Indecision. Feeling stuck. Fork in the road. Right or left. Up or down. Choosing to not make a decision is paralyzing, agonizing, and plain exhausting. I have spent some time in this camp lately. Gathering all my information to build a case for or against chemotherapy has been the hardest decision I have had to make. Ultimately it comes down to faith. Do I trust in the God of the universe who created the heavens and earth and holds my life in His hands, or do I trust in myself to pick what is best? I have been wrestling this out between the voices in my head and the dozens of pieces of papers from the doctor's office, google search tabs of breast cancer articles, notecards filled with scripture verses, and an abundance of cards/notes from friends and family. I've heard from many of you offering prayers and words of encouragement. I can't tell you how important each one of you is to me.
I have prayed for clarity, wisdom, and direction. My prayers were confirmed Wednesday evening. I was tying to justly a 2-3% in my favor or against my favor. On Wednesday night I went to bed with my decision made: No chemotherapy. I had weighed my options. Reasoned the pros and cons of partaking in the poison cocktail club and firmly announced to myself, nope not going to happen this time. I was ok with this. I honestly thought the side effects and potential risks involved outweighed the benefits of doing the treatments. But God had other plans...
On Friday afternoon my oncologist doctor called. There was a clerical error in the final pathology report she wanted to clarify and have corrected. I agreed. It was regarding how many lymph nodes were taken and tested. There were 3, and all 3 tested negative for cancer. This is good news and didn't change anything we knew. She wanted to repeat a previously completed study using a piece of tissue that had not been used for another testing. She was wanting to confirm the hormone status of my type of cancer as well and just ordered a repeat on that. It is not as common to have lobular carcinoma in situ with only estrogen positive. Typically you would see both estrogen and progesterone positive and she wanted to confirm my data. She also wanted run the Ki-67 test once again. This test is commonly used to measure the cellular proliferation (how fast cells are dividing) of the breast cancer tissue.
SCIENCE CONTENT WARNING (I know I love this stuff, maybe you do too!)
Ki-67 assessment is probably the best known. A monoclonal antibody is used for IHC (immunohistological) staining of the proliferation-association nuclear protein Ki-67 in tumor cells to determine the percentage of Ki-67 positive cells among the total population of tumor cells in formalin-fixed paraffin-embedded sections contained from a core-cut biopsy sample, this is the Ki-67 index.
Tumors are classified as having a high or low Ki-67 index based on a prespecified cutoff. Tumors with a high Ki-67 index have a larger number of proliferating cells and are therefore likely to grow more quickly. A score of greater than 30% of tumor cells showing staining compared to malignant cells is considered high. Breast cancers that are ER-positive (estrogen receptor) can be classified into two molecular subtype groups: Luminal A and Luminal B. Typically Luminal A tumors have a lower rate of proliferation than Luminal B tumors. This means Luminal B tumors are more aggressive types of cancer. About 85 percent of breast cancers are ductal carcinomas, while 11.4 percent are lobular carcinomas, according to a study published in the Annals of Medicine and Surgery. More than three-quarters of lobular carcinomas fall into the luminal A and triple-negative tumor category.
The results came back confirming what we previously knew -- ER-positive only. But the Ki-67 test confirmed again with a high index value greater than 30% of cells stained were present. She also mentioned that the subtypes were present and that indication "heightens" the aggressiveness of my lobular carcinoma breast cancer. She went on to say that she is changing her suggestion of adjuvant chemotherapy to recommending I really need to do this. Big sigh. Deep breathe. You got this! Ok, so what you are saying is even though...
- 3 out of 3 lymph nodes negative
- Stage 1
- Clear Margins from DBMX
- Grade 3
- ER + / PR -
- Oncotype score 18
- Ki-67 <30%
- Lobular carcinoma in situ (LCIS)
So we need to partake in chemotherapy? Yes, I'm so sorry. So my decision became clear. I am to do chemotherapy. The data doesn't lie.
The plan now is to coordinate doing chemotherapy here in West Plains for the sanity of myself and my husband. Driving to St. Louis is a long drive and the price of fuel is not helping! I am so glad that Siteman will work with my local oncology doctor here in West Plains. I will have more information soon as to when all of this will begin. I will do 4 treatments, 3 weeks apart. We will be placing a power port to receive chemotherapy IV directly. When this begins will depend on scheduling and getting insurance lined out. I have every intention to continue working each day for as long as possible. I know that some days that just may not happen. I am so grateful for wonderful teacher friends and administration who are willing to support me and give me time to take care of myself.
On Saturday my church family rallied together to support me with a benefit event. Everyone went all out. I am so grateful for the kindness and generosity of my friends at New Hope Baptist Church and the many local businesses that donated items to help raise money. You all know who you are and I love you!
You Make Me Brave
The greatness of your renown
I have heard of the majesty and wonder of you
King of Heaven, in humility, I bow
