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grace while pregnant with cancer

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Dear Ladies Home Journal,
I am a 39-year old educated (Yale PhD), career-orientated (in biotech managing clinical trials in cancer), mother of two healthy kids (3-year old Curtis and 5-month old Samantha), who was diagnosed with breast cancer during my 5th month of pregnancy. I’d like to share my story with Ladies Home Journal readers. This is not a story about breast cancer awareness, or how supportive friends, family and the cancer community are, or how I made drastic changes in my life as a result. This is a story about me, a woman who’s been in control and made her own decisions all of her adult life, and how I powered througha curveball that was thrown at me.

My story

[Pregnancy] I’m sitting in the waiting room browsing through an Entertainment Weekly magazine that is 4 months old. After about 10 minutes of vacuous reading, Wilson comes rushing in the door and announces, “Oh good, you haven’t been called in yet.” My husband and I are waiting for our 20 week fetal ultrasound to see the first pictures of our baby daughter. The results of the amniocentesis we did a couple weeks earlier told us that our second child was a girl. Eventually we’re called in and we see the first black and white images of our daughter. The radiology tech and doc say all looks normal. My husband Wilson and I were very excited to be expecting another baby to go along with our then two year old energetic son, Curtis. I secretly thought we were very lucky because at 38 years old, there were certainly no guarantees that Curtis would have a sibling. The fact that it was a girl was just icing on the cake. I never thought about whether I wanted a boy or girl because I knew there was nothing I can do to influence the outcome. I’m annoyingly pragmatic that way; I try not to waste time or energy toward something that is not productive or that I have no control or influence over.
[Biopsy] During my first OB appoint (approximately 8 weeks into my pregnancy), my doctor noticed a small lump in my left breast. She said that it was likely nothing, but suggested that I may as well get a breast ultrasound the same time as my fetal ultrasound “while I’m at it.” I felt the small bump before, but I assumed it was calcified milk as I had instances of clogged ducts while breast feeding Curtis. As I’m lying on my back with gunky gel on my breast, the radiology tech doesn’t say much; some techs are extremely chatty while others are almost mute, like this one who was very focused on her job I assumed. Finally the doc comes in, does a couple of more scans and says, “Well it is some sort of a solid mass. But based on your age and history, the probability is that it is nothing, maybe a benign mass.” She needed to do a biopsy to confirm and asked if I can stay for a bit. I had an important meeting that Monday afternoon and returned Thursday for the biopsy. Thursday’s procedure was pretty uneventful. I lay on my side as the doc took 3 pink-colored samples from my breast. Each sample felt like a sharp pinch or a tattoo needle penetrating the skin. The brief pain was much more tolerable than holding still in an awkward position for minutes at a time. After the procedure, she said the results should be back by Monday. I was not worried about the outcome in the least. I remember feeling more annoyed that I had to do all this “extra stuff.” I whole-heartedly believed it was nothing to worry about; once again, there was nothing to do to influence the outcome so I devoted no time to thinking about it.
[Biopsy results] It’s the afternoon of following Monday and I had yet to hear back from the doc. I gave the doc a call and her first words were, “Grace, I am very glad you called. I’ve been trying to reach you since this morning.” (They didn’t have my correct phone number on file.) She sounded more serious than I think was needed to tell me they found nothing. The next thing she said was, “the results of the biopsy came back and showed cancerous cells.” I was speechless. Luckily I was making the call outside and the fresh breezy air woke me from the shock. She continued, “Each of the three samples contained abnormal cells, indicative of carcinoma. Can you come in this afternoon for us to do a mammogram?” Completely ignoring the question, I asked, “Is it metastatic, what stage is it?” She replied, “I cannot tell you either of those things right now. We need to gather more information. Can you come in now?” I said, “I’m on my way.” Breast cancer? I have breast cancer? What?? I’m not even 40 and I have no family history. Is the real? Is it a mistake? Five minutes later I called Wilson. I knew the phone call to Wilson was not going to be easy. Wilson is an intelligent man but his first reaction to bad news tends to always be worst case scenarios. Further his father had passed away two years earlier with an extremely aggressive form of lung cancer. His dad lasted less than three weeks from diagnosis and his passing.
[My reaction] My mind was racing as I drove to the doctor’s office. What stage is the cancer? Has it spread? What’s the hormone status? What treatments have been approved? What clinical trials are available? What’s the prognosis? WHAT THE HELL IS THIS GOING TO DO TO MY BABY? The radiologist had no answers to these questions. Based on the imaging, the doc said that the mass measured about 2 cm in its longest diameter. She said she would make some calls and set up appointments with a surgeon, an oncologist, and a high risk OB. Things were moving so fast. I finally asked, “Can all this wait until after I give birth? I don’t want anything to harm the baby.” Her response was an absolute “No. You have to act quickly to remove the tumor before it has time to grow and spread.”
