Wednesday 2nd June 2021
This morning I received a phone call from the Breast Unit, calling me in for an appointment tomorrow at 10 a.m. to discuss the result of my biopsy.
I have more than a strong suspicion that the news is not good. If everything was clear, I think they would have told me this over the phone. Anyway, no point in worrying ahead of time.
Compared with the early stages of my colon cancer diagnosis, I am feeling completely calm and unworried about this. My faith is strong, and I know that my times are in the Lord’s hands.
Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving,
let your requests be made known to God;
and the peace of God, which surpasses all understanding,
will guard your hearts and minds through Christ Jesus.
(Philippians 4:6-7)
Thursday 3rd June 2021
I attended the Breast Unit at 10 a.m. as arranged. I was not kept waiting more than a couple of minutes, and was ushered into a room to meet the doctor, a charming Indian man, and the nurse in attendance.
He told me straight away what I was already expecting I would hear – it is indeed cancer. He explained that this type of breast cancer is called lobular cancer, and is rather difficult to detect on a mammogram or ultrasound scan. He examined me, and was pleased that the lump was not “tethered” to the skin; the nurse later explained that this makes its removal easier, because it doesn’t involve removing that area of skin as well, and leads to a better appearance of the breast afterwards.
He told me that they would need to determine whether there were further lumps, and their location, and this would involve an MRI scan, which would take place within the next fortnight.
He said that they would go back and re-examine my previous mammogram pictures (from 2019 – regular screening) just to make sure they didn’t miss anything, and they would send me the results of this.
The appointment didn’t take long, and the nurse then took me into another room in order to discuss what would happen next, and to give me some literature.
She began by telling me that the biopsy had revealed that this is a Grade 2 cancer. Unlike with colon cancer, she said that they wouldn’t do “stages” – my colon cancer was Stage 3, which meant it had fully invaded the bowel wall and into one lymph node. The grading of breast cancer is to determine how abnormal the cells are on microscopic examination; Grade 2 is medium.
She said I would definitely need surgery. The MRI scan would reveal whether this would be a lumpectomy or a full mastectomy. In either case this is now done as day surgery – amazing! However, if I had a mastectomy followed by breast reconstruction, this would involve a stay overnight as the procedure was quite a bit longer. There would be full telephone follow-up afterwards in either case.
If a lumpectomy is sufficient, they would remove the lump and some surrounding tissue. This would be sent for further examination, and if cancer cells were found in the surrounding tissue, I would need further surgery to remove more tissue.
They cannot say at this stage whether I would need chemotherapy. I will definitely have radiotherapy – five daily doses. There would be minimal side effects; merely a burning of the skin akin to sunburn. I am hoping that I will not require chemotherapy as I remember how very poorly it made me feel when I had it for my colon cancer, and I am still experiencing the after-effects of it (peripheral neuropathy and bladder problems, due to nerve damage) and problems with my veins, causing cannulae to fail when I’ve been in hospital subsequently.
The nurse told me that one of the things that feeds breast cancer is oestrogen. It is more than likely that I shall require a hormone blocker after my treatment, and I will have to continue to take this for the next five years. I asked whether this was likely to cause a return of my menopausal symptoms and she said it might – if so, they would be able to change me over to an alternative, as they have about five different versions to choose from.
I need to sit down and work my way through the literature, which is in a neat plastic box. I shall also start an A4 ring binder as I did before – it is handy having all the letters, appointment details, test results etc. all in one place.
After I have had the MRI, they will call me back to let me know the next steps.
For those of my readers who pray, I would value your prayers! I am not anxious and know that whatever happens, all will be well with me. I know Whose I am, and where my ultimate destinations lies! My faith (His gift, not my work) is strong, and I am safe in the palm of His hand.
And we know that all things work together for good to those who love God,
to those who are the called according to His purpose.
(Romans 8:28)
He who dwells in the secret place of the Most High
Shall abide under the shadow of the Almighty.
I will say of the Lord, “He is my refuge and my fortress;
My God, in Him I will trust.”
Surely He shall deliver you from the snare of the fowler
And from the perilous pestilence.
He shall cover you with His feathers,
And under His wings you shall take refuge;
His truth shall be your shield and buckler.
You shall not be afraid of the terror by night,
Nor of the arrow that flies by day,
Nor of the pestilence that walks in darkness,
Nor of the destruction that lays waste at noonday.
(Psalm 91:1-6)
Obviously I would prefer to remain alive, though, and would prefer not to have chemo (horrible!) and in particular not to lose my hair – it’s taken me years to get it this long!!
