Q&A: What’s Up With that Breast Cancer Thing?

I’m asked many questions about what’s going on with me and my breast cancer fight. Because I’m a trained PR professional, I’ve decided to develop a FAQ, which consists of four frequently asked questions.

FAQ

Q1: Is the cancer gone?

A1: Yes, they got it in surgery.

Q2: So you’re done?

A2: No, treatment isn’t over and won’t be for at least five years.

Q3: I see you talking about radiation. Are you…um…okay?

A3: Yes, and I still have all of my hair, which you don’t need to hold back while I puke.

Q4: What can I do?

A4: I need your encouragement- and maybe food deliveries at the end of June. Also, get your mammogram – and encourage others to do so, too.

What the heck are you talking about?

If this is the first you’re hearing about this, you can read the whole story here and here. In summary:       I had my first mammogram ever in December, 2011 and was told if I heard nothing from them within two weeks all was fine. 28 days later I received a letter in the mail letting me know something wasn’t right, and asking me to call to schedule a repeat mammogram. (Yes, I tore some heads off.) One month later on Feb.15 – following another mammogram, an ultrasound and a biopsy – I was diagnosed with ductal carcinoma in situ (DCIS) – stage zero breast cancer. (Mercifully, this diagnosis was delivered via a phone call, not a letter.)

To elaborate on my answers to the FAQ:

A1: Yes, they got it in surgery.

In March, I had three outpatient surgeries (lumpectomies) to remove the cancer. Why three? It’s actually common with DCIS because it's hard to see (ti's cells, not a lump). They could see only four centimeters of DCIS on mammogram, ultrasound and MRI but as they removed the stuff and analyzed it under a microscope, they found the area was actually much larger – seven centimeters. Finally, they got it all – or so the pathologist and a follow-up mammogram indicate. A side note: one never knows if a cancer cell is lurking somewhere. This is the stuff that invades my nightmares.

A2: No, treatment isn’t over and won’t be for at least five years.

With DCIS I have various treatment options. Being the kill-the-gnat-with-a-sledgehammer kind of girl I am, I decided to go all-out. Well not entirely – a double mastectomy was discussed (not recommended) as an option, too. I opted to proceed with radiation followed by Tamoxefin – a drug that blocks the action of estrogen, which fuels some breast cancer cells. My DCIS was hormone receptor positive, so the drug, which I will take for five years, will help prevent a recurrence and actually protect me generally – not just in the affected breast. Incidentally, this means that my baby store is OFFICIALLY closed. That estrogen-fest would be deadly. It also means I’ll probably be having my own personal summers in my 40s. (See? Undateable!) It sure beats getting invasive breast cancer.Together, the radiation and Tamoxefin are supposed to reduce the chances of recurrence to around 4-6% (vs. 40% with just a lumpectomy).

A3: Yes, I still have all of my hair, which you don’t need to hold back while I puke.

So let’s talk about the radiation therapy.  Here’s the definition, from the little booklet my radiation oncologist gave me: “Radiation therapy uses a stream of high-energy particles or waves, such as x-rays, gamma rays, electrons or protons to destroy or damage cancer cells.” It works by “killing or damaging cancerous cells so that they cannot grow, multiply or spread.”  It “breaks a strand of the DNA molecule inside the cancer cell, which prevents its ability to grow and divide.” And we all know those little bastards multiply faster than healthy cells.

No, this is not chemotherapy, which “exposes the entire body to cancer-fighting chemicals.” The radiation is delivered directly to my right breast (the “affected” one).  The expected side-effects, which are cumulative and I’m just beginning to feel, are fatigue, loss of appetite and skin changes (which I refer to as a gnarly sunburn.) These side effects are the reason I’m usually in bed by 9 p.m. these days; it’s actually helping. I’m also dealing with a bit of pain (kind of consistent dull pain plus sudden “shocks” a couple of times a day) because my nerves are regenerating from surgery. Because of these side effects, I’m working my way through a bottle of Motrin and a tube of “Jean’s Cream,”  both of which live in my purse these days.

By the way, you’ll note I didn’t mention hair loss or nausea. With radiation, hair loss only occurs on the “affected area,” and puking is one of the many awful side effects of chemo. So I pause for a moment to deliver this PSA:

I don’t have to do chemotherapy because this breast cancer was caught so early on mammogram.

