did, but it still feels overwhelming.




It's hard to handle the "good stress" in my life. Stress that I would have happily - even giddily - embraced a year ago. Applying for jobs, interviewing, planning the course of my career...

Making decisions about my life, my work, long-term goals, and all these other little choices is just hard. I just started working full-time, I just finished my master's degree, and we just moved into a great new area. There's so much to do and so much to experience. 

My personal issue now is the difficulty in negotiating how much having cancer should factor into making decisions. Should I just plow through, pretending like it never happened? What if that isn't good for me? What if I don't ever reach any of the goals I want to reach? I don't know if I should be okay with that. So...if I seem in a haze lately - that's why... I don't want to be to hard on myself, but I see no benefit in coddling myself either.


Decisions, decisions...

**Someone fun that I know suggested that I use Bitstrips to spice up the visuals of this blog, since I was wary of putting a bunch of actual pics of myself. I think I love it.**

Thursday, December 5, 2013

Patience

Well... I had a doctor's appointment on Monday. It was time for me to get my monthly shot (a bone strengthening medication) and some labs done. 

I don't know why, but I didn't ask my husband to go with me. Probably because I went for the shot alone the first time. This time, though, I met with the oncologist and he did a quick exam.


I'd been on tamoxifen for 35 days (38 days today). I'm going to be honest, I was hoping for something. But so far, there is no shrinkage - I was/am very disappointed. Shrinkage after 5 weeks is a lot to ask though, so we're hanging in there.


I'm scheduled for an ultrasound and mammogram at the end of this month. That will better show results (if any).


The great thing is I have a lot of options. Some are better than others, but they are options - a privilege not afforded by everyone.



Thursday, November 28, 2013

Gratitude

It's Thanksgiving, and I have a lot to be thankful for. It isn't perfect, but I have a good life. I am often in situations where I just don't understand how I got so lucky. I'm a people person, and good people, people I love, literally give me life. They give me energy, they bring me excitement, and right now, they make me feel loved.

I'm not the most selfless person - I frequently get overwhelmed with life and thoughts (even pre-diagnosis) and as a result, I'm not the most thoughtful person either. I get distracted.


A byproduct of a cancer diagnosis is suddenly having to deal with all the communication surrounding the patient (me). People say that when times get tough, you see who your real friends are - but I'm not experiencing that type of distinction. Right now, my times are tough - really tough, and instead, I'm getting to see how amazing my friends, colleagues, and family are. People are stepping up to the plate.

Not to brag - but my peeps have been out of control supportive. I always considered relationships real - no confusion there. This experience has given me an real opportunity to reflect and appreciate how great the people in my life are. Cards, flowers, gifts, emails, texts, offers to help (which I take seriously - I will call you, don't act all surprised)...none expected - and none have gone without appreciation. 


You all make the world (and my life) a better place.

Thank you all.

Tuesday, November 26, 2013

Time to Grieve

During my personal time of panic, right after being diagnosed, I had this conversation with the Nurse Navigator at the medical center. I was sitting in her office and asking her questions. Soon, I started to cry (this is how most conversations were going at the time). In those first few days, I wanted reassurance, I wanted someone to tell me that I was going to be okay. I wanted someone to tell me that I could still live my life – the one I was currently living. I wanted someone to tell me that I could still have kids and be happy with my husband. I think what I really wanted in those first few weeks, was for someone to just take it back. It didn’t need to be some dramatic production, but I needed someone to just sort of roll things back. I was willing to pretend like nothing happened, if they were willing to tell me they made a mistake.

FYI, Nurse Navigator was not having any of it. She was not about to let me get all entrenched in denial. That afternoon, I told her I felt sad because I just really wanted to have babies…like, now. I also felt bad because (at the time) we were planning on a double mastectomy, which meant I wouldn’t be able to breastfeed even if I would be able to have children. This is what she said to me, “I know, it’s hard, this is just something you will have to grieve.”

At the time, it felt like a slap in the face. Mostly because I couldn’t conceptualize grieving the thought of something. I couldn’t conceptualize grieving an idea, or my future, or a desire. It didn’t make sense. But it does now. I’m going to be honest though, I can’t do it. I am explicitly unable to put some of these things to rest.


