Oy, such choices!

Here is what the surgeon said:

·        The type is invasive ductal carcinoma. The Invasive part means it’s already starting to break out of the duct where it began. It’s still very small, so it’s PROBABLY Stage One, but we won’t know till the surgery is completed.

·        The grade is Grade 3, meaning this is an aggressive cancer. (It wasn’t visible on a mammogram 15 months ago.)

·        The receptor information is… not good. It’s triple-negative for hormone receptors, meaning I will definitely need chemotherapy AND radiation after surgery (if I go for a lumpectomy).

·        There is a genetic component to this which means I might be facing a double mastectomy and ovary removal, and still need chemo. We’ll get to that later.

Here is what the medical oncologist said:

·        Pretty much the same thing the surgeon said, but with more emphasis on survival rates and such. If I have a lumpectomy and then have the radiation and chemo, I can better than double my survival chances (whatever “survival” means in this context). Overall , the odds are better than fair.

·        Chemo is, at best, four treatments over three months. At worst, it’s more like 10 treatments over four months. And yes, I will be saying farewell for the present to my hair. Best and worst are decided by the pathology results after surgery.

Here is what the radiologist said:

·        Radiation does funny things to your skin and even deeper tissue. It can take years for this to go away.

·        There’s a risk of heart issues (they will need an echocardiogram), but they probably wouldn’t manifest for 10 to 15 years.

·        There’s a .002 chance of the radiation causing cancer.

Now for the interesting part – here’s what the geneticist said.

·        Because I am of Ashkenazi Jewish descent, there is a chance that the cancer is caused by one of three gene variants. IF this is true, I will probably want to go with a double mastectomy and ovary removal, because the cancer has a 65% chance of recurring, and the ovarian cancer risk is also high.

·        IN ADDITION, IF I have this gene, there is a 50% chance that my brothers and sisters have it as well, and a 50% chance we’ve passed it on, and a 50% chance that our children will pass it on.

·        This has consequences for boys as well as girls. The guys would be at increased risk for male breast cancer, and for prostate cancer. 

·        The geneticist is pretty sure this did not come from my mother's side of the family, because aside from Mom herself, all of the women on that side (except for me) are cancer free. She suspects that it’s from my father's side, given the prostate cancer that my grandfather and his brothers had, but it’s very hard to tell without knowing more about the women on that side.

I should have the results of the genetic test next week. If they are negative, I will probably have more tests done to try and rule out a more rare mutation on the same gene. And then I get to choose what to do… Oy, such choices!