“Your ovaries will be the size of an orange” and other fun facts

The title of this post is a direct quote from the very fun day at the fertility clinic. I will be letting you good people know all about that in just a bit, but before I do, I feel like I need to address a very common question that keeps coming up.

“So what’s next?”

Simple question, difficult answer.

One of the more fortunate things about having breast cancer, as opposed to other forms of cancer, is that treatment is on a linear plan. First you get the surgery, then chemo, radiation, and hormone therapy.  Depending on the type of cancer you have, you might not need chemo, you might not need radiation, and you might not need hormone therapy. From what I understand (keep in mind I am medically unprofessional), surgery seems to be a sure thing for breast cancer patients. It’s a streamlined process and every doctor I’ve spoken to about it is confident with it. The main holdup in my treatment options are coming from the first step of this adventure.

With breast cancer there are a few different surgeries available. You can have a lumpectomy, a single mastectomy or double mastectomy. There are different types of mastectomies but I’ll leave that alone for now. A lumpectomy, the least complicated of the procedures, consists of having the cancerous tumor, some of the surrounding tissue, and the axillary lymph nodes removed. (Those lymph nodes are up near your armpit and are tested for cancerous cells. As Kris beautifully explains, “Your lymph nodes are part of your body’s circulatory interstate.” If cancer cells are present, there is a very high chance of it spreading to the rest of your body, also known as metastasizing). The lumpectomy is an outpatient procedure and has a much shorter recovery time than the other surgeries. A mastectomy is a much more involved procedure that involves removing all of the breast tissue in either 1 (single) or 2 (double or bilateral) breasts. It is an intense procedure that will have you in the hospital for a few nights and a recovery time of a month or longer.

For my current diagnosis, my medical staff is saying they fully support doing either a lumpectomy or a bilateral (double) mastectomy. If you haven’t fallen asleep between paragraphs you might be thinking “Gee, those seem like two really different options. How can that be possible?” Well, there are a lot of factors that go into deciding the course of treatment and, without going into everything, a lot of it has to do with future risk factors and reoccurrence. Apparently, my wonderfully young age (I realize the irony of this to some of you but 28 is really young to have cancer) means I have a much greater risk of having breast cancer again at some point in my life. There are many benefits and drawbacks to each procedure, and it is a decision that has been causing an obscene amount of stress every time I try to think about it. I’m currently working on making a list of pros and cons for each to see if I’m unknowingly leaning towards one option over another but honestly they both just scare the shit out of me.

There is one factor that I’m still waiting to find out about that might help make a final decision on the matter. A little over a week ago I had blood sent out for genetic testing, more specifically it is looking for a mutation in the BRCA 2 gene (pronounced brack-a, at least I think, sine that’s what I’ve been hearing/using and no one’s corrected me…so far). If that mutation is present, then my chance for having cancer again becomes so high that every doctor I have spoken to recommends the bilateral mastectomy; no argument here. Because I was so young when cancer presented itself and I have a family history of breast and cervical cancer, my doctors feel there is a chance I have this mutation in my blood. The test should be coming back by a week from Monday (the 16^th if you’re tracking me with a calendar) and as soon as results are back, I will be scheduling surgery.

Whatever happens with surgery, my oncologist has informed me that I will be going through chemotherapy. This has been one of the harder pills to swallow in this whole process. I have talked to quite a few women who have gone through surgery and radiation, but none yet who had gone through chemo. I have been put in touch with some people through an awesome program in Portland called “breast friends” so I’m hoping to have that opportunity sometime in this next week. It sounds crazy but I feel like I’m having a harder time wrapping my head around losing my hair than the possibility of losing my breasts. And it’s not just the hair on your head, but eyebrows and eye lashes can fall out as well. If that happens, all I have to say is I better be losing my leg hair as well. If my eyelashes are gone but I still have to shave my legs, I’m going to be PISSED! I’m going to cut my hair shorter sometime in the next week (I think I’m going to go somewhere between my chin and my ears) and then within the next month cut it into some sort of pixie cut. As weird and crappy as it will be, at least hair will eventually grow back.

Chemotherapy, as I am learning, is not there to kill the tumor, but to take care of all the cancer and pre-cancer cells that are anywhere in the body. Chemo works by targeting dividing cells (cancer are cells dividing out of control), and destroying the actively dividing cells. It makes people nauseous because it destroys the cells in your G.I. tract (they turn over very frequently). It destroys hair cells because your hair is constantly growing. The largest concern out of this is that the chemo also targets the ovaries and can deplete the supply of eggs within. Depleted egg supply can lead to issues with fertility and could even put me into a state of early menopause (which happens to some women but not all).

