2. Surprise! It’s Me, the Big C

Thank you for following along on this wild and crazy (and totally unexpected) journey. I never, ever imagined I’d be diagnosed with breast cancer, let alone at 35 (and especially not during my clinical year of vet school). But life is weird, and here we are. I appreciate each and every one of you for wanting to stay in the loop and support me along the way.

So I guess I’ll just start it off like we do in vet school with a little bit of history…

On Wednesday, August 18th, I received my biopsy results. Based on the mammograms and ultrasound I had undergone the day prior (as well as the doctor’s face when he came into the room telling me that we needed to do a biopsy ASAP), I was expecting not so great news. Even though they warned me after seeing the results of the ultrasound, I think I still hoped there was a chance it was all just a big mistake. It couldn’t be malignant; there was no way this would happen right now, during my last year of vet school, at my age, and in my good health. But my sliver of hope was dashed when I saw the pathology report on my phone: ductal carcinoma in situ (DCIS), and invasive and infiltrative ductal carcinoma. Basically what this means is “cancer, in it’s original place”. And “cancer, now invading tissues surrounding that place”.

I have two primary tumors (both in my left breast), one that measures somewhere between 5-6 cm depending on which oncologist is doing the exam (it’s big), the other 1.7 cm, and a few in between that seem to connect the two larger ones. It was confirmed by biopsy the following week that the cancer is also in my left axillary (armpit) lymph nodes. I’m on about week 3 of knowing this information and I’m pretty sure my brain is still working on processing and accepting that it is real.

When I first read the biopsy results, my heart was racing and my brain was going at warp speed…so naturally I stood at my counter and stirred boiling water and rice for the next hour while I stared into the circling pattern of steam and confusion. How the hell did this happen? Of course this can’t actually be real; I have too much to do, I have externships booked, I have rotations to complete, I’m busy becoming a vet and living life and going to shows and hiking and trying new beers and laughing with my boyfriend and getting made fun of by my brother and planning trips with my sister. There’s no way it can be cancer. I’m way too busy living life.

But life is weird, and here we are. It’s cancer, and cancer doesn’t care what’s going on in your life. Cancer doesn’t give a flying F how busy you are, or whether you’re a good-hearted person, or how hard you try to stay healthy and fit. At least in my case it doesn’t.

As far as I know, we don’t have a family history of breast cancer aside from two of my great aunts having it very late in life. I had a genetics counseling session about a week ago to talk to an expert about the genes that predispose women to breast cancer, BRCA1 and BRCA2 (many people know these genes as the “Angelina Jolie” genes), and sent in a saliva test kit to see if I have these genes or one of seven others that have been linked to a higher risk of developing breast cancer. I’m curious to receive the results in a few weeks, because if it is hereditary and I do have a mutation in one of these genes, this will explain why I have developed breast cancer at such a young age. If it’s not hereditary, that means that this is most likely a spontaneously formed cancer (rather than inherited) and that somehow during my lifetime, certain cells began to change because of some unknown inciting cause and then they began to replicate, replicate, replicate. And wham bam…cancer.

According to the oncologists, in my particular case, the Big C may have grown due to me being on birth control for many years. It is still unknown whether birth control can be the actual inciting cause for the formation of breast cancer, but in cases where the tumors are receptive to progesterone and estrogen (hormones both naturally occurring and used in birth control), it is widely believed by researchers and oncologists that these hormones can speed up the process of cancer growth.

In terms of what I’ve got going on, it’s actually pretty interesting (to science nerds like me who knew nothing about human breast cancer prior to 3 weeks ago). The exact type of cancer in regards to specific hormonal markers within each tumor was finally determined just last week after three different teams of pathologists analyzed the biopsies.

One of my tumors is classified as “triple positive”, and one is classified as “HER2 negative”. Apparently this is rare and occurs in about 3% of cases (go figure). “Triple positive” means that the cancer cells within this tumor have receptors for PR (progesterone), ER (estrogen), and overexpress a protein called HER2. “HER2 negative” means that the second tumor is still receptive to estrogen and progesterone, but is not over expressing the HER2 protein.

The whole HER2 thing is a bit confusing; it stands for “Human Epidermal Growth Factor 2” and it is a growth-promoting protein on the outside of all breast cells. Cells that express higher than average amounts of this protein are called HER2+ (HER2 positive) and cells that do not express higher than average amounts of this protein are labeled HER2- (HER2 negative).

