So Here We Go Again

So here we go again.  The cancer is back.  This time, with a vengeance.  The consultation with my local oncologist on Wednesday confirmed what I had already deduced from the reports - Stage IV Metastatic Breast Cancer. It's managed to come back and invade multiple parts of my body.  All is fairly small at the moment, but it's there and it's everywhere.  It's in my liver, my spine, and on my scalp.  And this time, it's here to stay.

For those of you who are unaware, stage IV breast cancer is currently incurable.  The best you can hope to achieve is a long period of remission.  The treatment focuses on prolonging of life.  They give you a chemo treatment or a hormonal treatment (if you are ER/PR positive) or a targeted therapy (if you are HER2/NEU positive) for a short period of time and check to see if it's working.  If it is shrinking the tumors, they continue for a while, then stop and wait for it to come back. If it isn't working, they stop and switch to a new drug. 
 Your life expectancy, or prognosis, is dependent on the number of drugs you are responsive to and the periods of remission it provides.  Surgery is fairly pointless because even if they removed everything they could see, there's still more in your lymph nodes, blood stream, and most likely other areas that just haven't shown up yet.

I know it's a lot to absorb and probably doesn't make a lot of sense to those who aren't familiar with the terms, but the cancer is a grade 3 or poorly differentiated cancer this time.  What this comes down to is that it's a very fast growing aggressive cancer that is difficult to manage.  I haven't received the biopsy results with the ER/PR status or the HER2/Neu status yet.  These are tests they do to determine what feeds the cancer.  If the results are ER/PR positive, it means that it is fed by Estrogen and Progesterone.  Tumors of this type can be controlled by blocking estrogen to the tumor.  If the tumor can't feed it can't grow.  ER/PR negative tumors have an unknown food source and hormonal therapies do not work on them.  My two oncologists (one here and one at MD Anderson) are betting on this coming back differently.  My MDA oncologist has a feeling it's going to come back as an ER/PR negative tumor, while my local oncologist is leaning towards ER/PR positive.  There is good and bad to both.  ER/PR positive is easier to beat.  There are more therapies available because you have chemo and hormonal treatments to choose from.  It tends to reoccur more often.  ER/PR negative, on the other hand, is hard to beat, but if you can get it into remission and manage to survive for 5 years, there is a chance it may not reoccur for years or possibly never come back.  The HER2/NEU is the other type and it used to be one of the worst, but they now have a targeted therapy that specifically targets these cells and make it more manageable.

I've been waiting on the biopsy report.  Waiting and waiting and waiting.  I check the mymdanderson.com website multiple times every day waiting to see what the receptor status will be.  It will answer a lot of questions I have regarding my options for treatment.  I keep getting told it takes a while to do the staining and all that in the lab that is required.  The waiting is the worst part of all this.

I think this is enough to throw out there tonight, but I have a feeling I'll be updating this more often.