I don’t know if I’m being unrealistic, sometimes I feel like I just don’t know any better, but this is how it is right now.

Friday, November 22, 2013

Treat Me Right

When I was first diagnosed, we went through the process of consulting with doctors and contemplating treatments. Just thinking about the various directions in which we could go was overwhelming. After tumor board, we had resigned ourselves to the fact that I would have to do surgery, chemotherapy, and radiation. I think one of the most difficult aspects of being diagnosed with cancer is not the cancer itself, but understanding the difficult side effects that come with treatment. Surgery was cool, radiation sounded okay, but chemotherapy scared the crap out of me.

During the bargaining phase of our grief, C and I tried to wiggle our way out of chemo...the docs were not amused. Finally though, I decided that it was going to be okay - I was going to endure (obviously, cause you, know...to kill the cancer). I made plans. I called a friend who does hair and asked if she would cut it short, and eventually shave it. I researched wigs - specifically turning my own hair into a wig (it's totally a thing). I made a mental list of friend who offered to sit in sessions with me - sorry if you were just saying it to be nice. :)

When we found that the cancer has metastasized, though, everything seemed to change. It's hard to tell though, if the change happened specifically because of the metastasis.

A few weeks ago, when my bone biopsy had been scheduled, before I had results, we met with an oncologist and went over our Plan A and Plan B. They are markedly different:

Plan A: Stage III: We do chemotherapy first so that the medication can go through the body and kill any renegade cancer cells. Then surgery, then radiation to the chest wall.

Plan B: Stage IV: Endocrine therapy. See how it goes. Take it from there.

If you've seen any of the previous posts, you'll know that we are at Stage IV. The oncologist basically said that we don't want to exhaust our options. We want to try different methods, see what works, and proceed once we know how the tumors respond. Many women prevent breast cancer and/or prevent recurrence by taking tamoxifen. Tamoxifen is a hormone receptor suppressor that blocks the flow of hormones to the tumor. Many breast cancer tumors are very sensitive to estrogen and progesterone. Right now, this little pill keeper is my BFF. I used to have a moment of panic when I didn't put my keys, or my makeup in my purse. Now...on my drive to work each morning, I reach into my purse and make sure this baby is with me.
For the time being, I take tamoxifen everyday, along with my other vitamins. Because the tumor on my spine has already started to wear a little on the bone, I also get a monthly injection of Xgeva, which is typically used to treat osteoporosis. One doctor recommended injections of Lupron as well. Lupron shuts down ovaries and all hormone production. It also puts the patient into menopause for about a month (for reference, women usually experience menopause over a period of two years). I can handle a lot, but I can't handle menopause at 28. Funny how we have our tipping points. I told my oncologist that I'll do Lupron if I don't see decent results in six months. He's down.

Almost one month in, we aren't doing too shabby. I feel grateful each day that I get to hold on to a little bit of "normal" by doing this first. I don't know what the future of my treatment plan will bring, but I'm not inclined to worry about this now. Two weeks ago, I started to feel hot flashes. They don't really bother me much. I find them more amusing than anything - luckily, I'm too brown to look flush.

Tuesday, November 19, 2013

Achieving the Everyday

One thing that I have been striving towards is stability in my everyday life. I have to say, 7 weeks post diagnosis, I have very few unexpected bouts of crying (compared to before). Success*! A major part (I think) is actually starting treatment. This is the beginning of this part of my life where I take action and do what I can to save my own life. The day to day feels better, knowing that something is being done.

I can't say that I don't love my everyday life - it is pretty sweet. I love my husband, I love my routine, I love Candy Crush...etc. We aren't without stressors, but things we love aren't meant to come easily. Aside from the everyday, I'm trying to be more present so that everyday is good. I am also trying to inject my weeks with little things I love.


A few weeks ago, C and I killed some time running some canyons in San Gabriel Valley. It's where we went on our first official date.


It was fun to go back. It's been over five years now, and we have been married for two. Time races.

*Success is totally relative.

