5. Facts

April 29th, 2020.
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This morning, my aunt sent me photos of my medical reports on WhatsApp. I asked her to do so. I am a little bit upset because I feel like I don’t know anything about what’s happening to me. People recommend me to avoid reading things on the Internet, but no one explains to me in detail what I’m going through. I don’t even know how big my tumors are, and that bothers me. It makes me feel like I don’t have control over anything.

I’m not the kind of person who just listens to whatever other people say and is satisfied. I question things, I want to understand them. Dylan has told me that I need to ask the doctors about the doubts I have, but he doesn’t realize that it’s difficult to ask questions when you know nothing about the subject. For example, if someone says to you, come on, tell me your doubts about astrophysics, would you be able to come up with any questions beyond what astrophysics is? Perhaps you need to know the meaning of the subject first in order to have any doubts. I know it is a human bias, we tend to think that everyone understands the basics of what we know or do. I have a hard time with customers when I ask them to explain their business processes. They miss all the basics in the explanation. I have learned that if you don’t understand the basics, you will get everything wrong, so I always apologize for my ignorance and ask them about the basics why, what for, who?

I have heard the word cancer many times. A friend of a friend, someone from the television, a not so close relative. I knew that cancer means that cells go crazy and reproduce without stopping, but that’s it, that’s all I know about cancer.  And now it’s my turn to fight something I don’t know about. I’m sorry, but all I can do is reduce my level of uncertainty and try to understand what is happening to me. It’s not that I don’t trust doctors, it’s not that I want a second opinion. It’s just that I need to understand what’s going on. If this thing is taking my life, I have to at least know what it is. Perhaps it won’t make a difference, but at least I would feel like I still have some control over my life.

After work, I occupy myself with deciphering my medical reports. The American Cancer Society has very good material to help understand the diagnoses. At least that much I’m doing, trying to check only the reliable sources. As I read, I feel dizzy. I read the words, but I don’t understand them. I help myself with a notebook. I have to write down what I read to make sure I am processing it.

I am suffering from Invasive ductal carcinoma (IDC).

Before you read any further, please understand that I am not a doctor and the terms I use here might be inaccurate. 

Ductal carcinoma arises in the ducts that carry milk in the breast. If it is diagnosed early, cancer will only be in those ducts. If not, it may have already become invasive. Invasive means that it has spread to other parts of the body, that means, it has already metastasized. That’s the case for me. It’s also in the lymph nodes. In my reports, they refer to the latter as axillary lymphadenopathy, which means that the nodes do not look normal.

The lump I felt in my chest is 2.4 centimeters wide.  It has two satellites of 3 and 4 millimeters each. On the ultrasound screen, they look like a little string made up of balls. The first one is the biggest and chained to it, there are two other little balls.

I also have another small tumor, which is half a centimeter long. All this fuss over such a little thing, right?

I’ve read somewhere that a normal lymph node is less than 12 millimeters long, mine are 1.2 and 1.8 centimeters. In the scanner, they have also seen a third suspicious node.

So far, it seems that although it has spread a little bit, it hasn’t gone beyond my armpits.

The biopsy speaks of a histological grade III. There are only three degrees and this is the worst. That means that my carcinoma is poorly differentiated. When carcinomas are well-differentiated, the cells still look very similar to normal cells and they grow slowly.

According to the American Cancer Society, in poorly differentiated carcinomas the cells “lack normal features, tend to grow and spread faster, and have a worse prognosis”.

The biopsy also says that my tumors are B5 category. That is a diagnostic classification that indicates that the cells are clearly malignant.

Finally, Ki-67 biomarker also carries bad news. Ki-67 is a marker of cellular proliferation. That means, it serves to indicate how fast the cancer is spreading. According to a study of the Hospital La Paz of Madrid, the Ki-67 “its expression in breast tumors has been associated with worse prognosis and a better response to chemotherapy.” The high values, above 20%, according to the American Cancer Society, basically mean that the cells divide more quickly and the cancer spreads more quickly. My tumors have Ki-67 of 21% and 25%. However, the sources consulted do not agree on whether the high levels of this marker begin at 20 or 30%.

Those are all of the bad news. Now comes the good news. My tumors are HER2-positive. This means they have increased levels of the HER2/neu protein which is a growth promoter. Although HER2+ cancers tend to grow and spread faster, there are specific treatments that target that protein. Besides, my cancer has hormone receptors for both estrogen and progesterone, which makes it possible to treat it with hormone therapy. These cancers also have a good prognosis. Remember when I mentioned that my cancer was triple-positive? Well, that’s what the doctors meant. My conclusion is that I have a bad cancer, but a pretty positive one, which is good. We’ll have to hold on to that.

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