October 22, 2012: My Story - The Facts and The Stats

Why did I do all this?....

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Details about Breast Cancer Stages:

Taken From:

http://www.breastcancer.org/symptoms/diagnosis/staging#stage2

Stages of Breast Cancer

Page last modified on 09/17/2012 10:56 PM

Stage is usually expressed as a number on a scale of 0 through IV — with stage 0 describing non-invasive cancers that remain within their original location and stage IV describing invasive cancers that have spread outside the breast to other parts of the body.

• Stage 0
• Stage I
• Stage II
• Stage III
• Stage IV
• TNM staging system

Understanding Breast Cancer Stages

Your pathology report will include information about the stage of the breast cancer — that is, whether it is limited to one area in the breast, or it has spread to healthy tissues inside the breast or to other parts of the body. Your doctor will begin to determine this during surgery to remove the cancer and look at one or more of the underarm lymph nodes, which is where breast cancer tends to travel first. He or she also may order additional blood tests or imaging tests if there is reason to believe the cancer might have spread beyond the breast.

Cancer stage is based on four characteristics:

• the size of the cancer
• whether the cancer is invasive or non-invasive
• whether cancer is in the lymph nodes
• whether the cancer has spread to other parts of the body beyond the breast

You also may see or hear certain words used to describe the stage of the breast cancer:

• Local: The cancer is confined within the breast.
• Regional: The lymph nodes, primarily those in the armpit, are involved.
• Distant: The cancer is found in other parts of the body as well.

Sometimes doctors use the term “locally advanced” or “regionally advanced” to refer to large tumors that involve the breast skin, underlying chest structures, changes to the breast's shape, and lymph node enlargement that is visible or that your doctor can feel during an exam.

The stage of the breast cancer can help you and your doctor understand your prognosis (the most likely outcome of the disease) and make decisions about treatment, along with all of the other results in your pathology report. Cancer stage also gives everyone a common way to describe the breast cancer, so that the results of your treatment can be compared and understood relative to that of other people.

Your doctor may use another staging system known as TNM to describe the cancer. This system is based on the size of the tumor (T), lymph node involvement (N), and whether the cancer has spread, or metastasized, to other parts of the body (M). TNM is discussed later in this section.

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS (ductal carcinoma in situ). In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading normal surrounding breast tissue) Stage I is divided into subcategories known as IA and IB.

Stage IA describes invasive breast cancer in which:

• the tumor measures up to 2 cm AND
• the cancer has not spread outside the breast; no lymph nodes are involved

Stage IB describes invasive breast cancer in which:

• there is no tumor in the breast; instead, small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – are found in the lymph nodes, OR
• there is a tumor in the breast that is no larger than 2 centimeters, and there are small groups of cancer cells – larger than 0.2 millimeter but not larger than 2 millimeters – in the lymph nodes.

Microscopic invasion is possible in stage I breast cancer. In microscopic invasion, the cancer cells have just started to invade the tissue outside the lining of the duct or lobule, but the invading cancer cells can't measure more than 1 mm.

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

• no tumor can be found in the breast, but cancer cells are found in the lymph nodes under the arm (axillary) OR
• the tumor measures 2 cm or smaller and has spread to the axillary lymph nodes OR
• the tumor is larger than 2 cm but not larger than 5 cm and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

• the tumor is larger than 2 cm but no larger than 5 cm and has spread to the axillary lymph nodes OR
• the tumor is larger than 5 cm but has not spread to the axillary lymph nodes

Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

• no tumor is found, but cancer is found in axillary lymph nodes, which are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone OR
• the cancer is any size and has spread to axillary lymph nodes, which are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

• the cancer may be any size and has spread to the chest wall and/or skin of the breast AND
• may have spread to axillary lymph nodes, which are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone

Inflammatory breast cancer is considered at least stage IIIB. Typical features of inflammatory breast cancer include:

• reddening of a large portion of the breast skin
• the breast feels warm and may be swollen
• cancer cells have spread to the lymph nodes and may be found in the skin

Stage IIIC describes invasive breast cancer in which:

• there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast AND
• the cancer has spread to lymph nodes above or below the collarbone AND
• the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer that has spread beyond the breast and nearby lymph nodes to other organs of the body, such as the lungs, distant lymph nodes, skin, bones, liver, or brain.

