Positive or Negative

For this blog post I'm going to get all educational for you, so if science or learning has not been your cup of tea, I will excuse you from reading the rest of this post. Grab me a snack on your way out, For those of you that enjoy learning how things work (cough engineers cough), then this post is for you. So let's get educated.

We will start at the very beginning (Julie Andrews anyone?)...

I have a tumor in my left breast, it is roughly 1.5 cm which I like to compare to the size of a large blueberry. This blueberry is a ball of cells that really wanted to be normal, but with a little peer pressure from the wrong crowd, began multiplying out of control, making it more difficult for the normal cells to do their job. Much like the hallway of a local high school, this group of "bad kids" will keep recruiting more and more kids to join their "gang" until there are no good kids left.

This guy is a real jerk.

The good news is, every group of kids, or cells in this case, have a weakness, we just need to figure out what it is. Any time a breast tumor is identified, it helps to take a sample of the tissue to test for biomarkers, or receptors for tumor growth. If we can identify what type of receptor is feeding the growth of the tumor, we can hopefully turn it off, thus starving the tumor and stopping growth. It is really simple math. Oreos + my belly = muffin top. Take away the oreos, no more muffin top.

For breast cancer, there are three types of receptors doctors look for: Estrogen, Progesterone and HER2 (human epidermal growth factor receptor 2). If we can identify that the tumor has receptors for any of these 3 things, we can cut off the supply and at the very least, keep the cancer from spreading, if not eliminating it all together.

Estrogen and progesterone are two very important hormones in the female body, largely responsible for controlling fertility. They also can impact the growth of cells and in this case, the overgrowth of cells, leading to cancer. In addition, super smart scientists have also discovered the HER2 protein on breast cells and have linked higher levels of this protein to breast cancer. Enter stage left: the positive/negative game.

When I had my biopsy 2 weeks ago, they sent a sample of the tissue to a lab to test if I have any of these three receptors on my tumor. Eighty percent of women with BRCA2 gene mutations like me (this will be another future post entirely) have ER+ or estrogen receptors on their tumors. So naturally I believed I would be ER+, I would have surgery to remove my tumor, take an anti-estrogen medication to kill any remaining cells and go skipping off into the sunset because I have beat cancer. Mic drop.

Second Obama reference in a week? Must be an election year.

Unfortunately for me, I tend not to follow the curve.

Last weekend, I received the unfortunate news that my markers had come back and that I was ER-, PG- and HER2 equivocal, which is a fancy scientific term for "I dunno". They would need to run an additional, more specific test on my tissue sample to determine if it is HER2 positive or negative. The even better news (sarcasm) is that regardless of that lab result, my tumor is not the preppy-kid-who-ditches-school bad, its the smokes-behind-the-bleachers-and-robs-the-liquor-store kind of bad. The aggressive, fast growing, take no prisoners kind of bad. It just got serious.

That blueberry, he can be pretty mouthy too!

If I have an HER2 positive tumor, I will receive 3 medications to turn off the gene that creates the HER2 protein that is making my cells grow out of control. One of these medications is only approved by the FDA to be given prior to surgery, so if I am HER2 positive, I must have treatment before surgery. I will have 18 weeks of treatment, followed by surgery to remove all breast tissue, and then continue to get an infusion of one of the medications for up to a year. While all of this sounds pretty terrible, the good news is this treatment is very effective and can cure up to 50% of patients completely prior to surgery.

If I do not have an HER2 positive tumor, I am then branded as a "triple negative" breast cancer patient. Triple negative breast cancers are tough to treat because there are no known receptors for the tumor. We have no way of knowing exactly how to turn it off. For this reason, my oncologist is recommending we do chemo prior to surgery because then we are able to use my tumor as a barometer for how well treatment is working. Getting smaller? Good news. Not get smaller? Not good news. Since we don't know any receptors for this type of tumor, removing the tumor prior to surgery would make it more difficult to confirm that the medication I am getting is actually working on my specific tumor type. So either way we look at it, we are set up for chemo ASAP.

My oncologist assured us that the results of this second lab test would be back within a few days, so we would know by Wednesday or Thursday this week what my result should be. Once we know my result, then we will know which chemo plan we are going with and can start treatments. For reasons unknown to me, it's Friday and we still have no results. No positive or negative and now the waiting game continues.

In the meantime, we will stay busy. My mom flies in today to move into our basement for an undetermined period of time. If I catch her sleeping during the day and playing video games all night, she's gettin a job! We have date night planned for tonight and a lot of playing with kiddos for the next two days until my appointment at the cancer center Monday morning. Hope you all enjoy your weekend and I'll update again on Monday!

My sidekick at work on Thursday