As many of you know, last week I got permission from my doctors in Cambridge to travel stateside to see my new born nephew! He is an AMAZING MIRACLE. The wonder of new birth, the sheer grit of his fierce, beautiful Mama combined with the solid rock of his incredible Daddy, was as much inspirational as it was cathartic for my spirit. I felt so thankful to NOT be in the middle of chemo but instead, drinking up the excitement of new life and infinite potential. It was truly a blessing to be there! (See gratuitous Baby Jack and Aunt Laura pictures above…)
While I was preparing for my stateside visit, It made sense to plan a brief detour over to Houston’s MD Anderson’s Cancer Center for a second opinion regarding my treatment plan. And whadayaknow, they happened to have an appointment open up with a medical oncologist the very week I’d be stateside. People wait months to see some of the doctors and departments there, but they had an opening the very same week I’d already be in the states. (You thinking what I’m thinking?!) This place- as many of you have experienced first hand- is nothing short of remarkable. They had my whole 2 days planned and organized to the last detail, and I made the most of my time there for sure. I had a few exams, met with multiple oncologists, and even consulted with a nutritionist. I learned a great deal. Beware, you know me; I’m notoriously long winded...but here’s what I found out (skip to #6 for the bottom line):
- WELL, WE DIDN’T EXACTLY CATCH THIS EARLY: Both Addenbrooke’s Pathology in Cambridge and MD Anderson Pathology in Houston characterized the cancer in my left breast as invasive lobular cancer (ILC), T3N1aMx, ER/PR+, HER2-negative. With regard to their approach to treatment, Addenbrooke’s is looking at my case as a Stage II cancer; while, MDA views it as a Stage IIIa cancer and therefore have a more aggressive stance on treatment. They both agree, given the extensive size of the lesions in the left breast, and my node-positive status, that I’ve probably been living with this for at least a couple of years and it was likely present but undetected at my first mammogram when I turned 40. Also, it’s a small but interesting distinction - but due to a difference in the interpretation of the “globs” of metastasized cells in the sentinel lymph nodes, MDA measured MACRO-metastases in one lymph node and micro-metastases in the other node. (Addenbrooke’s characterized both nodes as micro-mets.) MDA also measured the surgical “margins” of my tumors- that is the distance between the invasive carcinoma and the edge of the breast tissue that was removed. Margin evaluation for mastectomies is used as an indicator as to whether cancer may have entered into the tissues of the chest wall. They measured one of the margins in my pathology slides to be less than 1mm and therefore considered it to be a possible reason for concern. It’s Addenbrooke’s practice not to measure margins for mastectomies. Finally, for what it’s worth, they agreed with the staging on the right breast, as ILC, early stage I, T1N0Mx, node negative.
- NO CHEMO, HELLO MENOPAUSE: MDA agrees that the results of the Oncotype-DX test suggests it would be of very little benefit for me to be treated with chemo. Also, my cancer cells are SO hormone sensitive, that the hormone therapy alone (which will block estrogen production in my body) will be enough to significantly slow down any renegade cells. So, let’s bring on the hot flashes! I’ve already started monthly Zoladex injections, and at some point in the near future, we’ll just remove the ovaries altogether. I’ll eventually begin a second drug called Letrozole to block oestrogen production in my fatty cells (of which I have many, lol). Menopause, here I come. I can feel the side effects starting to kick in….just ask Matt…I’m sure I haven’t been emotional or moody AT ALL. But you’re welcome to discuss the “Seven Dwarfs of Menopause” with him, as I’m sure he would be quite an entertaining story-teller. 😂
- SNEAKY LOBULAR CANCER: Ok, so remember ILC is only 10% of breast cancers. The other 90% are mostly ductal cancers (IDC). My breast surgeon in Cambridge has said from the beginning - ILC is sneaky. It doesn’t form lumps, and it is hard to detect. When you do finally detect it, it’s often found to be more extensive than the initial imagery shows. “We all know the way lobular cancers misbehave”, he says. My MDA docs also said that lobular cancers don’t spread like ductal cancers. IDC is more orderly, typically going from sentinel nodes first and then on down the line to other nodes. But invasive lobular cancers tend to spread like buckshot - they can spatter cancer cells in a random pattern and are often found in other nodes beyond the sentinel nodes, even if some of those sentinel nodes were seen to be clear. They say there's a large body of data to suggest that there's a 45% chance there are more metastases lurking round in my lymph system and they want to start killing them with radiation sometime yesterday.
- RADIATION: So no chemo, but everyone agrees I need radiotherapy. MDA wants to aggressively treat not only my left chest wall (where the cancer has a higher probability of local recurrence) but also three major regions of the lymph system surrounding the breast - axilla nodes (the ones under the arm pits), the superclavicular nodes (the ones around the neck and collar bone), and the mammary nodes (on the inside of the breast/chest wall area near the sternum). AND they want to do a 6-week protocol with two daily “boost” sessions vs. 3-weeks at Addenbrooke’s.
