I’ve been asked many times – and it’s a valid question which I don’t mind clarifying – if they got all my cancer. It came up at dinner, and I thought of this analogy which would help answer “Did they get all of it?”
The answer from me, my surgeon Dr X, my oncologist Dr. F is … we don’t know.
I thought I would try make a comparison of my tumour to a baking cake to help people understand how delicate it is.
To start with, let me describe my Triple Negative Breast Cancer tumour. It was 3.5cm with only 0.7cm margin to my chest wall. My surgeon – the gorgeously talented Dr. X – performed a lumpectomy and removed four sentinel nodes, which were thankfully negative for cancer. He said he went down as far as he could without touching the chest wall muscle which would require major reconstruction and recovery. I asked him to show me a photo of the tumour, which he did if you read Hello 911? I’m on fire!
The best way to describe it is a reversed pomegranate. The “seeds” are white globs of ducts, fat with overgrown white/pinkish tumour cells. The pith is red to represent the veins and arteries feeding my breast and the tumour. It was splashed at the top with blue nuclear dye to identify the sentinel nodes. Except this pomegranate was living in my chest and my veins and arteries are connected to the pomegranate cake and supplying it with blood. It isn’t a stable mass … meaning it can fall apart when removed. That’s why they want to get clean margins around it. And to know that the cancer hasn’t creeped farther into my breast tissue.
So imagine this “cake” has been baking in my breast. And it’s one of those ooey-gooey lava cakes with a rich, creamy centre and maybe some chocolate chips with the pomegranate. It’s not perfectly shaped and solid like a hardboiled egg. Crumbs could spontaneously pop off the cake and travel to a distant site via my plentiful bloodstream. Your job as a surgeon in this game of Operation is to remove the entire cake from the cake pan … without breaking that lava centre OR leaving any trace of crumbs. Those crumbs are cancer cells that are trying to escape via the capillary system in my breast and tumour.
One crumb = cancer cell. ONE.
They can grow a new cake in my breast.
They can metastasize via the blood or lymphatic systems to take up residence on my lungs, bones or brain (which is where breast cancer usually goes). It’s not that I get cancer of the lungs. I get breast cancer on my lungs, bones or brain. The cells migrate and take up the bakeshop there.
So that is why we have to bomb the shit out of my body with 6 months of dose-dense chemotherapy and another month of radiation targeted on my breast then tumour site.
We don’t know where the one crumb is.
Dr. F told me that if I didn’t do the chemotherapy, I had a 40% chance of baking new cancerous tumours and could be dead in two years. 20% chance if I did do all the chemo & rads.
The cancer can and does escape the original site.
The cancer can and does survive the chemo blast.
In the U.S. it is very common to do neoadjuvant therapy for Triple Negative Breast Cancer, meaning they do chemo and radiation prior to surgery to reduce the tumour before surgery. I had chemo (and subsequently radiation) therapy done adjuvant (after) my lumpectomy. I just wanted that fucker out of my body immediately.
In some cases in neoadjuvant therapy, the tumour does NOT respond to the Cocktale of Chemotherapy … I had AC-T … so perhaps it is resistant. That is why my cure rate is NOT 100%.
If it comes back, they will blast me with a different cocktail of chemo drugs.
That’s why I am terrified. And all I can do is try to do what they tell me. And pray.
P.S. I used the cake analogy because one of the foods that chemo has turned me off is … cake and most sweetstuff. My sweet tooth has made a few appearances, but I still can’t eat cake!
Hopefully I’m not baking any new cakes!