April 21, 2022

This is the post that we’ve all been waiting for.  I will say that this post is going to be a lot of details and information – consider yourself warned.  In full transparency for those following behind me and needing information, I am going to share all the details that I am aware of now.  My prayer for this post is for God to use this to help someone else in the future.  

As I mentioned in my earlier posts, we were praying and hoping to have the pathology report come back with a Pathological Complete Response (PCR) which would mean that there was no cancer found in the tissue that they excised during surgery, however, that is not the news that I received.   

The excised tissue still has residual cancer in the tissue, although very, VERY, small, however, it was still there.  In fact, the pathology report states:

• RESIDUAL INVASIVE DUCTAL CARCINOMA WITH CHANGES CONSISTENT WITH THERAPY EFFECT.  (This means that my cancer responded to the chemotherapy).
• MINUTE FOCI OF RESIDUAL DUCTAL CARCINOMA IN SITU (DCIS) WITH CHANGES CONSISTENT WITH THERAPY EFFECT.  (This means the ductal carcinoma, which is a small amount of cancer that was found in the tissue that was still in the milk duct but shows that it responded to the chemotherapy).
• RESIDUAL INVASIVE CARCINOMA PRESENT IN AN AREA MEASURES 1.7 x 1.3 MM IN GREATEST SLIDE DIMENSION.  (Residual cancer they found is so super small >2 mm)
• TOTAL VIABLE CARCINOMA COMPRISES 80% OF THE AREA, DCIS COMPONENT IS 1% OF THE TOTAL CARCINOMA.  (Shows the portion of the cancer that is still present in the excised tissue).
• RESIDUAL INVASIVE CARCINOMA IS PRESENT 5 MM FROM ANTERIOR MARGIN, 6 MM FROM INFERIOR MARGIN.  (Shows how far from the margins (edges) the cancer is on the excised team).
• DCIS IS PRESENT 4 MM FROM ANTERIOR MARGIN AND AT LEAST 6 MM FROM SUPERIOR MARGIN (This is another duct that had cancer which was part of the excised tissue and it shows how far it is from the margins/edges).
• LYMPHOVASCULAR INVASION NOT IDENTIFIED.  (NO LYMPH NODE INVOLVEMENT!!!! PRAISES).

Let me try and break this down and explain what this means for me and my future treatment, hopefully, this will answer all questions you may have.  

Because there was residual cancer present in the excised tissue – radiation is a must.  The radiation should handle any other remaining residual cancer that is in the tissue.  Before going into surgery I had already planned on doing radiation next but this solidified that radiation will happen.  I am still not sure how many sessions of radiation I will be required to do and I won’t have those answers until I meet with my radiation oncologist (Dr. Benjamin Smith) at MD Anderson on Tuesday, May 3rd.  I expect that my radiation protocol will be around a month of treatments.  I expect it to consist of whole breast radiation and then a week of what they call a “booster” for radiation treatment, which is where they align the radiation to treat just the area where the tumor was removed.  

There is another calculation that they run to determine the RESIDUAL CANCER BURDEN (RCB) as defined here.  The RCB is used for determining the possibility of breast cancer reoccurrence in a distal location.  The RCB is estimated from routine pathologic sections of the primary breast tumor site and the regional lymph nodes after neoadjuvant therapy.  They use 6 factors in the calculation formula.  Please find the link here on how this is calculated.  Based on the calculations a person will fall into one of 3 categories – RCB-I (minimal burden), RCB-II (moderate burden), RCB-III (extensive burden).  

My RCB score calculates to an RCB-II (moderate burden) with a score of 1.439.  This article and chart give the percentages of Event Free Survival at 5 and 10 years – found here.  From this chart, my percentage for Event Free Survival is 61-66% however, the reality of my RCB score is that it is just barely over the cutoff for an RCB-I and then moving into the RCB-II category or as Mano likes to say, it’s like being 2 pages into a 1000 page novel.  My oncologist, Dr. Hellerstedt also says that she feels that I am way closer to an RCB-I than an RCB-II, which is what I believe as well.

Additionally, because there is residual cancer in the cells, my oncologists (both Dr. Beth and Dr. Chavez) have recommended that I will need to do an oral chemo pill called Xeloda (link here) for 8 cycles = 24 weeks.  A cycle of Xeloda 3 weeks, with the first 14 days of pills – morning and night and then 7 days off.  Bloodwork will be checked every 3 weeks to assure that I am tolerating the oral chemotherapy well.  This chemo regime comes with a different set of possible symptoms the most common being hand/foot syndrome (red and cracking hands), diarrhea and/or nausea/vomiting.  Of course, with getting this news the other day, I was not super amused to hear that I would need to do another round of chemotherapy, however, I will do it.  Hearing this news, I, of course, have already reached out to Dr. Luepnitz to start researching supplements that I will need to take to support my body and I have spoken to my acupuncturist to start building my body to be ready for the next round.  Either way, I have confidence that I will be fine through all of it.  (Prayers please!)

I hope this posting gives you a lot of information and not more questions than answers.  If you have any specific questions, please just let me know what they are and I will be happy to answer them to the best of my ability.  

Keep the prayers coming for me, my marathon just got a bit longer. God willing I’ll be finished with all treatment just before Christmas. 

Love to all!

Xo,

Tracy