You may hear the words “advanced” and “metastatic” used to describe stage IV breast cancer. Cancer may be stage IV at first diagnosis or it can be a recurrence of a previous breast cancer that has spread to other parts of the body.

Learn about what treatments you can generally expect according to cancer stage in the Options by Cancer Stage section in Planning Your Treatment.

TNM staging system

TNM (Tumor, Node, Metastasis) is another staging system researchers use to provide more details about how the cancer looks and behaves. Your doctor might mention the TNM classification for your case, but he or she is much more likely to use the numerical staging system. Sometimes clinical trials require TNM information from participants, so talk to your doctor if you are considering participation in a clinical trial.

The TNM system is based on three characteristics:

• size (T stands for tumor)
• lymph node involvement (N stands for node)
• whether the cancer has metastasized (M stands for metastasis), or moved beyond the breast to other parts of the body.

The T (size) category describes the original (primary) tumor:

• TX means the tumor can't be measured or found.
• T0 means there isn't any evidence of the primary tumor.
• Tis means the cancer is "in situ" (the tumor has not started growing into healthy breast tissue).
• T1, T2, T3, T4: These numbers are based on the size of the tumor and the extent to which it has grown into neighboring breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (lymph node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can't be measured or found.
• N0 means nearby lymph nodes do not contain cancer.
• N1, N2, N3: These numbers are based on the number of lymph nodes involved and how much cancer is found in them. The higher the N number, the greater the extent of the lymph node involvement.

The M (metastasis) category tells whether or not there is evidence that the cancer has traveled to other parts of the body:

• MX means metastasis can't be measured or found.
• M0 means there is no distant metastasis.
• M1 means that distant metastasis is present.

Once the pathologist knows your T, N, and M characteristics, he or she can use them to assign a stage to the cancer. For example, a T1 N0 M0 breast cancer would mean that the primary breast tumor is less than 2 centimeters across (T1), has not involved the lymph nodes (N0), and has not spread to distant parts of the body (M0). This cancer would be grouped as stage I.

For more detailed information on the TNM staging system and how it relates to the numerical stage, visit the American Cancer Society’s section on breast cancer staging.

October 17, 2012: Milestone - End of Radiation

October 17, 2012: End of Radiation

My radiation experience has ended after 28 treatments that started on September 7, 2012.  In retrospect, I was more anxious about this treatment than I needed to be based on how well I tolerated radiation.  The expectation was relatively high that I would experience skin reactions including an intense sunburnt look and feeling, potential skin lesions, skin/muscle tightening and fatigue.  Remarkably, my skin seemed unscathed up until the last week or so and even at that, it was not tremendously impacted.  I also did not feel overly tired and fatigued other than the fact that my sleep continues to be interrupted due to menopausal symptoms more so than anything else.  I kept asking the Radiation Technicians (of which there were many, I only remember a few of the names, but they were ALL really pleasant and competent) if they were giving me placebo treatments based on how good it all seemed to be going.

Here is a visual of the machine that was used for CT simulation to prepare the radiation treatment and then used to administer the treatments:

The worst parts of this treatment was: the long sessions during the first week where I needed to be fitted to a mould for my arms to rest in above my head while lying down; trying not to cough while I was getting over a cold; worrying that they might radiate my heart and lungs in error (I kinda want these two babies for the rest of my life:o)); driving to Surrey (Surry Memorial Hospital) and back every working day for 28 days; finding parking in the ridiculously narrow and limited number of parking stalls; AND giving up my life for 2 or more hours every day for this treatment.

By the time the final day came, I was on cloud nine.  To commemorate the day, I gave a box of chocolates for the Radiation staff to share and as a thank you.  I gave a big hug to the two Radiation technicians that were treating me that day.  I changed out of my lovely blue patient gowns, through them into the hospital laundry bin. 

And then I walked out the door…..

