Ohio to Erie Trail - Boston Mills to Massillon, OH - July 30th

This has always been one of my favorite quotes. It seems so appropriate now. Last Monday, Tuesday and Wednesday were spent with medical appointments. Looking at my calendar, I knew we were going to have a few days free, so Bill and I decided at the last minute to head north with our bicycles. Our plan was to take off from where we ended 11 days earlier. Riding the Ohio to Erie Trail, that transverses the state of Ohio from Cincinnati to Cleveland, has long been on Bill's bucket list. 

I've found on my breast cancer journey that there are two things that help me cope: 1) writing this blog, and 2) taking small trips that do not put me at risk of exposure to Covid 19. We headed up to Columbus to my daughter's house. (They were away on vacation, so no chance of exposure there). The next morning, we drove to Boston Mills in the Cuyahoga Valley National Park. Here we were able to start again. Bill rides the entire distance and I meet him with the car at the predetermined endpoint. As you can see, every precaution is taken.

I rode the first 12 miles with Bill and then returned to the car. The scenery was incredible.

Cuyahoga Valley National Park

I don't think I spent one minute thinking about cancer or surgery. The skies were a bit overcast with the high reaching about 80 degrees -- a perfect day for a bike ride.

                                                            

 

This Week in Cancer - July 26th to August 1st

This week began with the knowledge that I was going to need a second surgery. During the first surgery, a lumpectomy, it was discovered that the mucinous carcinoma had invaded the chest muscle. Further tests found that the invasion extended to my sternum and or rib. Not only were further tests going to be needed, but the second surgery would require three surgeons: my breast cancer surgeon, a plastic surgeon and a thoracic surgeon.

A CT scan was ordered for Monday. I visited the thoracic surgeon on Tuesday for the first time, and he let me photograph one of the scan views. In the image below, the part that is within the rectangle is the part of the cancer that has invaded the area near my sternum and rib. The good news is that they still think this cancer is localized and has not spread to other parts of my body. Until they literally are doing the surgery, they will not be able to determine if the cancer is just wrapped around my sternum and rib, with the possibility of just being scraped away, or if it has invaded the sternum and/or ribs.

On Wednesday, I visited the oncologist who has been assigned to me. He already had been given a "heads-up" that I was not a fan of chemotherapy or endocrine therapy. So here is how the conversation went:

Me: I value quality of life over quantity of life.

Him: You want to know what poor quality of life is? Bone cancer. Both chemotherapy and endocrine therapies can have bad side effects, but medicines can be changed and symptoms controlled. In no way do those issues compare with bone cancer.

He told me they were waiting for the results of an "oncotype" test. This test will tell them what the odds are of my individual cancer returning within a certain timeframe. It would also tell my doctors whether my cancer would be responsive to chemotherapy or endocrine therapy.

I told my daughter that I feel like I'm a fish who has been hooked and is now being reeled in slowly. I started this process with one set of assumptions that are constantly being challenged. Their arguments do make sense.

The thoracic surgeon mentioned the possibility of either a PET scan or bone scan to verify that, in fact, my cancer is localized. He also said a PET scan would give him additional information about the chest wall muscle before surgery.

So what to do as the final pieces fall into place -- my Dad always said that when he spoke with his sister that she was either dying or going on vacation. Taking a page from my aunt's playbook, Bill and I left from the oncology appointment and traveled north for a few days of biking the Ohio to Erie Canal. I'll discuss that in the next post. Thanks for sharing this ride with me.

Back to Reality - July 25, 2020

Note: This post discusses the latest developments re: my breast cancer diagnosis. I'm writing it for my family and because I personally find it therapeutic to write about my journey. You may choose to skip this post if it has the potential to make you uncomfortable. You've been warned.

*********************************************************************************

A Short Recap

I went to see a plastic surgeon. After the last surgery, my cancer surgeon knew that this next surgery would involve a much deeper incision requiring reconstructive surgery. When I went to see the plastic surgeon, she was looking through some of the MRI images on her computer and became concerned. You could tell that she wasn’t convinced that the radiologist had read the MRI correctly. If you recall, they were surprised when they did the surgery that there was cancer in the underlying chest wall. The radiologist had determined that "Enhancement posterior to this mass, anterior to the right pectoralis musculature corresponds with a vascular structure without invasion of the right pectoralis musculature identified."

In layman's terms, this means that the radiologist felt the MRI showed a vascular structure (blood vessel) and that there had been no invasion of the chest muscle by the mucinous carcinoma. During the original surgery, it was discovered that there was extensive invasion of the skeletal muscle.

At this point, the plastic surgeon suggested that we request a second review of the MRI results by radiology. Following that review, I got a phone call from my cancer surgeon who said that, in addition to the invasion of the chest wall muscle with the carcinoma, there may also have been an invasion of the underlying rib and/or sternum. She was going to refer me to a thoracic surgeon. I will meet with him on July 28th.

Friday’s Update

My surgeon called me Friday and said that my case had been discussed in their multidisciplinary team  meeting. The following recommendations came from this meeting:

      1) They are going to have my tumor “oncotyped.” This test is designed to predict recurrence and whether chemotherapy would be a beneficial treatment.

      2) They suggested I have a CT scan to get a better look at the vessels within the breast. This has been scheduled for Monday.

3    3)  She knew I had an appointment with the thoracic surgeon on Tuesday and said she will be very interested in what he has to say. I then asked if after their meeting that they suspected that the mucinous carcinoma had “invaded” my sternum and a rib. She said it was all part of the original carcinoma when I asked her about the possibility of metastasis.

      4) The team suggested that I see a medical oncologist. I’ve already got that appointment set up for Wednesday.

So her final comment was that after they get all the information, the three surgeons will meet and come up with a surgical plan. She is still hoping to have the surgery scheduled by mid-August. It should be an interesting week.