Friday, November 8, 2013

Not as Planned

I met with a breast surgeon at City of Hope on October 16. It was the day after I had the PET scan. I had to drive there myself from work and my husband met me there. I remember City of Hope being a totally different animal - they assign you a number, you meet with a representative who orients you, they give you a patient card...a lot happened. 

When I went into the examination room, I don't know why, but everything started to wear on me. I had handed over all my slides and information, I was waiting, I wanted my husband to be here now. The nurse spoke to me a little severely and I lost it (a little). It was embarrassing, I started to cry. Finally, she left. 


It seemed like an eternity before my husband showed up. 


When the door opened again, it was a man - not the doctor I was expecting. He was a surgeon fellow - and he looked like Zach Galifianakis. He was wearing a bowtie. He examined me and then once again, we waited.


Finally, the surgeon walked in. Immediately, I loved her. She was small and slightly frantic. For some reason I enjoyed this. She talked extremely quickly. Love! We started to talk about options. At City of Hope, their plan wanted chemotherapy first. The idea is to kill all the cancer cells floating about in the body before you have surgery. This sounds good...this sounds like a really great plan. Out of nowhere, there's a knock on the door, a hand pokes through with a stack of papers and the doctor takes them. Once again, I'm blown away by the amazing treatment we are getting. The report from my PET scan has been rushed and we have the results. Totally amazing.


I stare at the doctor and she stares down the page. Everything seems okay, until she gets to the end. At this point, my impatience gets the best of me and I ask if everything is okay. 


No. There is one thing that concerns her. A spot on my spine.


Fast forward to today, these are the things that have happened:


1) I have a bone biopsy: totally cool. Completely knocked out for this - almost no residual pain. The nurses had a little bit of trouble with my i.v. Seriously...that part was torturous. But it's cool - one nurse called my veins squirrelly, which totally made my day.


2) I get the results of the bone biopsy: totally not cool. The breast cancer has spread to my spine. 


3) I have a new job: I'm working closer to the doctors and the hospitals to make treatment more convenient.


4) I've been staged: I have Stage IV cancer. Here's the thing...from III to IV, there is a huge paradigm shift in terms of treatment that I was not aware of. We aren't treating to cure anymore. That is difficult to absorb.

Tuesday, October 15, 2013

Best Test EVER

I had to "fast" last night to go in for a PET scan this morning. It really wasn't that bad in terms of hunger. The food rules though....ugh....the food rules! No caffeine, no sugar (at all - no fruit), no carbs, no starches, etc. It was out of control. I almost didn't eat because everytime I looked at the "do not eat" list, whatever I was about to eat was on it! Also, there's a countdown list: 24 hours before/12 hours before/8 hours before. How the hell am I supposed to remember this? How did people figure this out before smartphones?

Around lunch time, I almost freaked out because I bought a juice that had beets in it. Luckily, I determined (thanks to Google), that it was okay. PET scans are kind of funny. If you look at a PET scan prep list (here's a good one: http://www.texasoncology.com/uploadedFiles/For_Patients_and_Public/Patient_Resources/Forms/Instructions-for-the-PET.pdf) there are some prep items that are kind of unexpected: don't exercise and keep warm for 24 hours. Weird.


Now that it's all over, here's what I have to say: PET scans are AWESOME. I loved it.

First of all, the PET scan tech reminded me of this guy I know who has the most effective, cheesy sense of humor. It was fabulous! Plus, he was Indian, which totally inspires trust within me. I told him that I don't mind needles, but I can't look at them when they go inside of me. He says, "Me too, that's why I didn't look when I stuck it in." I don't even remember if I laughed, but it was hilarious! So, here's what I learned from the awesome Indian man (and a little from the interwebs):

1) PET scans for someone like me, who is diagnosed with breast cancer, use sugar to determine if there is a tumor in any part of the body being scanned. For me, this is mid-thigh up to my head. Cancer likes sugar, cancer attracts sugar, so the sugar will pool and be concentrated at sites where there are tumors. The radioactive part makes it glow.