The Radiation Technicians and others asked how I was going to celebrate this milestone, but really, walking out the door of the BC Cancer Agency that day and knowing I was going to be able start regaining my days and rebuilding my life was celebration enough.  I called Todd before I left the parking lot and gave him a big Whoawho in his ear because he deserved to feel the relief with me.

Here’s to my renewed life!!!

October 6, 2012: Anniversary

October 6, 2011 - Lumpectomy: coincided with the birthday of niece Jacqueline and the day after my Dad's birthday (October 5th).

September 26, 2012: Anniversary

One year since my diagnosis was confirmed by Dr. C.  It was a tough day for her and for us, but we are all doing so much better now!  I see a bright future....

September 19, 2012 - Anniversary

One year since my biopsy.

September 16, 2012: Living and supporting the Terry Fox legacy of courage...

Living and supporting the Terry Fox legacy of courage...September 16, 2012

It is mid September with unseasonably warm weather and a welcomed dry spell that has lasted most of August and is forecasted to last the rest of the month!  Mid September is also what I would call Terry Fox season as the main run is scheduled at this time in Canada (and I believe many other places in the world) and school organized runs are scheduled later in the month.  It is truly amazing that one person along with his amazing support team of family and friends have been able to reach into my life and that of so many others in the world in a way that we mark our calendars every year to join in a positive and active way to support the fight against cancer.

I have participated in the Terry Fox run since approximately 1985 when I was first introduced to it by a university and work friend named Dana.  Initially it was a cool thing to do that kept me active.  I have participated in runs at various locations in the Lower Mainland including the home town run in Port Coquitlam, but I now enjoy the yearly run in our community of Port Moody.  The day, for me, has morphed from a chance to be cool and going for a run to taking the opportunity to get my family out for a run/walk, to enjoying the sense of community to now really feeling connected in an intrinsic way to the purpose and meaning behind the cause.  With the road that Mom and I have been on this past year along with my family, friends, neighbors and colleagues, the thoughts and words of courage, determination and hope from Terry Fox now echo in my mind, body and soul.  As I type this entry, I realize that Terry Fox's annual run falls very close to the anniversary of my biopsy and confirmed diagnosis (September 19th and September 26th respectively).  It warms me to know that I have a closer connection to Terry whom I, and so many others, see as a hero from unassuming roots.  I can completely relate to what I think he must have felt bursting through his chest in terms of wanting desperately to make sense of his cancer and wanting make a difference for others even if it was too late for himself.  I can also fully relate to wanting to make a difference as just an ordinary person.  We are all capable of so much, and just need to find ways to tap into our desires and passions.  My wish is that this passion does not always need to come from such painful experiences.

On this gorgeous September morning with the run starting at Rocky Point this year, I have a renewed sense of the purpose for the run, a renewed sense of courage, hope and the love that we should share with each other every day no matter what the circumstances.  During one of our poignant moments on this road (vividly it was the day Todd had to cut all my hair off as it was falling out quicker than my bob cut could keep up with), I reminded Todd that the way he was treating me with such love and kindness was the manner in which we should always treat each other.  I reminded him and myself of this on during this run as I wore the survivor t-shirt that Victoria kindly offered to me and as I looked around at all the people around us supporting the run for hope and supporting their own stories and loved ones.  We always need to be cognizant that we all have our stories, we do not know the difficulties that someone may be going through and cancer is just sometimes more visible than other difficulties.  If we all just take the time to be kind to ourselves and to others, our ability to support, better tolerate, be kind and to love each will be more effortless and turn into so much good.

