T2N2aM0(?)

Be careful what you wish for!  Right after posting last night about not getting pathology, Dr. Lal called me with the pathology.  The fact that she called at 9 pm, and said, "do you want to put your husband on the line so I can talk to both of you?" tipped me off that it was not going to be stellar news.

I wrote earlier that my cancer was staged "T1cN0M0" and that it was a preliminary staging based on the biopsy, which could change after the surgical pathology, when they had a more accurate look at the size of the tumor(s) as well as lymph node involvement.

As you can tell by the topic of this post, my staging changed.  The tumor was larger than expected, so I went from T1 to T2. In addition, cancer was found in multiple regional lymph nodes, moving me from N0 to N2. We still don't know about metastasis (M).

The cancer staging that most of you are probably more familiar with is stages 0-4.  I'd initially been called Stage 1, but the newest findings bump me up to Stage 3a.  My wise friend Dawn tells me that, with breast cancer, anything under Stage 4 is really the same (Stage 4 includes metastasis), so I'm choosing to believe her. :)

The best news is that they found absolutely nothing cancerous in the left breast.

As Greg shared on Facebook, the two sentinel nodes were both found to have cancer in them.  Additionally, one of them was 1.5 cm and had extensions (i.e.: was not confined in the lymph node).  Dr. Lal then took an additional ten lymph nodes, and of those, 6 were positive.  Of those 6, the largest was 0.3 cm and none of them showed extension outside of the nodes.  She said that was a good sign that the lymph nodes are doing what they are supposed to--stopping the cancer from spreading further.  (Of course we haven't done any testing for metastasis, so don't know that for sure--thus the "?" after the M0 above)

In the right breast, there were many cancerous spots (she called them multi-foci).  They ranged from 1 mm to 4.6 cm.  There was invasion into the lymphatics of the breast and deep margins which she thinks she was able to remove, since she took tissue all the way back to the chest wall.  It was also relatively near the skin in front.

None of this really changes what we believe will be the course of treatment.  Dr. Lal said that she never makes recommendations on reconstruction for her patients, but she is very happy that I opted for the expanders.  The plan is for me to heal from surgery and have the implants expanded while I undergo chemotherapy.  Then hopefully the permanent implants will go in before radiation, and they will lift the chest wall farther away from my lungs, so that the radiation can potentially be even more intensive and therefore more effective with the "cushion" of the implant between the chest muscle and my lungs.  

I asked Dr. Lal how it was possible that everyone was so surprised at the lymph node involvement as well as the size of the tumor (everyone underestimated).  She said that it's the type of cancer--lobular as opposed to ductal--that is just really, really hard to find.  Again, I am very lucky to have found the lump on my own.  She said that she is still VERY optimistic and that, after all, it's breast cancer!  I think what she means is that it's a very, very treatable cancer.

I've allowed myself some time of being scared, but I need to dig down and find that "FUCK YOU, CANCER" part again.  I need to call on Joan of Arc and to channel all of you strong fighters who have messaged me with your survival stories.  Enough wallowing!