It is with this knowledge in mind that I was sent on an interesting trip to Portland to meet with a fertility specialist. As someone who has spent most of her adult life speaking up for women’s reproductive rights, this was a very interesting experience. I wasn’t quite sure what to expect out of all of this. I had some idea that people could get their eggs harvested and then implanted later and the miracle of life could all happen in a petri dish. My concept of this whole process was pretty much “Jurassic park, but with humans!” Here’s what really goes down in this wild practice:

To have your eggs harvested, the process starts a few days into your period. There is an estrogen cocktail that must be injected twice a day. It is a device that looks like an epi-pen, and you have to inject it into your abdomen (I asked, there is bruising that will occur). Every other day, you come in for an ultrasound to check and see how the eggs are growing. The elevated level of hormones in your body makes it so instead of one egg fully growing, anywhere from 10 to 20 eggs in each ovary grow to full size. This process of injections and ultrasounds goes on for just under 2 weeks. At the end of this time, with all of the eggs fully grown, each of your ovaries will be the size an orange. AN ORANGE!!!! Obviously there is some bloating involved with that level of growth. After the eggs are fully grown, a minor surgery takes place to harvest them. A small needle on the end of an ultrasound probe is used and they remove the eggs. From there either just the eggs are frozen or, if you have a partner, you can take a semen sample, combine the two, and make an embryo. Embryos statistically have a higher survival rate (they’re multi-celled instead of an egg which is just a single cell) and a lot of people choose to do a mix of embryos and eggs.

I will be completely honest here, this process is terrifying and this whole thing pisses me off a little. I don’t know if I ever want to even have kids, and while Kris and I have talked about our future, I feel like we’re being forced to look so much further than either one of us wanted to right now. We are both secure in our relationship, but we’re not married right now, and we’re not even engaged. Honestly it’s just unreasonable that on top of all of this cancer bullshit, we have to also try and plan a huge component of our future. We don’t know if we will even want children in the future but we both like the idea of having it as an option for later in our lives. This has massive potential outcomes on the rest of our lives and it just makes me a little angry. Oh and the cost of all of this is insane. It would be about $8,000 for the whole thing. It just seems to me that spending that amount of money on the chance that something might happen, and not yet knowing if I even want to have kids later, does not make sense.

There are other drugs that I can be put on while going through chemo to lessen the impact on my ovaries during the process. I also feel like great advancements are being made every year with in-vitro fertilization, and by the time we would be ready to have a child, who knows what would be possible? There’s also the fact that the hormone injections I would need to harvest the eggs would be the exact opposite of good for my tumor. My particular kind of breast cancer is reactive to estrogen and the incredibly high level of it coursing through my body to grow eggs is good for growing cancer too. Kris and I have discussed this and we both feel like opting for the drugs during chemo instead of going through what sounds like a hellish process just for extra insurance is going to suffice.

The day was really informative and ended up being pretty fun. Through this process thus far I have realized that my parents know entirely too much about my reproductive system and my relationship with Kris. My dad could not wrap his head around the storage process of the frozen eggs. He was convinced that someone was going to steal my genetic material and sell it overseas. In his words, “They steal bank accounts every day, how do I know your eggs aren’t ending up in a research lab in Asia?” We were able to meet up with my brother, Moses, and his lovely girlfriend, Alyssa, for lunch where far too many jokes about eating eggs were made. It was nice to see them and hopefully I can do it again before Christmas or surgery, whichever comes first.

Things are kind of calm for me right now. I have a much desired lull between doctor’s appointments this week while we wait for the BRCA testing to come back. I never thought I would be so excited to spend time at work;  pretending to be a completely normal employee for a little while makes me incredibly happy. That and I missed my kids. I know with chemo I can’t interact with kindergarteners as much, but for right now my immune system isn’t completely compromised and I love it.

I won’t have very much new information coming in over the next week. I’ve got a few smaller meetings after work, but I’m honestly just waiting on test results. Once again I really am so thankful to everyone out there who has given me their support and words of encouragement. It means the world to me knowing that I have such a large family of people out there and please know how much it helps me every day. You guys are the best!