Getting the news

My hands were shaking, but my reporter's instincts kicked in. I grabbed my laptop and took the crappiest. notes. ever. as Dr. C delivered the news over the cell phone I'd been clutching in my sweaty palm all morning.

Biopsy results were in for the lump in my right breast. "The pathologist sees evidence of invasive ductal carcinoma." She paused a moment and then put it super-simply, in case I hadn't grokked those words. "That means you have breast cancer."

She quickly moved on to "the good news." The tumor was small, only 1 cm. (A day later, when the final pathology report was in, she upped that to 2 cm.) It was still being tested to see if it was positive for estrogen receptors and progesterone receptors; the pathologist thought it likely would be. If so, that might mean I could be treated with hormone blockers, rather than chemotherapy.

They think they removed all of it -- "got clear margins" -- but there is a chance there are still some cancerous cells near the skin that she would remove in a future procedure.

There are still some other unknowns. Has it spread to the lymph nodes? Since it's an invasive cancer, they need to check for that by doing a sentinel lymph node biopsy - another surgery under general anesthesia in which she'd made a small incision in my armpit and then remove one, two or three sentinel nodes. I asked if the pathologist who read my breast MRI had spotted anything on my lymph nodes and wriggled with automatic teacher's-pet pleasure when she said, "Good question." The answer wasn't entirely reassuring: "He noted that your lymph nodes were prominent but there was no sign of malignancy. They could have enlarged in reaction to the two needle biopsies you had earlier."

Since I'd spent the past week taking an accelerated medical course at Google U, I immediately asked about whether the lymph-node surgery could trigger lymphodema - a painful, debilitating and permanent condition in which your arm swells up with lymphatic fluid. (Warning: Do NOT read the Wikipedia entry on this, and do NOT look at the gruesome photographs therein.) She said the risk was only 3%, since she's be removing very few nodes.

She paused and said, "You're taking this remarkably well."

I mumbled something lame. "Well, what else can I do?" (Later, I thought of a few things: Cry, scream, throw things, curse at her, curse at the universe, etc.)

Next she'll send the cells they extracted for a test called Oncotype DX, which looks at 21 different gene types present in the tumor. The results will help determine if I should have chemo or not.

She wrapped up with the ultimate good news (and her cell phone number). "This is 100% surviveable. It's just a matter of jumping through hoops to get the appropriate treatment."