I was feeling quite relaxed, but as the minutes ticked by I began to get fidgety and restless and when it got to 15 minutes and no one had appeared, I became quite agitated – why bring someone through from a waiting room to a consulting room just to leave them waiting?!! Patience has never been an attribute I was blessed with and this would be one of many times along the way it would be tested! Finally there was a knock on the door and Mr Masannat bustled in and took a seat. He went through the tests that I had had to date, and recapped that the mammogram had not shown anything up, but the ultrasound had shown a lump and the needle test had not been conclusive, hence the need for a biopsy. He explained that the results of the biopsy had come back positive and that I did have cancer. I didn’t quite catch whether he said I did or didn’t and my brain was processing whether “positive” meant good news, or positively bad news, so I asked him “Sorry, did you say I do or don’t have cancer?” He confirmed that I definitely did and I remember being completely unshocked and fairly unphased – I had felt right from the first day I found the lump that this was probably going to be serious. Despite being reassured that most people who presented at the breast clinic were cleared and each time I went for tests being told that more than likely everything would be fine, there were those tell tale “signs” that may or may not have been completely coincidental – the fact my appointments had all been scheduled quickly, as if they were of some urgency, the radiologist commenting it definitely was not a cyst, my own internal “intuition”. So my reaction was one of practicalities and wanting to know more details of what treatment I would need and what would happen next.
Mr Masannat explained that I had a grade 3 invasive ductal carcinoma and that it was HER2 positive. We asked various questions and he told us that the cancer was graded according to how quickly the cells divided and grew, 1 being the slowest to 3 being the fastest and most aggressive. However, he reassured me that I had done extremely well to spot it so early and that there was a good chance that with surgery the lump could be removed and would not have spread.
He went on to explain about HER2, saying that around 15% of breast cancers showed high levels of a protein called Human Epidermal Growth Factor Receptor 2 and that a drug called Hereceptin can be used to help control the growth of cancerous cells by blocking the effects of the protein and encourages the immune system to attack the abnormal cells. This would involve monthly injections for a year and also going on hormone tablets for 5 to 10 years after my treatment had finished.
Surgery Options
We then went through the more immediate care and discussed the options I would need to consider for surgery. I could either opt for a lumpectomy (or as they now referred to it as a wide local incision) or a mastectomy. For a lumpectomy they would remove the lump and a small portion of the surrounding tissue, to ensure that they got a clear margin, and that they had removed all of the cancer. They would also need to remove a number of the lymph nodes from under my arm to check to see if any of the cancer cells had spread from the lump. In order to identify the lymph nodes that would need to be removed Mr Masannat explained, they injected either a blue dye or a radioactive fluid into the nipple that would then trace through the breast tissue and they could then pinpoint which lymph nodes it fed through to first and remove these, rather than all of them. Mr Masannat explained that as the lump was small, he would try to reshape the area where it was removed, but I would probably find that it was a bit misshapen and that the nipple would be pulled down after surgery.
The other option was a full mastectomy, which would involve removing all of the breast tissue and all of the lymph nodes. This would obviously be a more major operation and I would need to have drains fitted to take off the fluid that would accumulate from the wound. I would not be able to drive for a number of weeks as my arm would be too sore and recovery would be 6 to 8 weeks rather than 2 to 3 for the lumpectomy. However, with a lumpectomy there was a chance that if they did not remove the lump with a clear margin of non cancerous tissue, I would require further surgery.
I remember both Mr Masannat and Fiona, the nurse, saying that I didn’t need to decide immediately, but I am very much happier when I have a clear plan of what is going to happen, so I felt I wanted to make the decision so that I would know what to expect right from the outset. So we discussed the options in more detail and when I weighed it all up I knew that I would rather go for the lumpectomy and hope I didn’t need any further surgery, than lose my whole breast. I figured that the lump was relatively small and so it was worth seeing if we could save my breast, despite the tantalising possibility of not requiring chemo or radiotherapy if I went for a mastectomy. But as Mr Masannat was very clear that if I went for a mastectomy they would not know for certain if further treatment was necessary until after the operation, I felt that I might as well go for the less invasive procedure of the lumpectomy (or wide local incision as they liked to call it).
So, after discussing it with Andrew and being reassured that he was thinking similar thoughts as I was, I decided to make the decision to go for the lumpectomy with the expectation that I would need both chemotherapy and radiotherapy afterwards, to give me the best chance of the cancer not returning in the future.
Setting the date for surgery
The next decision was to set the date for my surgery. Mr Masannat said that he was keen to get on with it and suggested that we set the date as the Friday 10th June. My instant reaction was “I can’t do that we are going away for the weekend” which when I blurted it out, sounded both ungrateful and ridiculous. I then went on to explain that this was the weekend I had been training for to do the Dirty 30 challenge at the Kyle of Lochalsh – a thirty mile circular walk which I had decided to enter. I had always fancied running a marathon but my knees have continually let me know that that was going to be just a pipe dream, and the furthest I have ever managed to run was about 11 miles. So when I had been told about this challenge that was open to both walkers and runners and was a stunningly beautiful route, I decided that I really fancied giving it a go, despite not being able to persuade anyone else to enter with me! So I asked Mr Masannat if we could set the date for after this and whether it would be unwise to delay the operation. He seemed very relaxed and assured me that waiting an extra week was not going to make any difference and he said if I was keen to still do the walk then we would make the operation after it. He then said that Fiona would be my appointed cancer nurse throughout my treatment and that she would go through some paperwork with me and answer any questions I might have.
Missed out on the previous blog post? Click here to read it.