As there has been so much that has been serendipitous this year, so was my experience during this year's Terry Fox run.  The first was the reminder of how we should treat each other with love and kindness.  The second happened while I was walking with Todd near the beginning of the walk as we were in a pleasant forested part of the route with the sun shining through the trees.  Behind Todd and I, I overheard a mother speaking to her young son about the meaning behind the annual walk/run.   I caught snip-its as they related the event to other similar activities and other people in their lives.  I mainly took notice as the mother was describing meaning behind the colour of the t-shirt I was wearing (red was the colour of the survivor’s t-shirts this year).  As she described the meaning, she relayed that there were others in their family that were surviving cancer as well.  The son seemed to genuinely ask what it might be like for me be to a survivor.  The mother paused and gently suggested that perhaps he may want to give me a hug as a way to show his appreciation and caring.  The boy never did reach out to me and nor I did not turn back during this conversation.  This was the right thing as the discussion was what was important. The interruption with words or actions would have broken what I feel was the magic behind the close moment that the mother was having with her son on that beautiful sunny Sunday morning.  With this simple discussion, my belief reinforced that we should always try to be kind, giving and loving to each other in any way we can in our day-to-day lives.

No matter how "big" the Terry Fox run is or gets, the simple message of hope and continuing on what Terry could not finish will not diminish in my mind.  While I have never met Terry or his family, in my heart I believe we are holding true to his hopes and ideals and that this and other journeys we may be on are not about the individual, but about all of us coming together to do good and to do the right thing.  Great things come from humble beginnings and humble hearts.  Terry Fox lived this and has taught us this.

Jen, it was great meeting you at the run. Todd, thank you for being by my side.

January – August 2012: We got our “Fake Boobs” on…lalalalala….

January – August 2012: We got our “Fake Boobs” on…lalalalala….

My “Chic Gathering” was a great success as 30+ of my most awesome “breast friends” celebrated the end of my chemo journey with me.  Even though the evening fell on one of the few rainy evenings this summer, my house was able to make for a cozy scene.   There were so many more that were not able to make it due to holidays, conflicts and distance.  If they had all attended, I am not sure where we would have fit everyone as the original plan was to have the event in our back yard.

True to the generous nature of women, there was so much food, spirits and deserts that I had to have a dinner with some friends the next night to make a dent in the mountain of mouth savoring goodies that everyone brought (I had to share more after that to make sure nothing went to waste!).  I am truly blessed!:

THANK YOU!!! 

To add to the celebration, Dana brought some sugar cookies in the shape of boobs – she was “kind enough” to break one in two and gave half to me and half to my Mom based on our “missing halves” :o)

Speaking of boobs, this is part of the journey for my Mom and I that I have not spent to much time “expanding” upon.

You all know the sordid tale of my post surgery skin infection and the decision process I went through to either keep or remove the tissue expander that was inserted at the time of surgery. The result was that I kept the expander in and all has gone well through the rest of the chemo treatments.  During this time I could not keep “dangling” on my right side while we waited for the final reconstruction on the left side.  There are many relatively decent prosthetic (“fake boob”) options these days that are not too bad given the situation.  The Cancer Agency offers free prosthetics if you need assistance, however, if you have appropriate coverage or are able financially, there are many outlets that sell interesting new options.  After learning a little bit about what a prosthesis and appropriate bra might entail, I found what seemed to be a good place for such products in the phone book.  The place I found was near Metrotown and the people there were very knowledgeable, helpful and sympathetic.  The options are varied in terms of size, weight, materials, etc.  The experience is pretty interesting when you have to think about how such a product is engineered to simulate the size and weight of your natural breast so that you don’t look or feel lopsided.  Sizing is also important if you are considering tissue expansion before a full reconstruction is possible.  For me, I am a reconstruction candidate where my Mom has opted out and therefore our needs and preferences were different.  In the end we both came away with various prosthetic products that suited day-to-day needs vs “looking our best” needs vs minimizing the issues with being lopsided.  Boy what an education we both have had with respect to managing “fake boobs”.  Good thing there are options out there for us!

I thought the parody below on the lyrics of the song “New Shoes” by Paolo Nutini might add some color and humor to the “fake boob” experience.  The song is pretty upbeat and the parody is meant to be so too....enjoy...