My greatest wish is that throughout what lies ahead, I will be a faithful witness to the Lord Jesus, and bring glory to Him, and that through my behaviour and example, others may be drawn to faith in Him.
I do feel for my hubby, who has been through all this with me before, and he is a terrible worrier, always thinking the worst, and dreaming up worst-case-scenarios as massive castles in the air with very shaky foundations! Things never turn out as badly as he anticipates, but he will put himself through it every time!
Friday 4th June 2021
Today I received a copy of the letter sent by the doctor to my GP after I saw him yesterday at the Breast Unit. In it, he stated that the diagnosis is “grade II lobular carcinoma which was ER positive Herceptin negative.” Grade II breast cancer cells are different in appearance from normal breast cells, and grow more rapidly; they are intermediate, and not as abnormal as grade III which are the most aggressive. ER positive means that the cancer cells have receptors for oestrogen, and Herceptin negative indicates that the cancer cells are not showing high levels of HER2 (human epidermal growth factor receptor 2) receptors, so the drug Herceptin would not be indicated. HER2 is found in all human cells, and controls cell growth and repair. Some breast cancer cells contain high levels of this protein, which encourages them to grow. My cancer is not of this type. According to the Breast Cancer News website (a US site), “The most common treatment for ER positive and HER2 negative breast cancer is hormone blocking therapy.” The nurse at the clinic told me I would be on oestrogen-blocking therapy for five years following my treatment. The Breast Cancer News site states, “Overall, oestrogen receptor-positive breast cancer is treatable, especially when diagnosed early.” My researches so far therefore indicate that the prognosis is probably good, although we will have to wait for the result of the MRI scan, and post-operative pathology to be sure.
In the letter, he also stated that he’d explained this to me and that these cancers are sometimes not properly shown on mammogram or ultrasound, which is why we need the MRI to be done. He reported that he had examined the breast and described the lump as “about 2.5 cm which is causing mild dimpling of the skin as it is close to the skin but it is not really causing any tethering or skin involvement,” and also that the lymph nodes were not involved. He said that I would be reviewed again in the clinic in two to three weeks’ time after the MRI had been done, in order to discuss the surgical options.
I think it is very good that they now routinely send the patient a copy of the letter to the GP; you no longer have to request it. It will go in the file along with the other papers, as part of the record of my diagnosis and treatment.
Saturday 5th June 2021
I got my appointment for my MRI this morning – it’s on Wednesday 16th June at 9.30 a.m. There should be more news fairly quickly after this, with another appointment at the Breast Unit.
Wednesday 16th June 2021
This morning at 9.30 I had my MRI appointment. We hadn’t realised that the MRI unit was so close to the oncology department – there’s another entrance around there, and my hubby could have dropped me off there, as he used to when I was having treatment for my first cancer, but as it was, I had to trundle for several miles of seemingly endless corridors to get there! The hospital employs some very helpful people whose sole job is to stand by the main entrance and guide people wherever they need to go – this is really helpful, especially for people like me who have no sense of direction and can never remember the way to anywhere! (My hubby says I could get lost in the bathroom.)
There was a bit of a wait, because the lady who was before me was late arriving. In the meantime I had to fill in a questionnaire about whether I’d ever been a welder and things like that – they have to be sure you haven’t got any bits of metal floating around in your body because you enter a very strong magnetic field and these could presumably burst out of you! – also whether I have any medical implants etc. I had enquired about the metal staples that Mr. Pullan explained he’d used to close off my rectal stump when he removed my colon, but they said these would be fine.
I was then led into a cubicle and told to change into a gown with the ties at the front, and to come back to the waiting area. When I was called in, they inserted a cannula into my right arm (they can never find a vein in my left arm), through which they informed me the contrast would be injected about half-way through the procedure. I was then helped onto the scanner and told to lie face down. For breast MRIs you have to dangle your boobs into two cup-shaped depressions. You rest your head on a padded horseshoe-shaped ring like those on massage tables. Everything was covered with thick soft paper which was quite comfortable to lie on.
They put earplugs in for me because the machine is very noisy, and then gave me some earphones so I could listen to some music during the scan – unfortunately the volume was rather low, and the music was drowned out by the noise of the machine. They put a rubber bulb in my left hand which I was told I could squeeze if I wanted them to interrupt the scanning for any reason (a sort of panic button!) – I didn’t need to use this. The cannula was connected to the pump to administer the contrast at the appropriate moment, and then I was slid into the tube of the scanner. I was quite comfortable, and there was fresh air blowing gently around my face so no problem with breathing. I do not suffer from claustrophobia.
