Breast cancer blog: The waiting game as I receive my pathology report

PUBLISHED : Tuesday, 04 June, 2013, 6:06pm
UPDATED : Monday, 10 June, 2013, 4:07pm

There must be a slant of sun amidst the storm, I’d like to think. The breast surgeon holding the final pathology report smiled, but she always smiles. It’s reassuring but hard to read. The aunt and I sat there on the edge of our seats, fidgety, leaning forward, no longer truly able to maintain a sense of calm. I’ve been fretting about this pathology report for the past two weeks.

This report – a detailed look at the tumour and lymph nodes (the channel between the cancer cells and the rest of the body) - determines the fate of my treatment and future. The mind spins with questions: What stage cancer? What kind of treatment? God forbid if chemo is involved. I try hard to steer my thoughts away from the dark side, but it’s tough. My nervous chatter breaks the silence of the packed waiting room.

“We’ve been here for about forever now, can’t we just get this report and get it over with?” I said.

Turns out that finding the lump and removing it was only the very beginning of what will be a long journey.

For the moment I am elated... The report was probably the best news I could have received in a worst case scenario

Friends have been somewhat surprised by this. “You mean it doesn’t end with the surgery? I thought they got all of it,” a good friend said shaking her head.

Cancer, as I’ve learned, is never as simple as that. The treatment for early stage cancer survivors like me is similar to cancer patients at a later stage. The goal is all about lowering the chances that the disease will return. The breast cancer treatment menu, despite many milestones in medical advances, remains mostly unchanged: radiation, chemo, hormone therapy, targeted-therapy, with side effects including infertility.

And if you’re in your 30s you have a long way to go and it’s a long time to worry if the rogue cell will return.

In the hopes of getting a dose of sympathy, I reach out to my peer counsellor by e-mail asking - and really hoping - that she would give me a list of the positives of getting cancer in one’s 30s, maybe something along the lines of “adversity makes one stronger and more resilient” or some platitude that can be found in a Hallmark Card.

My peer counsellor wrote to me and said: “Honestly, I cannot think of one benefit of diagnosis at such an early age other than your body is stronger than when you are older. I will admit though, that thought did not make me feel any better,” she wrote, herself having survived Stage 2 breast cancer.

So I’ve become a Google monkey, Googling treatments for early bird cancer victims, reaching out to women with similar diagnoses on chat forums or seeking out the few ladies I’ve connected with in Hong Kong who have the same diagnosis.

The added knowledge has stirred up more fears. I’ve read that DCIS is often more aggressive in women under 40, and younger women have a higher chance of reoccurrence.

Back in the waiting room, I am now thinking about the tumour itself, what if it comes back with poor scores? The tumour is scored based on it being positive or negative when it comes to estrogen, progesterone and HER2. Before I can fret too much more the nurse calls me into the office.

The breast surgeon flips out the report and reads the diagnosis: “High grade ductal carcinoma in situ (DCIS), 2.1 cm tumour, none of the sentinel lymph nodes showed metastatic disease.” The pathology report is complex, numbers, stats, negative, negative, positive but the bottom line is it is non-invasive and the cancer is localized.

The surgeon gives me the additional stats. Having DCIS means that my other breast is now five times higher at risk for cancer, and there is a 30 per cent chance for reoccurrence in the same breast without radiation. If it returns some women get a mastectomy.

“I just need to tell you the reality,” she says. With radiation she says the risk for reoccurrence drops to 10 per cent and “the prognosis is excellent, 98 per cent survival rate over 10 years,” she says. “This report is very good stage 0,” she says. She hands me a letter, thus handing me off to the oncologist for radiation.

For the moment I am elated, so happy, there are fireworks going off and I’m sporting the million dollar grin. The report was probably the best news I could have received in a worst case scenario. It means no chemo and hormone therapy.

But in the back of my mind lies a backdrop of worry. If the tumour was so fast-growing and aggressive, wouldn’t it come back swiftly with even greater vengeance? The surgeon kept her smile, looked me in the eye, and said: “There are no guarantees in life. Whether we have this disease or no disease at all, our job is to live every day to the fullest.”

It was philosophical, lovely to hear and briefly, if just briefly, made me feel at peace. The aunt and I could finally exhale, if just for now, and enjoy the news over celebratory sushi.