- ADDED RISKS OF MORE RADIATION: First, the risk of lymphedema is greater with the more radiated nodes. Second, many patients experience shoulder/neck issues like pain or limited motion and loss of strength after radiation, especially when more nodes are involved. Also, because all this radiation is on the left side, there is some minimal added risk to the heart (mainly heart wall function which can result in fatigue, breathlessness, and chest pains) but MDA has one of the lowest mean heart dose rates in the US (not sure how it compares to the UK) and uses a deep inspiration technique during therapy delivery that pushes the heart farther away from the radiation field for added protection. And then there's also a small risk to the upper lung tissue, which in rare cases has resulted in lung cancer down the line. But my MDA doc is confident in their equipment - highly precise/accurate- and advanced techniques for radiation delivery; and she says (believably) that it's cutting edge stuff and she feels it's all necessary in my case.
- CAMBRIDGE vs. HOUSTON - THE PLAN: Well, it’s just not easy to make a decision like this. I KNOW I’d get great care in either place. Both places have qualified, incredible doctors with lots of experience. MDA has a world class facility, and no doubt has the reputation to go with it. But Addenbrooke’s is also known as the premiere cancer treatment facility in our region. MDA is advocating for a more aggressive approach, which comes with some added risks, but given their reasons, I’m convinced it’s the right thing to do. My oncologist at Addenbrooke’s would probably be willing to modify his radiation plan to add some of my other node regions…but the process takes a while to get sorted here, and due to some specific circumstances with my doctor, I wouldn’t be able to begin treatment in Cambridge for at least 4 more weeks.
So, after talking it over with Matt, praying, and crying at the drop of a hat for a few days….We decided. I’m headed back to the states tomorrow. I’ll report to MDA on Oct. 26th, receive my first dose of radiation on Nov 2nd, and finish on Dec 16th. I don’t know how I’m going to do this without Matt and my kids, but we believe this is what I need to; and so I’m trying hard to keep my eye on the end game and see the long-term benefits. I’ll be back in England just in time for Christmas, and what a sweet holiday reunion it will be. ❤️
FOR MISSION SUCCESS, WE ALL MAKE SACRIFICES: As a family who’s been in military service for a long time now, we know very well that in every war, there are going to be a few tough deployments. In our family, Matt has always been the one deploying. In an effort to ensure our safety and prevent bad guys from having their way, he sacrifices time away from his family to help accomplish the mission. And we sacrifice in our own way, too, while he’s gone. So I suppose, in my own little microcosm, ILC might as well be our own group of terrorists. They’ve invaded my body, they’re unwelcome, they’re brutal and sneaky, threatening my life and in turn, the lives of my children, my marriage, my family and friends. And so I’ve declared all out war. Thanks to a highly skilled breast surgeon, the mastectomies got ‘em where it hurt. That was a big win for us! But they’re sneaky little devils, and some stray sleeper-cells could be plotting their next attack. So we’re looking at my leave for MD Anderson like we look at Matt’s deployments…I’m at war with ILC, and in an effort to ensure my body’s safety and prevent the bad guys from having their way, I’m sacrificing time away from my family (and they’re sacrificing, too) to accomplish our mission: Beat Cancer. And there is every reason to believe we’re winning.
There is so much about this battle, this journey, that I’ve already won. I’m in such good hands - incredible doctors from all over the globe at this point, have reviewed my case. From a faith perspective, I know I’m equipped. I really do feel the peace and presence of God. I’m fighting with the tools I’ve been given - spiritually, mentally, and physically. So, when fear creeps into the deep places of my heart, I try to remind myself that I’ve chosen to surrender myself and my body to The One who I trust to guide and lead me along this race that’s been marked out for me. I believe His timing and leading is trustworthy even when I don’t understand. My stronger feathers are still coming in, and I’m soaring now with some endurance and perspective that’s not of my own strength. I know....I don’t mean to sound like a 5¢ devotional blurb, so thank you for indulging my deeper, more personal convictions. 😍
My frontline is moving to Houston, but I’ll keep on posting right here. YOU all continue to be such a huge source of encouragement to me. Thank you, thank you, thank you!! Remember when I said you’d be the cool breeze that propels me along? Well, you’re that, and so much more. Every one of your sweet notes, thoughtful gifts, cards, flowers, meals, and comments has propped me up just when I needed it. I know I’m ridiculously behind on replying with individual thank you’s (I’m so sorry!), but if you’re wondering if I’ve been uplifted by what you said or sent, please know that I HAVE in more ways than you could have imagined. I love you all so dearly!! And just imagine me giving you a big ‘ole Laura hug right now.
PHOTO NOTES: First & Second Photos: Meet my brilliant, adorable, already talented, precious nephew, Jack Henry Weaver! I'm completely chuffed, as they say here in England, and Aunt Laura is already madly in love with this little guy! Third & Fourth Photos: Without a doubt, I'll be in really good hands at MD Anderson. 💙