Another sleepless night before going to get the biopsy results at the breast clinic. We sat in the waiting room and, although we knew what was coming, we were quite calm. Fiona, the consultant surgeon, came straight to the point. I looked across at hubby and kind of shrugged. I wasn’t shocked. I didn’t cry. I didn’t feel afraid.
Invasive ductal carcinoma (IDC), 35mm, grade 3, hormone receptor negative, HER2 receptor positive. It had spread out of the duct into the surrounding breast tissue. Grade 3 is the highest grade, meaning the cancer cells look most different from normal cells and are most aggressive (fast growing). The receptors indicate what the cancer is “feeding” on. There was a satellite lesion, also grade 3, hormone negative, HER2 positive. The biopsy on the lymph node in the axilla (armpit) was inconclusive and would have to be redone.
Fiona said, “It’s treatable.” That was all I needed to know right at that minute. I would have chemo first to try to shrink the tumour and make it more likely that I could have a lumpectomy rather than a mastectomy. I would also have a drug to block the HER2 receptors and slow down the division and growth of the cancer cells. Surgery would follow, then radiotherapy. After a chat with a breast care nurse and a blood test, we made our way home. I felt relieved and hopeful and went to work that afternoon.
I began to be a bit concerned about the delay in starting treatment and thought about getting a second opinion on the treatment plan, possibly privately. But I found out that requesting a second opinion could delay things further, and I still needed to get the second biopsy done. In the end I decided that I would put my trust in my team and the NHS.
A couple of days after the diagnosis, the reality started to set in. Breast cancer had been confirmed and there was still the possibility that the moles might also be cancerous but I would have to wait 4-6 weeks to find out. Appointments came through one after the other: an MRI, a meeting with the oncologist to plan the chemotherapy, a date for the second biopsy. Anxiety started to well up again. What if I needed treatment for skin cancer? Would that interfere with the treatment for breast cancer? Which was more urgent? Would I be better off with a mastectomy? Would the cancer keep growing and spreading while waiting for further tests and the start of treatment? I made my first call to the Macmillan support line and voiced my fears and concerns. The nurse addressed each of my questions and reassured me that my team had put together the best treatment plan for me and everything would happen in good time.
After reading that doing at least 150 minutes of moderate intensity activity per week could help counter the side effects of treatment and reduce the risk of breast cancer recurrence by up to 50%, I decided that my little home workouts were not really cutting it. So, with my husband’s encouragement, we started going for a brisk walk every evening, aiming for 30 minutes a day. At weekends we did some longer walks.
On 24 August we met with the oncologist. He explained about the different chemo drugs I would have, all the scary-sounding possible side-effects, how I would be monitored, etc. Hair loss was inevitable. That didn’t worry me. What did worry me was having pain, feeling unwell, possible damage to my heart and lungs, and the risk of a new cancer. But the benefits far outweighed the risks and I signed the consent forms. Chemo was scheduled to start three weeks later. As with the meeting with the surgeon, I took away just one word: whilst the outcome was not guaranteed, the intended benefit of chemotherapy was “curative”. Treatable and curative. Good words to take away and hold onto.
I had the second biopsy on 26 August and we returned to the hospital on 2 September for the results. Metastasis to the lymph node was confirmed. Not great news. All the lymph nodes in my armpit would have to be removed after chemo. I now needed a CT scan and a bone scan to check for spread beyond the lymph nodes, scheduled for 22 and 29 September respectively. Chemo would still go ahead on 13 September but before that another appointment: insertion of a PICC line on 7 September. This is a fixed “port” in the upper arm for the duration of the chemo treatment so that the drugs can be administered directly into a vein, bloods can be taken, etc, without the need for a cannula each time. A tube is inserted, guided by ultrasound, goes through a vein up the arm, across the chest, ending close to the heart. As with all the other appointments and procedures, the staff were wonderful – professional, but also kind, caring and very reassuring. The PICC line would have to be checked, flushed with saline and redressed every week throughout the four months of chemotherapy.
I thought I would work around chemo, but then decided against it. Working in a big school, exposure to Covid and many other bugs was too much of a risk. Chemo would reduce my immunity, fatigue would build up, and I didn’t know what other side-effects I would have. I also felt it would be better all-round if a long-term plan could be put in place to cover my absence.
Having told our family about my diagnosis, I told all my colleagues on the first day of the new school year. We also told all our friends. I wanted to be open with them and not have them wondering why I was not around. It was a good move. The love and support that came back was overwhelming and really lifted my spirits. It was an extremely busy final week at school, putting things in order, tying up loose ends, and handing over to my replacement. Chemo would start the following week.
On the day, I felt upbeat, jolly even. We took selfies in the chemo unit and sent them to the family. I joked about the “cocktails” of mojitos and virgin Marys – one chemo drug was clear and the other bright red. I was fine for the next week but then I picked up an infection which landed me in hospital for five days, during which time I was scheduled to have the CT scan. I called the department to tell them I wouldn’t be able to attend and asked for another appointment. But on the day a porter turned up with a wheelchair to take me down for the scan. They hadn’t got the message but they found out that I had been admitted, so it went ahead.
The nurse on duty on the ward that evening gave me the result of the CT scan: no distant metastasis to my chest, abdomen or pelvis. Needless to say this was great news but I had not actually been worrying about it, perhaps because I was focused on getting through my first chemo, then the infection and being admitted to hospital. There was still the whole-body bone scan to come but again it wasn’t uppermost in my mind, although I was well aware that if anything was found, I would be on a very different path. I started losing my hair at about this time, fatigue was setting in, and I was getting into the rhythm of weekly hospital visits to have my PICC line checked.
The next cycles of chemo came round, each preceded by blood tests to make sure I could take another dose. We kept up the daily walks, met up with the family outdoors at weekends or had “doorstep” visits. I was also reading and learning all I could about breast cancer and its treatment. I joined a couple of online forums where I connected with other women and men going through the process of diagnosis and treatment for mutual help and support. I also started writing this blog, primarily to keep family and friends informed as I went through treatment, but I hoped that it would be helpful to other cancer patients who read it.
There was more good news in a letter I received at the end of September from the dermatology department. The two moles were benign and would not need further treatment.
Almost four weeks after the bone scan, I had not heard back about the result. I called the breast care nurses and they told me that the results were in and that an appointment should have been made for me to come in. They said a doctor would call me the next day but the call didn’t come. I called them again and they said clinic was over and all the doctors had left, not realizing that I was waiting for a call back. However, the nurse I spoke to told me that the scan was clear. The next day, the doctor called me and confirmed the results: no distant metastasis. I hadn’t been stressing or worrying about the scans – I had just parked them somewhere in the back of my mind – but there was still an indescribable feeling of relief to be told that they were clear.
And that is how I found the lump, got my diagnosis, and started on the treatment plan. The waiting was hard at times – it felt like a ticking time-bomb, but I’m glad I put my trust in our NHS. At every stage and from every person I met, I received excellent care, and I am very, very grateful.
