T1cN0M0

Several people have asked for more specifics on the type of breast cancer I have. This post will have all the medical-speak information for those so inclined.  But before some of you tune out, I will repeat my newest Public Health PSA:

DO YOUR BREAST SELF-EXAMS!!!

I have been told by several medical professionals (radiologist, nurses, oncologists) that my cancer would likely *not* have been found this month in my routine, screening mammogram.  [The type of cancer I have (lobular), combined with how early I found it, and then toss in the whole small, dense breast thing...]  Know, too, that the earlier it's found, the better the prognosis.  So do your breast self-exams.  Or have your significant other do them.  Or do them ON your significant other.  But seriously--get to know your breasts (or those of someone you love).

I did not know until my journey began that there are at least 15 types of breast cancer.  Mine, invasive lobular adenocarcinoma, is the second most common, accounting for approximately 10% of breast cancer cases.  The lobules are the area in the breast where milk forms.  The more common form is found in the ducts of the breast--the pathways by which milk exits the lobules.  It (ductal) is more readily found in a mammogram and is more likely to form a "lump" as opposed to a "thickening."  

From Wikipedia

On the "continuum" of breast cancer, invasive cancers are in the middle.  The less aggressive forms are called in situ--they are localized to the ducts or lobules.  The most aggressive form is inflammatory.

So, my cancer:

T1cN0M0

From Cancer.org:

A staging system is a standardized way for the cancer care team to summarize information about how far a cancer has spread. The most common system used to describe the stages of breast cancer is the American Joint Committee on Cancer (AJCC) TNM system. 

The stage of a breast cancer can be based either on the results of physical exam, biopsy, and imaging tests (called the clinical stage), or on the results of these tests plus the results of surgery (called the pathologic stage). The staging described here is the pathologic stage, which includes the findings after surgery, when the pathologist has looked at the breast mass and nearby lymph nodes. Pathologic staging is likely to be more accurate than clinical staging, as it allows the doctor to get a firsthand impression of the extent of the cancer.

The TNM staging system classifies cancers based on their T, N, and M stages:

• The letter T followed by a number from 0 to 4 describes the tumor's size and spread to the skin or to the chest wall under the breast. Higher T numbers mean a larger tumor and/or wider spread to tissues near the breast. 
• The letter N followed by a number from 0 to 3 indicates whether the cancer has spread to lymph nodes near the breast and, if so, how many lymph nodes are affected.
• The letter M followed by a 0 or 1 indicates whether the cancer has spread to distant organs -- for example, the lungs or bones.

Until my surgery, we won't know the definitive stage of my cancer, but right now it looks pretty good.  :)   There is one larger area (estimated to be 1-3 cm) and several smaller areas clustered around it, which may be separate, or part of a larger tumor.

In addition to appearing to be stage 1 (won't know for sure until lymph node biopsies), we also know that it is positive for estrogen receptor (ER+), for progesterone receptor (PrR+) and for HER-2/neu (HER2+).  Those are all receptors on the cancer cell that encourage its growth (bad), but that can therefore be targeted with chemotherapy and/or hormone therapy (good).  Of course, the more chemotherapy, the more side-effects (bad), but if I could do 5 1/2 years of Grad School, I figure I can do a year+ of chemotherapy ;).

The other things that they look for are Ki67 (a cell proliferation protein), and the grade of the cells, based on three factors (T=tubule, N=nuclear, M=mitotic).  These are all measures of the aggressiveness and/or likelihood of recurrence (indirectly) of the tumor.  Unfortunately, my results there are not so good.  My tumor has a relatively high Ki67 score (62, where greater than 20% indicates rapid divisions) and it is Grade 3, meaning that it is poorly differentiated, with the cells no longer looking like normal breast cells, multiple nuclei per cell, and many cells in the stage of rapid division.

What that meant to me is that I wanted to be sure to get rid of all of it, and to decrease my chance of any recurrence.  While the doctors assured me that outcome would be the same whether choosing lumpectomy with radiation or mastectomy, I know that I am a worrier and would not relish the frequent clinical exams, mammograms, MRIs, and worry that would come with saving breast tissue.  Furthermore, my breasts have served their functional purpose, so I no longer feel the need to preserve them at all costs.  

So I chose to do a bilateral mastectomy.  And I will write more on that (and my chemotherapy plan) at a later time.  For now, I need to get to the hospital to do my pre-op tests.

Thanks for reading so far.  :)