2) Once he determines my blood sugar is okay (it's great...FYI) he's going to inject me with some radioactive sugar. This radioactive sugar is legit. It comes in this crazy metal container that is more than an inch thick and is totally out of a sci-fi movie.
3) I have to be warm because shivering will make the PET scan machine (scientific name, in case you were wondering) less accurate.
4) After I have radioactive sugar in my body (seriously, how cool), I must lie in the room with zero stimulation - no reading, no Candy Crush (I asked), no music, NOTHING. Can I sleep? Yes, sweet baby Jesus, I am allowed to sleep.
5) MOST IMPORTANTLY, because I must be warm, he wraps me in warm blankets so that I can sleep. No joke, this guy tells me that I cannot move, I must be in this dark room, and I must be wrapped in warm blankets. There was no better way for me to spend an hour this morning.

After the nap and the scan in the machine, I run around the medical complex gathering my medical records to deliver to City of Hope tomorrow. The PET scan tech tells me that he'll put in a rush for my slides and that I can come back after going to medical records to pick up the CD. I roll into work earlier than expected.

I don't really know how to feel about the City of Hope tomorrow. I don't see how the information can be different, more likely than not...it's going to be a different doctor telling us something we've already heard. It's worth it though, if we meet a doctor that gives us more promising news about fertility and starting a family soon. That's too much to give up.

ETA on 11/17/2013: I edited a statement above where I said that cancer cells ingest sugar. It's not true. They attract sugar and the sugar pools to the tumor locations. There is still some correlation though, between sugar consumption and cancer. Here is a link from MD Anderson: http://www.mdanderson.org/publications/focused-on-health/issues/2012-november/cancersugar.html

Monday, October 14, 2013

Second Opinions

More than one person has asked if C and I are going to get a second opinion. I didn't really see the point - clearly, I have cancer. But after going over treatment options, order of treatment, aggressiveness of treatment, etc....I felt like we should.

Someone said that we need to go to a teaching hospital - they do the research and they do the cutting edge treatment. That made sense to me. When we talked to a volunteer at Mission's Women's Wellness Center, she told us that City of Hope didn't just accept any patient, you had to be a "special case". I didn't think we were a special case, but they said they would take me as a patient. Even better - they finagled me an appointment for this Wednesday!


I have a PET scan tomorrow morning, because I'm paranoid and need assurance that this cancer is nowhere else in my body. The doctor said it probably hasn't, but it's worth the inconvenience to be certain. I don't think we'll have the PET scan results by the time we go to City of Hope. I have to scramble tomorrow to get all my medical records to take over to City of Hope. All these weird things that I didn't know went on in the medical world...we are slowly learning.

Friday, October 11, 2013

Back from SF...

I had a blast! C had to work - not as much fun. I felt bad taking this time off...but after the diagnosis, I felt relieved to have some downtime. Seeing two really good friends helped too. It feels so amazing to have had a little mini-break - and still have a weekend ahead of me!

Wednesday, October 9, 2013

No Go

We are in San Francisco!!! Today we had an appointment with an oncologist (back in OC). He's the oncologist recommended by the Women's Wellness Center and the surgeon we met with. I was on pins and needles all day, he was going to tell us -definitively - what he recommends for treatment. C and I arrived a few minutes early and walked in together. I guess this is to be expected - but I've been the youngest person (patient) everywhere I go. I wonder what people think when they see me (I wonder if they even notice).

After signing in and completing ALL the paperwork, we wait...and we wait...and we wait. About 20 minutes after the appointment is about to start, we find out that the doctor is still with a previous patient and we have to leave to catch our flight to SF. C and I head to the airport and reschedule the appointment for next Wednesday.

Now we are in San Francisco! I'm so excited to eat explore, and see some Bay Area friends!

Monday, October 7, 2013

Calling Off the Goalie

I have a really darling friend who refers to going off birth control as "calling off the goalie". Very clever.

As of last Thursday, I have "called off the goalie".

If you had told me six months ago that in October, I went off birth control, my excitement would have been hard to contain. My husband and I have been waiting for the "right time" to start trying. Lots of talk about my working, our finances, raising children, schools, those hilarious arguments about which of us will successfully be the disciplinarian.

We were perpetually waiting for the right time.

Instead, it's October 2013. I'm 28 years old. I just finished grad school. And I have breast cancer.

