"The bad news...if there is any bad news..."

Karen has breast cancer. But to be more specific, her diagnosis is: Dx 04/15/09, IDC, ER-/PR-/HER2-, 1.5cm, Grade 3, nodes-TBD, stage-TBD.

That's all short-hand. I quickly learned that most breast cancer survivors use short-hand like this on discussion board postings or blogs to let others know about their diagnosis, and later, about their treatment plan. To the average person, it means little. So let me explain:


Dx = date of diagnosis

IDC = type of breast cancer (there are several); IDC stands for Invasive Ductal Carcinoma. This means the cancer has spread outside of the milk ducts in the breast to the breast tissue. About 80% of all breast cancer is IDC. So, at least she's in the majority here.

ER-/PR-/HER2- = This is known as Triple Negative Cancer. It sounds scary. It is. What this means is that Karen's type of cancer is not fueled by estrogen or progesterone. Nor is it sensitive to growth signals from the HER2 protein -- whatever that means. Anyway, the doctors can't use hormone drugs to starve the cancer or target the HER2 receptors. This means that chemotherapy will definitely be a part of her treatment plan. Only 10-15% of breast cancer is triple negative (3N). Karen's now gone from being in the majority to being in the minority. I'm sure we'll learn a lot more about 3N in the weeks ahead.


(Sidebar here: when Karen's first doctor shared the results of the pathology report with us, she said, "The bad news, if there is bad news, is that the cancer is not receptive to estrogen." What does she mean "if there is bad news"?...Did I miss the goods news somewhere here? She has cancer for christsake? She went on to tell us that "you'll be offered chemotherapy" ...."offered"....she made it sound so pleasant...sort of like "you'll be offered coffee and pastries." Let's see...I'll have one order of chemo and a side order of radiation...thank you very much! Having said all of that, she is a very good doctor and our decision to go to Penn had nothing to do with her offer of chemotherapy).

Grade 3 = Cancer tumors receive a grade of between 1 and 3. The grade tells you something about how the tumor cells are growing and dividing. For example, "calm, well-organized growth with few cells reproducing" is considered Grade 1. OK, we know that there's nothing "calm and well-organized" about Karen. She's not a Grade 1. With a Grade 3 tumor, the cells are growing and dividing more quickly and they are very disorganized. This, unfortunately, is Karen. But I'm told that the cell growth is all "relative" and that the grade doesn't mean all that much in the "big picture." I'm not sure about you, but that doesn't put me anymore at ease. In fairness, I've also learned that the higher the grade, the more vulnerable the cancer is to treatments like chemo and radiation...so that's encouraging. See, there's a good side to everything.

1.5cm = tumor size; that's on the small side; under 2 cm is a good thing, I think. The tumor size is a factor in the stage of the cancer. The larger the tumor, the higher the stage.

Nodes = refers to how many lymph nodes are found to have cancer. We won't know this until after surgery and a biopsy of the lymph nodes they remove. And depending on the initial results, they may have to remove more.

Stage: Can't know this until we have the results of the lymph node biopsy. The stage of the cancer -- which can range from 0 to IV, determines in part, the treatment plan. Three pieces of information factor into the stage: tumor size, # of lymph nodes "involved" and whether the cancer has metastasized anywhere else in the body. Based on tests so far (chest x-ray, MRI, bone scan), no signs of cancer elsewhere -- very good sign (more on staging later...let's not get ahead of ourselves).

I've probably violated every HIPAA rule in sharing these details. It's funny how we sign all the paperwork to guard our privacy and then turn-around and blast it over the Internet for all to see. It's also funny how we used to write in journals and diaries and keep them under lock and key...or at least hidden under a mattress. Today, we simply write blogs and let everyone in on the details of our lives.