So, as hormones like estrogen and progesterone travel though my bloodstream and come in contact with the receptors on the cancer cells, they bind and allow the cancer cells to grow. This is certainly not the case for everyone on birth control for most of their lives; it just happens to certain people, and sometimes the reason for the inciting cause is unknown. In my case, it may be that this cancer is totally spontaneous and the birth control I’ve been on for years and years just happened to aid in the growth once it started. Or, I inherited the mutation in one of the genes linked to breast cancer and the hormones have helped it to grow. We asked how the tumors could be doing different things, and my oncologist said. “Because…cancer.” …aka- cancer is crazy and it does what it wants.

The reason the type of tumor is important is because the hormonal markers determine my chemotherapy protocol. Because I have one tumor that is HER2-, my chemo regimen is more frequent than if both were triple positive. I will go in for my chemo IV infusions once every other week for 2 months (8 treatments), then once a week for the next 3-4 months (12 more treatments). Each infusion is about 4-5 hours depending on the selected drugs for that week. Overall, the total timeline for chemo will be about 5-6 months, depending on my body’s response. Unfortunately this protocol means that I won’t have much time in between treatments for my body to heal/recover, so I’m planning to use integrative therapies such as acupuncture, physical therapy, nutritionist help, etc. to mitigate some of the dreaded side effects (and yes, I will lose my hair).

Hopefully that made at least a little bit of sense. I’ve had so many things running through my head at warp speed every day and night since the diagnosis, so when I sit down to write, many of my thoughts just disappear into the abyss. They warned chemo brain is a real thing; maybe my mind is just preparing me for the next 6 months of having to sift through the fog in my head.

What follows chemo is surgery, likely to take place sometime in late winter. Surgery will include a double mastectomy and possibly removal of my uterus and ovaries. Many decisions to make on that front, but not until we get through a few months of chemo and see how the cancer responds do I have to make the final say on surgery. After surgery will be 6 weeks of radiation, then reconstructive surgery, and then 5-10 years of endocrine therapy with some more chemo in pill form thrown in there. Yikes.

For now, the latest happenings around here are tons of diagnostics (last week was a nuclear bone scan, full-body CT, chest MRI, and port placement), waiting to get the results of those diagnostics, and then scheduling more if need be. I also have something this coming week called a “ChemoTeach” where they go over each drug used, show us the infusion room, talk about side effects, etc. as well as a meeting with an oncology surgeon here in Fort Collins. It is amazing the amount of phone calls, meetings, and appointments I’ve had over the past 3 weeks. We are hoping that I can begin chemo on September 15th; for now this is my start date as long as we don’t have to delay for further testing. I am hoping by the end of this coming week I will have a final “stage” on my cancer. Where it is, where it isn’t…all the things that will either help put my mind at ease or prepare me to pivot and adapt to a new mindset.

The hardest part in all of this so far has been having to put vet school on hold. The amount of time and energy I have spent dedicating everything to the DVM program over the past few years, as well as applying to and preparing for externships that I’ve now had to cancel has definitely been deflating. I’ve dropped all 4th-year rotations under the advisement of my oncologists, and will have to delay graduation by a year as well as my boards. I will be maintaining my student health insurance by taking a Spanish for Veterinarians class and will be able to continue working part-time as a data specialist for an amazing company that I have been with for years. I’ll also be super busy with chemo, integrative therapies, my dogs, exercising when I can, visits from family and close friends, and whatever time I can spend with Brandon on the days I am feeling up to it. So, I am extremely fortunate to have these things to keep me busy on the days I can hack it. Hopefully they will also help in keeping my brain sharp so that I can return to the DVM program a year from now and finish my clinical year (with a sweet buzz cut).

I’m super lucky to have all of you- my family, friends, classmates, and people far and wide rooting for me in this. I am beyond grateful and know just how fortunate I am. I try to wake up every morning still thankful for everything and everyone that I have in this life. Of course there are dark moments every day, and I know there will be many more ahead, but for now I am trying to stay very busy and as positive as I can while I accept this as my new reality. I will write more soon once we have some more diagnostic results, info from the ChemoTeach, and a definite “full steam ahead” plan. Sending love and doggie kisses to all of you.

Published by vegterac

Hi! I am Amanda, a 35-year-old vet student in Colorado. I am here to share my journey through Stage 2 breast cancer and keep those I know and love (and those I don't even know who are interested in following along) informed along the way. Thanks for being here with me.

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