Official Lyrics	“Updated” Lyrics
Woke up cold one Tuesday	Woke up cold one Thursday
I'm looking tired and feeling quite sick	I’m looking tired and just coming to
I felt like there was something missing in my day to day life	I felt like there was “something” missing in my day to day life
So I quickly opened the wardrobe	So I quickly took off my patient gown
Pulled out some jeans and a t-shirt that seemed clean	Pulled out some jeans and a t-shirt that seemed clean
Topped it off with a pair of old shoes	Topped it off with my old bra
That were ripped around the seams	That drooped around the left seam
And I thought these shoes just don't suit me	And I thought this bra just doesn’t suit me
[Chorus] Hey, I put some new shoes on	Hey I put my “fake boob” on
And suddenly everything is right	And suddenly everything is right
I said, hey, I put some new shoes on, and everybody's smiling	I said, hey I put my “fake boob” on and everybody’s smiling
It's so inviting	It’s so interesting
Oh, short on money	Oh, short on normal life
But long on time	But long on time :o)
Slowly strolling in the sweet sunshine	Slowly strolling in the sweet sunshine
And I'm running late	And I’m running late
And I don't need an excuse	And I don’t need an excuse
'Cause I'm wearing my brand new shoes	‘Cause I’m wearing my new “fake boob”
Woke up late one Thursday	My Mom woke up late one Friday
And I'm seeing stars as I'm rubbing my eyes	And I’m seeing stars as I’m rubbing my eyes
And I felt like there were two days missing	And I felt like this situation was just unreal
As I focused all the time	As I focused all the time
And I made my way to the kitchen	And we made our way out of this mess
But I had to stop from the shock of what I found	But I had to stop from the shock of what I found
A room full of all my friends dancing round and round	A world full of all my friends dancing round and round:o)
And I thought, "hello, new shoes	And I thought, “hello, “fake boob”
Bye bye them blues."	Bye bye them blues

[Chorus] Take me wandering through these streets Where bright lights and angels meet Stone to stone they take me on I'm walking to the break of dawn I'm walking to the break of dawn	[Chorus – hey we got our fake boobs on....”] Take me floundering through this road Where second chances and angels meet Stone to stone it takes me on I’m walking to the break of dawn I CAN walk to the break of dawn
[Chorus: x2] Take me wandering through these streets ...	[Chorus – hey we got our fake boobs on....”] Take me wandering on this road..

Hope you enjoyed this musical interlude:o)

Now that chemo is over, I was able to schedule “expansion” appointments with my plastic surgeon and time everything up with upcoming radiation.  After some deliberation and with the goal of an overall “C” cup in mind, we estimated that I would need four “expansions” to get to my desired cup size.  This helped confirm that radiation would start at the end of August or the beginning of September.  As I would also need to be “sized” up via a CT scan and prepared with tattooed dots to indicate where I should be radiated, it became clear that the beginning of September would be best (which also allowed us to take our annual vacation to Vancouver Island to get away from this mess for at least one week).

So expansion started just like the teenage girl chant goes – “I must, I must, I must increase my bust”.  The chant has a whole new for meaning now!  This is exactly what I did. I increased my bust (at least on the left side).  For now, I am the proud owner of “C” cup on my left side and a “D” cup on my right until next April or May.  Reconstruction can’t be booked until at least six months after radiation to allow the skin on the affected area to properly heal in preparation for surgery.  While I would have preferred to get the whole thing over with one go and one leave of absence, it does seem prudent to allow my body to heal before it gets invaded again with another surgery.

After just three separate injections (spread across three weeks – one injection per week) from an unbelievably large needle, I was at what both the plastic surgeon and I thought was the desired C-cup size (this also accounted for some potential constriction of the skin due to radiation) -- I think I am good to go.  I never liked being a D-cup after having babies anyway.  A C-cup will also be much more posture and fitness friendly for me.  Given that age, skin elasticity and gravity will just increase a “drooping” effect, going smaller and perkier seems like a nice choice given that I have to choose.  Who knows, maybe I will have a “hard body” and run a ½ marathon in my old age without the extra weight in the “front end”:o)

Now that I have a party in my head most days post the crazy chemo trip, all this is much easier to take.  I am not even dreading radiation yet.  I am looking forward to a great summer, bright days, rejoining my colleagues at TELUS in the probably the November timeframe and enjoying my new lease on living.

Here’s to fake boobs and choosing the size you want to be....