First of all, thank you for praying for us this past week.  Thanks for everyone checking in, etc.  Overall, things are going well . . . more about that in later paragraphs.  I am very glad to be home!

This round of chemo has resulted in more severe gastrointestinal side effects.  I started vomiting four hours after chemo ended and it basically hasn't ended yet.  It's worse in the mornings and evenings and after movement (i.e. after the MTR stopped moving; after the car stopped moving; after the plane stopped moving, etc.).  The heightened hyper sense of smell has kicked back in so that triggers the gag reflex as well. Even talking makes me feel very nauseated, so believe it or not, I'm being quite silent! 

I am forcing myself to eat some very plain pasta right now as I haven't had a full meal since Tuesday afternoon.  I did manage to eat 1.5 pieces of toast yesterday.  I feel wussy and whiny and weak.  Have I ever mentioned how much I *hate* throwing up?  I would never be a good bulimic!   Hopefully, today will see lots of improvement.  (Side note . . . one benefit to having no hair is that you don't have to hold it out of your way when you are vomiting into a barf bag!  This is probably too much information . . . !)

This makes two down; six to go!  One quarter of the way through the chemotherapy!

Now that I have the complaining portion of the program out of the way, let me tell you about the good news!  After just one chemo treatment, the tumor has shrunk by about 40%!  This was better than the doctor expected.  From what I understand, such a large drop in area typically happens after the second treatment.  He said that the reduction in size will level out till treatment five, when a new drug will be used and then another sharp drop will occur.

The next good news is that the test results for the Her2 gene that stimulates cancer cell growth came back negative!  This is good news on two fronts . . . the first being that there isn't a stimulation for faster cell growth.  The second is that while there is a drug to address the faster cell growth, it is quite expensive and some insurance companies balk at paying for it.  (This drug has to be taken for a year and it can cost up to $100,000 US).  It's nice to know that this won't be a concern for us. 

I am so very grateful for how everything is falling into place.  We still have no guarantees . . . but we do have the constant reassurance that our Dad loves us and that he will work all of this for his good and glory.  Our hope is not in statistics or in medicine . . . but in his righteousness.  

And that's a good note to end on!  He is good . . . all the time!

For those of you who like details . . . here they are!

First core biopsy results:
Estrogen Receptor Score:  8 -- Positive
Progesterone Receptor Score: 6 -- Positive
Ki-67 Proliferative Index:  45% -- High
c-erbB2 overexpression:  2 -- Equivocal
Immuohistochemistry:  E-cadherin stain is positive, thus excluding lobular expression.  The p63 stain shows all tumor clusters in this biopsy are invasive rather than in situ.

Final diagnosis:  Invasive ductal carcinoma, provisional grade II (modified Bloom and Richardson).  (NOTE:  Grade II is an intermediate growth rate.  It is not the same thing as staging.)

PET scan results (summed up):  Large lesion spanning 5:00 - 9:00.  No local invasion of underlying right pectoralis major muscle, right chest wall or ribs is noted.  No other tumors noted.  Few lymph nodes affected (level I, level II) suggesting regional nodal metasteses.  No evidence of distant metastasis to the brain, lungs, liver, adrenal glads, distant nodes or bone is found.  (This means that the cancer has not spread to distant organs.)

TNM rating:
T3/T4 -- This would usually be a single number.  The tumor is more than 5 cm across.  That makes it a definite T3.  However, I am presenting with some skin redness, even though the cancer does not appear to be in the skin at this time.  If it were present in the skin, the rating would be a T4.  Therefore, I have a "/" between the two.  Definite T3 with some characteristics of T4.
N2 -- Cancer has spread to 4 to 9 lymph nodes under the arm
M0 -- No distant spread is found

SUMMARY:  Locally advanced breast cancer (LABC), Stage IIIb, T3/T4, N2, M0 -- The tumer is larger than 5 cm across and may be growing into the skin.  It has spread to 4-9 axillary lymph nodes.  It has not spread to distant sites.

Grade II -- Intermediate rate of growth.

ADDITIONAL TESTING:  Fluorescence in situ hybridization (FISH) is a test that “maps” the genetic material in a person’s cells. This test can be used to visualize specific genes or portions of genes. FISH testing is done on breast cancer tissue removed during biopsy to determine whether the cells have extra copies of the HER2 gene. The more copies of the HER2 gene that are present, the more HER2 receptors the cells have. These HER2 receptors receive signals that stimulate the growth of breast cancer cells.  (http://www.breastcancer.org/symptoms/testing/types/fish.jsp )

A positive result would mean an additional drug would be added to chemotherapy to stop the growth of the cancer cells.  A negative result means that drug would not be added.  My test results (two now) keep showing up as "equivocal" . . . meaning my tumor is neither strongly positive or negative.  (My doctor says that my tumor is "strange" in that it has degenerative cells not responding in a "normal" way. )  A third pathologist is now doing additional testing, hoping for a definitive answer.  There are possible risks to taking the drug when not needed, so we, along with the doctors, are hoping for a clear direction! 

TREATMENT:  Due to the size of the tumor and the intermediate rate of growth, chemotherapy is recommended first.  (I like to call this a "search and destroy" mission.)  Surgery will follow chemotherapy.  (I like to call that the "total evacuation!")  Additional chemotherapy or radiation may be needed following surgery.  This will depend upon how I respond the first round of chemotherapy.

TYPE OF CHEMOTHERAPY:  Four cycles of AC, doxorubicin (Adriamycin), and cyclophosphamide (Cytoxan).  This will be followed by four cycles of a different drug combo, depending upon the final results of the Her2 testing.  The "A" part of this "chemo cocktail" both blocks DNA production in your cells, and also inhibits the enzymes responsible for repairing DNA. Cells can't live without DNA; thus when they're deprived of it, they die (in fact, some even kill themselves when their DNA is damaged). "A" can't distinguish between cancer cells and normal cells; but because cancer cells are dividing so rapidly, it has a greater negative effect on them than on your normal cells. The "C" part of this chemo combo stops cancer cells from replicating. So between them, you have some pretty powerful agents working to destroy those cancer cells.  http://www.healthcentral.com/breast-cancer/c/78/10889/chemo-faqs-ac