I had to lie still for the whole procedure, which took about 35 minutes, with a number of scans being performed. The loud noises the machine made varied from banging, very loud prolonged single-tone sounds, and the sound of a pneumatic drill. At intervals I’d hear a disembodied voice telling me what would happen next (some of which I couldn’t hear because again, the volume was rather low) and they told me when the contrast would be injected, which I might or might not feel. I didn’t feel anything.
When the scanning was finished, they pulled me out, and disconnected the pump, and helped me up again. Returning to the anteroom I had my cannula removed, and then I was told I could get dressed and go home.
The whole appointment took rather less than two hours. I phoned my hubby and he came to collect me.
They told me the results usually come through pretty quickly, with the pictures being examined either today or tomorrow, and the Breast Unit would be contacting me very soon with another appointment.
I continue to be remarkably unworried by the whole experience. I can do nothing about it anyway, so I may as well remain calm and continue to trust in the Lord Jesus to see me through whatever lies ahead!
Wait on the Lord; be of good courage,
And He shall strengthen your heart;
Wait, I say, on the Lord!
Psalm 27:14
Friday 18th June 2021
Today I received a letter from the hospital with an appointment for Thursday of next week, 24th June, at the Breast Unit. The appointment is at 9 a.m. and the standard letter stated that I may need to allow a couple of hours extra if they decided to do my pre-assessment appointment at the same time. It would be logical for them to do it then, to save my having to attend on a separate occasion, and this may be why my appointment is the first of the day. This extended appointment is a kind of pre-operation MOT to establish one’s fitness for surgery – not that they will deem me unfit for surgery, but that they will know what extra kinds of care they may need to prepare for me to expedite my recovery. I had this with my first cancer – when I went up onto the ward, I found an airflow mattress waiting for me, which is not standard, and they had a note to the effect that I might not be able to spend as much time sitting out of bed as someone without a disablity. I also had those wonderful foot-massaging air-filled boots – such a gorgeous relaxing feeling!
At the appointment on Thursday they will discuss the results of the MRI scan with me. They will be able to see from the pictures whether or not there are further smaller lumps in my breast. This will determine whether I need a full mastectomy or merely a lumpectomy. They will not be able to tell at this stage whether I will need chemotherapy; this will be determined after the operation when the samples are sent to the lab for analysis.
More news later.
Thursday 24th June 2021
Today was the follow-up appointment at the Breast Unit after my MRI scan.
The surgeon told me straight away that they were not able to detect any further lumps, and that a lumpectomy would most likely be sufficient to remove the cancer. Originally he told me it measured 2.5 cm but the scan showed it to be larger, at 3.4 cm, but this does not present any additional problems.
He informed me that I would have a “wide local excision and sentinel node biopsy.” This means that he would make an incision in my breast and remove the lump with a 1 mm rim of breast tissue all around it. This would be sent to the lab for examination. If the rim showed any cancerous cells, I would need further surgery to remove more tissue – if this was a large amount (unlikely) it would leave me with considerable disfigurement of the breast and it might be advisable to go for a mastectomy. If the breast was noticeably reduced in size, he would reduce the other one also, to make them the same size. However, he thought this was unlikely. With the removal of the lump, there will be a noticeable difference in the appearance of the breast, but this would not be observable when wearing a bra. I can live with this.
The sentinel node is the first axillary (underarm) lynph node in which breast cancer cells are likely to appear. They can distinguish this node by injecting a radioactive substance into the breast prior to surgery, and then test with a Geiger counter. Removing only this node is better than removing a larger number of nodes indiscriminately, because the more nodes that are removed, the more likely one is to develop lymphoedema which causes swelling of the arm and/or breast; this condition can be long-term. The sentinel node will be sent to the lab along with the breast lump for analysis, and if cancer is found in it, then further axillary lymph nodes will need to be removed. My surgeon is hoping that the results will be negative because the ultrasound and MRI scans both indicated that the lymph nodes were normal in appearance, but only a lab test can prove this one way or the other. The surgeon may also remove a few more axillary nodes to make sure they are free of cancer.
In addition to the reduced likelihood of the development of lymphoedema, removing only the sentinel node also means that I will not require a wound drain. This targeted surgery means less discomfort, less likelihood of reduced shoulder motility, and a faster overall recovery from surgery.
The date of my operation is provisionally set for Friday 9th July, a fortnight from tomorrow. This is nice and quick – they are not messing around with this! I have to attend the department I went to for the MRI first thing, in order for the injection of the radioactive material, and after this, I will go to the Day Surgery Unit for my operation under general anaesthetic.
