HER2 Positive Breast Cancer and My Treatment Plan
The first part of my tumor pathology came back the Monday after the biopsy. Both sites biopsied were “infiltrating ductal carcinoma of the breast.” They were classified as Grade 3 which, on a scale of one to three, makes them the most aggressive type of tumors.
And I was diagnosed as Stage 1, meaning cancer had not been found in my lymph nodes. My staging was changed to Stage 2 a few days later based on the analysis of my breast MRI. The breast MRI showed a third small tumor, in the same vicinity of the other two. The MRI verified that there was no sign of cancer in my lymph nodes, which was awesome.
But it’s the second part of of the pathology report that dictates your treatment. That part of the report tests to see if your tumor is Estrogen Receptor Positive, Progesterone Receptor Positive or HER2 Positive. If your tumor is none of the above you are diagnosed with Triple-Negative breast cancer.
And that report took a few more days to come in.
The first oncologist we saw, Dr. Sberg, didn’t have the full picture and could really just give some what-if scenarios. But both Fred and I really liked her and her staff. She took a blood sample to send off for genetic testing since I’m of Ashkenazi descent. My mom had tested negative years back so I was hoping I would too. (This test came back and I am indeed negative. Yeah!!!!)
From there we had a consult with a breast surgeon, again a little premature without knowing the pathology but we wanted to get the ball rolling and see if we liked him and felt comfortable with what he had to say.
We didn’t. And I had a few disturbing phone calls from him in the interim, one of which was very upsetting to me. And will not be returning to him if I need surgery at the end of chemo. And I would never recommend him to anyone locally. Enough about that.
That afternoon we went down to the University of Miami Sylvester Cancer Center to meet with one of the oncological gurus in the field. And I had just received the second half of the pathology report which showed that I was HER2 positive. So I was able to bring it down to Dr. Vogel. Everybody knows Dr. Vogel. He is an older doctor and is very well respected for all of the work he has done in this field.
Dr. Vogel had a very specific treatment plan, which involved neoadjuvant therapy. Neoadjuvent therapy means that you have the course of chemo treatments before the surgery. Dr. Vogel was going to send over his report to Dr. Sberg, who he knew. He was very kind, a little quirky and matter-of-fact. He told me I would be fine and that this was curable. When the consult was over, he gave me a little peck on the cheek, which made my day.
I made an appointment with Dr. Sberg for the next Tuesday armed with the HER 2 diagnosis. We reviewed both Dr. Vogel’s specific treatment plan and hers. They were very similar and she said that we could choose which one we wanted. Hers was a little more aggressive and given the new staging of a Stage 2, we opted to go with her plan. I have so much confidence in this oncologist and feel very comfortable with her and her staff especially her nurse practitioner Emily. I can ask them anything and no question is unimportant.
She said we could start treatment in two days, on Thursday. I must have hesitated because she said or Monday. But no, I wanted to get started.
So Thursday, February 25, 2016, at 11:00 am, the long process of ridding my body of all cancer cells began.
And it continues.
The complete timeline goes something like this:
20 weeks of chemotherapy
Week 1: Adriamycin (The Red Devil) and Cytoxan
Week 2: Off
Week 3: Adriamycin (The Red Devil) and Cytoxan
Week 4: Off
Week 5: Adriamycin (The Red Devil) and Cytoxan
Week 6: Off
Week 7: Adriamycin (The Red Devil) and Cytoxan
Week 8: Off
Week 9: Taxol, Herceptin and Perjeta
Week 10: Taxol
Week 11: Taxol
Week 12: Taxol, Herceptin and Perjeta
Week 13: Taxol
Week 14: Taxol
Week 15: Taxol, Herceptin and Perjeta
Week 16: Taxol
Week 17: Taxol
Week 18: Taxol, Herceptin and Perjeta
Week 19: Taxol
Week 20: Taxol
Which takes me to July 7th, 2016. The Herceptin will continue every three weeks until April of 2017. (Yikes.)
I’ve found a breast surgeon who I really like and feel confident about. I’m scheduled for a lumpectomy on July 27th.
And four weeks later, I’ll begin a six week course of radiation, five days a week.
So, sometime in October I’ll be done with everything but the Herceptin. That’s a long fucking time. But life will go on around me and I’ve vowed to myself to make sure that I am an active part in that life. I don’t want to miss a thing but I’ve come to terms that I’m going to miss a few of them. And that’s okay.