Pink Lotus - My Pathology

Dr. Yashari had mentioned that several of his patients had had good experiences with their breast cancer treatment at a practice called Pink Lotus. After reading about the importance of getting a second opinion, and reading about Dr. Kristi Funk, the founder of the group, I made an appointment for Friday, August 29. Dr. Funk was not available, so my appointment was with Dr. Marian Miller, another doctor in the group.

Dr. Miller turned out to be very young, probably younger than me, and while I have no idea how good a doctor she is, she was an excellent communicator. In fairness, between our appointments with Dr. Giuliano and her, we had read the pathology report and had two more days to process and research what we'd heard from Dr. Giuliano, so we were able to hear what we were being told much better. Still, it was obvious that Pink Lotus had designed and trained their doctors to use a framework for talking to women about their illnesses so that they could actually understand them. In talking with Dr. Miller, the fog suddenly cleared and all of these disparate pieces of information that were floating around my diagnosis came together into a whole picture.

• The best information came first - she had the results of my second lymph node biopsy: negative! That means my cancer has not spread to any other part of my body and my prognosis is automatically much better.

• I have some Ductal Carcinoma in situ (meaning cancer contained within the milk duct) and some Invasive Ductal Cancer (which means it has broken out of the milk duct and is spreading). Invasive Ductal Cancer is as bad as it gets - it's real, unequivocal cancer. It's also multifocal, meaning multiple tumors arising from a single original tumor, which indicates a higher rate of recurrence.

• My cancer is Grade 3, which means the cancer cells are "wild", as she described them. Again, unambiguous cancer.

• My cancer is triple positive - positive for estrogen receptors, progesterone receptors, and HER2. 

• The ER/PR positivity means that my cancer will respond to the drug tamoxifen, which I will take for ten years after my treatment. Tamoxifen helps to prevent recurrence by blocking the estrogen receptors on any new breast cancer cells and preventing estrogen from binding to them.

• The HER2 positivity means that my cancer is more aggressive and faster growing than other types of breast cancer. However, it will respond to a type of drug called antibodies, specifically Herceptin and Perjeta. (Amazingly, Perjeta was only approved by the FDA last fall, so if I had gotten this cancer a year ago, my prognosis would have been worse.) These drugs will be given simultaneously with chemotherapy.

• They also did a test called Ki-67. Ki-67 is a cancer antigen that is found in growing, dividing cells but is absent in the resting phase of cell growth. The test is able to estimate how fast the cancer is growing. In my case, it is 60-70%, which means that in approximately three months, I would have 60%-70% more cancer cells if left untreated - which again shows that my cancer is very aggressive. 

• If my BRCA test comes back positive, the risk of getting cancer in the other breast is 60-70%.

The piece of pathology that is missing here is the one that everybody knows about, the stage. It turns out that the cancer stage can't be determined until after surgery, so we won't know that one for a while.

It's such a relief to understand what is happening in my body! It feels like the first step toward understanding how to fix it.