Preparation beforehand will involve my having a Covid swab, and my hubby and I having to self-isolate for several days prior to the operation. I will also need to stop taking my rivaroxaban (anticoagulant) five days before the surgery. The surgeon will tell me when I can resume this later.
The nurse took me into another room after the consultation, and gave me some literature about the two procedures, and was prepared to answer any questions I might have. She said that the bra I was wearing would not provide sufficient support post-operatively; I would need one that was quite elastic and tight (a bit like my hernia support pants, I suppose) which I would have to wear day and night for a couple of weeks, to keep everything from moving around, so that the wounds would heal. She said that they had a bra-fitting service at the Breast Unit, or I could buy something similar – apparently Sainsbury’s have them! However, you can’t strip off in the middle of the supermarket to try on a bra, and I think it would be better to get the real deal from the Breast Unit, which is what I have chosen to do (more expensive but worth it in the long run because I know this will be something that fits properly and has the full approval of the experts).
In the literature is a full list and explanation of what to expect after surgery, and possible complications, so that I will know whether anything needs to be reported, or whether it is just part of the normal healing process.
After the operation I shall be monitored daily by phone, when I can report any concerns I may have. The surgeon will want to see me again at the Breast Unit about three weeks after surgery, to check on my recovery, and to report on the lab findings. I will also be referred to an oncologist who will deal with my subsequent treatment. Both consultants will be part of the multidisciplinary team (MDT) in charge of my care. I will also be given exercises by the physiotherapist in order to keep the shoulder mobile. It will be important to take all painkillers that are recommended, because this will help me keep my shoulder moving without pain.
I should be able to resume cooking and other light tasks after a couple of days, but should not expect to return to full normal activities for about 3 weeks, during which time I should not lift anything heavy or do any tasks like ironing. My hubby will be on hand to lift heavy freezer baskets for me, and carry loads of laundry!
I will receive a letter in the next few days detailing everything that has been discussed, with dates and times when and where I must make an appearance. There was a lot to take in today but all will become clear once I get all the information in writing.
From the information I have been given today, it is clear that I am going to experience some pain and discomfort, and reduced ability to do certain things, for a few weeks, but this is mild compared with what I went through with my previous abdominal surgery for colon cancer. If I am careful to take all the advice given, and achieve the right balance between exercise and rest (something I have to practise all the time with my ME anyway), and give myself time to recover, all should be well. After this, we will face whatever further treatment is deemed necessary by the oncologist.
Saturday 26th June 2021
Today I received the copy letter sent by the surgeon to my GP. It summarised what we had discussed on Thursday, and he stated that he had informed me fully of the various risks and possible post-operative effects, and that I was agreeable to proceeding with the surgery on 9th July.
We now wait for further information in writing as to when and where I should attend for my pre-assessment appointment, Covid screening etc.
I am taking advantage of this period to get ahead of myself on the domestic front, doing more cooking than usual so that we have a good supply of ready-cooked meals in the freezer. I have also made up daily batches of my rehydration/electrolyte drink, enough for a week, with all the ingredients apart from the water, and have frozen these. All I will need to do is defrost them and make them up to a litre with water each day – no point in freezing all that water and taking up unnecessary space in the freezer which is already going to be pretty full! The freezer does require some reorganisation so that the meal portions will be easy to find. I have also been reorganising my whole-food supplies in the pantry and additional storage cupboards, and will be putting in another online order in time to store that before I go into hospital.
Some of these tasks have taken me longer than I would have liked because of the added work caused by the failure of my laptop’s hard drive last weekend. All is now well again and I’ve got everything reinstalled, apart from a few ongoing tweaks which are showing up as I begin to use the programs again.
The timing of the operation suits my self-imposed schedule very well, being the second week of the month. This means I can do all my usual beginning-of-the-month tasks and get them out of the way in time, and have enough time to recover before I need to do them again at the beginning of August. I need to be compus mentus enough to tackle the accounts during the first week of the month, and I have various monthly cleaning jobs that I do then as well.
I have also got enough time to finish getting my studio reorganised and tidied, so that it will at last be the peaceful and inviting environment it was designed to be, instead of the dumping-ground tip it had degenerated into over the past months! Once I feel up to it, I will be able to go back in there and be creative again, which will be tremendously therapeutic, and give me something really good to look forward to, especially as I am expecting a new crafting machine to arrive soon from a generous friend (see my main blog posts for details about this) – I have been buying some supplies so I can start using it as soon as I feel up to it.