 GET YOUR MAMMOGRAMS, LADIES!!!

Back to the treatment: it’s delivered in five-minute increments, and the radiation oncologist determined I needed (and could withstand) 36 treatments. So, every weekday morning at 6:30 I pop in to lie in this big machine for a few minutes, then stop by Starbucks for my morning coffee and drive straight to work. It’s pretty much a normal existence, except for the whole radiation thing. As of today, I’ve received 20 treatments so I’m a little over halfway done.

So what happens during these appointments anyway?

As I mentioned earlier, the radiation is directed specifically to treat my right breast. To achieve this, they go through a planning process to determine how much radiation to deliver and specifically where.

They use all of the information gathered through diagnosis and surgery, a physical exam, and a diagnostic X-ray machine to figure out my “treatment field” – where they need to aim the nifty beams.  They create a “mold” (pictured below) that helps ensure I’m in the same position every time I come in. I have to lie very still during the treatment, so this mold also prevents me from shifting around uncomfortably. (It really sucks when my nose itches during treatment.)

They also “marked the field” with three tiny tattoos – freckle-sized dots they put in the middle of my chest and on either side. I asked for []_[] tattoos but  they couldn’t do that…and the freckles hurt enough! If you look closely at the machine pictured below, which is what greets me every morning, you’ll see one thin red line created by a laser.

The laser you you see on the table comes from the wall at my feet – from some gadget up by the ceiling – and is used to line up to the tattoo in the middle of my chest. There are two more that shoot from the walls on either side, which line up to the tattoos on my sides. The side lasers point out the precise height at which the table should be positioned per the treatment plan..

Each morning, I walk straight in, change into a robe and stow my stuff in locker #7 (No, I have no idea why). Then I lay on the table, arms up and hands gripped on to the white handles you see in the picture of the mold, while the technician lines my tattoos up to the red lasers to ensure I’m in the exact position they need. (Yes, there’s a bad bondage joke in here. It pops into my head every single time.) I chatter nervously about sports or some other such nonsense while the poor technician who drew the short straw that day works, and he or she smiles kindly while surely praying quietly for me to shut the hell up. When I’m perfectly lined up, I'm told not to move, a few buttons are pushed, and the technician leaves as the table slides into the big tube. (The kid says it’s like a portal to the future. He’s right: a cancer-free future.)

The machine starts up and I stay still for the five-minute treatment, while I imagine the machine's whirring sound to be ocean waves, because the truth of what it really is distresses me so much I cried throughout the first treatment. So I imagine it's the ocean, and at the suggestion of a kind woman I know from Twitter, I repeat over and over in my head: “I am healed. My body is healthy.” These thoughts are helpful.

A4: I need your encouragement- and maybe food deliveries at the end of June. Also, get your mammogram – and encourage others to do so, too.

Also helpful is the daily text I receive from my dear friend Cathleen. She counts each treatment along with me, with a sweet and often corny poem that always makes me smile.  Every week, I receive a card from Cathleen in the mail, recognizing the latest milestone and passing along her encouragement, which helps keep me going.

I’m not going to lie:  this is tiring stuff and sometimes I want to sleep in and ignore it all. The daily encouragement I get from many of you all is also really helpful. And while I’ve been told more than once: “You got this, you can do anything,” this is only true because I receive the encouragement I do. So thank you and please, keep it coming.

Those of you who live nearby may need to do a little more at the end of June because from what I understand I’ll be too tired to do much more than get up, receive my treatment, go to work, come home and sleep. So food deliveries might be cool, if I’m hungry at that point.

OMG TMI!

People ask me why I’m so “out there” with all of this. There are two reasons.

 I need your encouragement. My family offers support from where they live far away (and one sister came to visit recently) but it’s brutal to go through something like this alone. Because I good friends – and feel like I can talk about it openly – I feel less like I’m doing it alone.

 I’ve said this before: I’m so very lucky this was caught so early. I have the treatment options I do because of it. Unfortunately, many of us delay mammograms out of fear, or because other things seem to be more important. But they’re not. A friend of mine gets her annual mammogram on her birthday, because it’s the best gift she can give herself. I write about this because breast cancer is totally beatable – especially if it’s caught early. So, please. Go get your mammogram. Ask lots of questions. Get multiple opinions. Protect yourselves. Pass it on.

###

And this concludes today’s press conference. We’ll answer your questions in the comments below!