I'm off birth control to limit the hormones in my body. Biological children may be off the table forever. Life is not going as planned. 

Friday, October 4, 2013

It's NOT the Same

Yesterday, we met with a surgeon. He was such a nice guy. Very compassionate, very kind. This is what he told us:
- No lumpectomy for me
- All three of the common treatments: surgery, chemo, radiation
- His wife had breast cancer about 10 years ago

I get super anxious and paranoid about cancer spreading - it could be anywhere! He kindly tells me that it's unlikely that there is spread. I don't back down, so he orders a PET scan to make me happy. It works.


Today, we went to the tumor board and he represented us. The tumor board is an awesome thing. All cancer patients at this hospital + medical center go to tumor board. A doctor takes your paperwork and info and presents it to a group of doctors. They are surgeons, radiologists, oncologists, plastic surgeons, etc. The nurse navigator tell me that an uncommon number of doctors have turned up for my tumor board. I am special - clearly, yes.


In the waiting room, we are accompanied by a very sweet volunteer. She tells us her survivor story. I cannot relate.


After the doctors meet, our surgeon representative comes back in and tells us their recommendations. They are essentially the same as his: surgery, then chemo, then radiation, then reconstruction. Chris wants reconstruction in the same surgery as the mastectomy. They also want to do a genetic test to see if I have a gene mutation. Stuff just seems to be spiraling...


Chris and I are still bargaining - can we skip chemo? Can we do less Tamoxifen? How are we going to squeeze babies into this equation??? The doctor says that we should do everything as prescribed. He recommends egg freezing, but they don't want me to do the fertility meds. When we become frustrated, the surgeon tells Chris, "I know it's frustrating - I was in your shoes ten years ago."


I resist the urge to yell, "It's NOT THE SAME. You already had kids, you shared a life together."


I don't really hear a lot after that.

Thursday, October 3, 2013

Scare Tactics

One of the worst things about breast cancer (so far......) is how scary every. single. thing. is.
Food, drinks, work, stress, treatment, and just about anything - scary. I started googling causes of breast cancer, I can't help but think of all the things I did wrong in my life to this date that must have caused this. I drank too much wine, I ate too much meat, there was the time when I decided to be a casual cigarette smoker for a year, I ate too much bacon, I ate Lunchables Pizza a lot.....

Our medical center is amazing, God bless them. My primary care physician called me to check in on me and ask if I needed a referral for a surgeon or an oncologist. Our nurse navigator had already helped me get the earliest appointment possible for a surgeon, but I do need an oncologist. I asked about a woman oncologist I found via Google. Ha! I have an appointment for next Tuesday. Tomorrow, I meet with the surgeon - he will have my MRI results. We will find out if the cancer is anywhere beyond my left breast and lymph node area. Hopefully, we'll find out what stage I'm in. It's not stage I.

People keep telling us to get a second opinion. I don't yet understand the reason. I have cancer - that doesn't seem to need confirmation. I suppose it's for treatment options.

Today, the ultimate scary idea occurred to me: I may never be able to have biological children. If I have to do chemotherapy, my fertility may never return. I can't reconcile not giving my husband children of his own. Will he be able to reconcile this?

Wednesday, October 2, 2013

The First Day of October

This morning my husband and I went to the doctor to results from a breast biopsy I had last Friday. When I felt the lump, I was completely unimpressed. Under 30 years of age and no history of breast cancer - what I am worried about? Worst case scenario - it's a cyst and I have surgery.
When the doctor came into the room with the nurse, I was still stupidly unaffected. Imagine my surprise when I was handed the pathology results, clearly showing that I have cancer.

I ask the doctor how bad it is.

She says it's pretty bad.

It's not that my world stopped - it shattered. Very quickly I find out that the tumor is too large for a lumpectomy. A mastectomy is probably my only option.
I opted to go to work, where I was wildly emotional, though not entirely unproductive. Thanks to a very assertive nurse navigator at the Women's Wellness Center, I get a phone call within an hour asking me if I can come in today for an MRI. I say yes. I am injected with dye and lay face down in the machine for an hour. I go home. The results don't seem too scary, I already know I have cancer.