[Back at work] Did I mention that for the last 5 years, I have been a project manager for biotech companies that conduct clinical trials in oncology? I knew the doc was right. Like most cancers, if the mass can be removed, surgery is the best treatment. My only concern regarding the surgery was what the anesthesia would do to the fetus. Eventually I realized that pregnant women get emergency surgery all the time and there is minimal, if any, effect on the fetus. Eight days after the biopsy results and many medical appointments later, I was on the operating table having the mass removed (lumpectomy). Wilson encouraged me to take a couple more days to recover physically and emotionally, but I felt fine. I knew staying at home wouldn’t “help” get rid of the cancer, but work was different. I can contribute; I can be productive. I was back at work two days after the surgery.
[Diagnosis] So at 5-months pregnant, I had a left breast lumpectomy and sentinel lymph node resection. The mass they removed was a grade 2 (out of 3, describing the aggressiveness of the tumor) carcinoma that measured 1.7 cm (relatively small) with differentiated carcinoma in situ, DCIS, (stage of cells just prior to being cancerous). The sentinel node biopsy was negative; it had not spread beyond the left breast. The first place the cancer would have spread would be to the lymph nodes and the fact that it came back negative indicated that the tumor has not spread, i.e. it was not metastatic … thank goodness. The histology came back as well and the tumor was strongly PR positive, mildly ER positive (dependent on progesterone and estrogen to grow) and HER2 negative. Based on this information I had stage one breast cancer that was hormone sensitive. The prognosis for this type and stage of breast cancer is very good if I followed the recommended treatment, which was chemotherapy and radiation. The only part that was unclear was how chemo would affect my baby? After reading the latest articles on the topic (of which there isn’t much since clinical trials almost always exclude pregnant women), I found that the only notable trend is that babies are born with lower birth weights. Further, the chemo that was recommended does not pass through the placenta and if any amounts did, the fetus’ liver was too immature to metabolize it. Satisfied with my research, the course of the next nine months of my life was set: first chemo treatment (8 weeks of Adriamycin and Cytoxin[AC]), deliver baby, second chemo treatment (8 weeks of Taxol), 6 weeks of radiation, followed by 5 years of Tamoxifin (a daily pill).
[My reaction] For all intents and purposes, all this was decided for me. I had no input nor could I really alter anything, not without it having a negative effect on my prognosis (survival and recurrence). And these were major decisions, like receiving cell-killing chemotherapy while carrying a growing fetus! Not once did I wonder why it was happening to me. Being in the cancer field, I knew cancer was indiscriminate; I knew I didn’t do anything to “get cancer”. So after I accepted the new turn of events, my attitude was “Okay what’s first? What’s next? When and how soon can we do it? How can I expedite things?”
[Work deprioritized] I was 25 weeks pregnant when I started my first chemotherapy treatment of AC. I was also working full time. Work has always been a priority for me, ever since graduate school (ironically I went into Chemistry because I wanted to make the molecule that would cure cancer). At the time, the project I was on (a phase 3 study for a cancer vaccine in prostate cancer) was close to being initiated. There was an important meeting the day after my first chemo infusion. Determined not to let work suffer, I knew I should travel to the meeting and the timing worked out as I could head straight to the airport after my infusion. (Wilson was very much against it but he wavered and said only if the doc said it was okay.) In my most convincing and diplomatic tone, I asked my oncologist if I can go on my business trip. To my annoying surprise, he said “Cancel it.” He said that I would be in a foreign place and if I reacted adversely to the chemotherapy, my care will not be optimal and my health and that of the fetus may be jeopardized. Hearing that my baby may be affected hit me like a rock. First and foremost, baby comes first. I had to accept the fact that during the remainder of my pregnancy (while on chemo), my life centered around my medical appointments. Strangely, realizing I was no longer in control was more difficult to accept than my diagnosis and treatment. I have made my own decisions most of my adult life and now I was thrown a curveball.
[Powering through] Believe me, it wasn’t easy, but for me, the key was not to think or dwell on my situation, challenges, and even side effects. I was still working full time and had so many medical appointments. Despite all my attempts to plan my schedule, my appointments often ran late (doctors are overbooked), and I was often racing back to the office. (In time, I learned to ask for the first or second appointments of the day). Nausea is a common chemo side effect. I carried a plastic bag with me so whenever I needed to vomit, I always knew I wouldn’t have to panic to find a bathroom or garbage. This mentally took away the stress from this nasty side effect. Keeping up my energy level up was probably the most challenging. I forced myself not to compromise on sleep and rest. For example, I was in bed most nights at 11pm. I didn’t try to “get a couple more things done” right before going to sleep. I constantly told myself that being tired was temporary and that my situation shouldn’t negatively affect my work or being the best mother, wife and friend I knew how. My pregnancy took center stage so I just powered through having cancer.
