the kitchen sink
“We’re throwing everything but the kitchen sink at this,” my oncologist recently said. Kicking off the first week of the year with an infusion of Herceptin and Perjeta, and throwing in my follow up with my oncologist, was a lot. Thankfully my mom was with me.
There are different types of breast cancer and it has to do with what “feeds” your tumor. They determine the type when they do a biopsy at initial diagnosis. Then they only retest the tumor after your mastectomy.
My initial biopsy in August 2021 showed my tumor was Triple Negative. This determined my entire treatment plan. Thus, when my pathology after my mastectomy showed it was actually parts HER2+, I had to alter my treatment path. Ultimately, this was good news. After the chemo before my surgery I still had a lot of tumor left and many (17!) lymph nodes involved. We were worried my cancer just didn’t respond to chemo when in reality I didn’t have the right drug cocktail to kill all of it.
Well that same pathology from my mastectomy ALSO showed my tumor was Estrogen and Progesterone positive, but only 10%. Some people are 100% positive. This means that ER and PR could feed any remaining cancer cells that might have survived ALL of this treatment.
We will never know if my tumor cloned/morphed during treatment or had different “ecosystems” throughout. As horrifying as biopsies are - I wish I had advocated for more.
Since my cancer cells may be fed by these hormones I have to start yet another new treatment. I have started a pill called Tamoxifen. This is not chemo. This blocks estrogen in my body, thus blocking it from feeding any remaining cancer cells. It’s one pill, once a day, for FIVE years. Ugh. Side effects are hot flashes, irritability, depression or low mood, and joint pain.
This now means I’ve had treatment for pretty much all typical breast cancers. I’ve been treated for triple negative, HER2+, and now triple positive. Overall, it’s good news. Because good God I cannot imagine a cancer cell surviving in this toxic work environment. But, cancer is a tricky B, so who knows, she could still be floating around somewhere hoping to set up shop and survive.
I’m going to be honest, this news has hit hard. EVERY SINGLE TIME I’m even remotely close to the finish line, it moves. And then moves again. And while each thing to get to that finish line has seemingly gotten easier, it’s still so damn hard.
When I was diagnosed as triple negative I scoured the internet for information. No cancer is good. So I learned as much as I could and armed myself with the silver linings of being triple negative. One of the big ones was that it’s typically one year of treatment, and then done! You monitor closely but after 5 years your risk of recurrence drops dramatically. My surgeon even said, you’re not in this for the long haul. But, I’m not typical and we’re in this for the long haul.
I guess now I’m technically Triple Positive. But, really, I’m kind of all three. Since we will never know if it morphed or was parts triple negative and parts triple positive and parts just HER2+ it will be tough to know what we’re up against in preventing recurrence. Thus, throwing everything but the kitchen sink at it and why I’ve now had treatment for all types.
So, I’m trying really hard to change my perspective. I’m overall thrilled that there are these treatments available. And I’ll do whatever it takes to stay cancer free. Bring it on Tamoxifen - but seriously be nice to me please because I’m tired and have had enough of the hot flashes and joint pain.
Background information from the Mayo Clinic.
Are your cancer cells fueled by hormones?
Some breast cancers are sensitive to your body's naturally occurring female hormones — estrogen and progesterone. The breast cancer cells have receptors on the outside of their walls that can catch specific hormones that circulate through your body.
Knowing your breast cancer is sensitive to hormones gives your doctor a better idea of how best to treat the cancer or prevent cancer from recurring.
Hormone status of breast cancers includes:
Estrogen receptor (ER) positive. The cells of this type of breast cancer have receptors that allow them to use the hormone estrogen to grow. Treatment with anti-estrogen hormone (endocrine) therapy can block the growth of the cancer cells.
Progesterone receptor (PR) positive. This type of breast cancer is sensitive to progesterone, and the cells have receptors that allow them to use this hormone to grow. Treatment with endocrine therapy blocks the growth of the cancer cells.
Hormone receptor (HR) negative. This type of cancer doesn't have hormone receptors, so it won't be affected by endocrine treatments aimed at blocking hormones in the body