[Juggling] Wilson joined me for my first chemo infusion. (He couldn’t make it to all of my appointments because of work and having to pick-up or drop-off Curtis from school.) I had a very nice infusion nurse that hooked up the IV to my medi-port (which I had surgically installed the week previous). I watched as the red-dyed medicine (AC) went into the tubes and into my medi-port. It was now in my bloodstream. Surprisingly I tolerated the chemo quite well. One of the more severe side effects from AC is nausea. Perhaps I was used to the nausea since I was pregnant but I really didn’t feel any more nauseous than the first couple of months of my pregnancy. The worse side effect was constipation, ironically from the anti-nausea medicine and not the chemo itself. But the utmost taxing thing for me taking chemo while I was pregnant was juggling work and making all my medical treatments and appointments (chemo infusions, blood draws, oncology appointments, post-op follow up, OB and ultrasound appointments). Most of my appointments were during work and I often found myself thinking how I wasted so much time in waiting rooms, waiting to be seen by doctors. They’re always over-booked. I remember the radiologist who told me the biopsy results saying, “The process is almost as worse than the disease.” She was right. For Wilson, managing all the bills and insurance-related questions were taking their toll on him. Without Wilson taking this task on, I would not have handled my situation with as much calm or patience. Wilson was very supportive during the process and Curtis didn’t know the wiser since the treatments didn’t take away any family time, a point I wouldn’t negotiate.
[Hair loss] And yes, my hair fell out. It started about two weeks after my first infusion. First it was a few strands, the next day it was dozens of hairs (enough to clog the shower drain). Wilson bought a hair clipper the next day. We put a chair out on the kitchen floor, played some music and he buzzed all of my hair off. It’s just hair … it’ll grow back. I wasn’t ready to share with too many people my situation while I was pregnant. I didn’t want to answer their questions about how all the drugs will affect the baby. Regardless of what I said, they wouldn’t be convinced until the baby was born. So for the remainder of my pregnancy, I wore a wig. Besides a few close family and friends (and select co-workers), no one else knew what I was going through.
[Baby] Two weeks after my last AC infusion, the results of my blood text cleared me to deliver my baby by cesarean. Samantha was 5 lbs, 13 oz. She was smaller than normal, just as my oncologist had predicted. All of the stress of the previous 4 months melted away. Our baby was healthy and that’s all that mattered. After Samantha was born, Wilson and I had still not decided whether I should do the second chemo treatment with Taxol. The prognosis after surgery, chemo and radiation was ~95 % no recurrence after 10 years. Adding a second chemo bumps that up to ~97%. Was that statistically significant? Both Wilson and I just had this wonderful baby. Can’t we just enjoy it? But I realized I did not want to have any regrets later in life if the cancer did come back. We decided to move forward with the second round of chemo.
[Telling people] The second round of chemo was fairly uneventful (made easier by being on maternity leave). My hair had grown back about ½ an inch since the first round of chemo. But once again, about two weeks after the second round started, my hair started to fall out again. Once again, Wilson buzzed my hair off. Going back to work was right around the corner and I had a big decision to make: do I tell people at work? I do not like drawing attention to myself and whatever medical condition I have (or had) shouldn’t affect my work performance so I at first felt there was no need for them to know. But my hair was just starting to grow back (for the second time) and I wasn’t comfortable going back to work almost bald. I hated wearing a wig and can’t imagine how uncomfortable it would be during the summer months. I went back and forth on this decision. Wear a wig to work or a headscarf? Wilson said that I should just “rip off the bandaid” and wear the headscarf. So that’s what I did. Needless to say, that first day back at work was intense. It did not get easier with each person I told. I got some confused looks and plenty of blank stares; there were even a few co-workers who didn’t even recognize me! But I survived that day.
[Cancer free] I am now in the waiting room to see my oncologist. I have been waiting for over half an hour, yet the status board says my doc is “on time.” (I wasn’t surprised). This was my “graduation” visit. In addition to the two chemo courses, I had also completed 4 weeks of daily radiation. (I drove half an hour each way every day to lie on a table for about 5 minutes – fun!) During my appointment, my doc tells me that my blood work is back to normal and the MRI came back clean; I was cancer free. The ride I was on the last nine months was over. I still need to take medication for the next five years, but that’s just a daily pill; the bulk of my medical appointments were now over. Woo Hoo! Wilson suggested that we go out for dinner to celebrate. When we got to our favorite local sushi restaurant, it was closed while the owners were on vacation. Once again, this turn of events was beyond my control but after the last nine months, it didn’t bother me at all. We went home and put some frozen chicken nuggets, fries and vegetables in the microwave. Ahh a celebratory meal to remember!


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