My Fight for Life: Theresa’s Story
A woman’s worst fear is realized as doctors tell her the cancer has spread
“Wake up, Theresa! Its over. We need you to wake up!” It was dark and I couldn’t see. I felt confused and wondered if I was dreaming. It felt as if I were surrounded by dozens of people and all of them were yelling. “Why is everyone yelling?,” I wondered. Why couldn’t they just be quiet so I could sleep?
Someone was hollering about my oxygen saturation level being low. Another yelled back to try another finger, my thick acrylic nails were interfering with the monitor.
Then another voice shouted that my blood pressure was very low. I thought groggily to myself that I needed to tell them that my blood pressure was always low, but I couldn’t make my lips move.
Then, as if being slowly pulled from darkness back into the light, my eyes fluttered open and quickly shut again. I was suddenly aware of several things all at once: My limbs felt leaden, my throat felt swollen, my armpit hurt like hell and I felt like I was going to vomit.
“What’s wrong, Theresa?” a male voice asked.
“Sick,” I croaked.
“Roll over to your side!” the male voice demanded, and I felt hands helping me turn over to my side. Unfortunately, that movement caused searing pain.
A nurse told me that she would give me an injection of morphine. Then, she asked me how I was feeling. I tried hard to focus on her face, but that feat somehow seemed superhuman. Through the slits formed by my heavy eyelids, I could see that she had blond, curly hair.
“Very sleepy. Nauseous. My armpit really hurts,” I muttered.
How had I gotten here? My head cleared a little bit and then I remembered: My surgery was over and I had taken the first step in a long journey in the treatment of breast cancer. Then, thankfully, the darkness returned.
An emotional roller coaster
A few weeks earlier, my world shifted on its axis when doctors announced that I had a malignant tumor in my breast.
Like millions of women before me, the diagnosis left me walking zombie-like through life. I received the initial diagnosis and began the sad process of informing others.
I told my husband and he held me as I cried. Together, we made the decision to keep the news from our children until our son’s wedding was over.
With the wedding over, the newlyweds embarked on their honeymoon and were still blissfully unaware of the turmoil about to enter their lives. That night, during the post-wedding festivities at our home, I began the sober task of informing the other children.
I shivered in the warm night air as we gathered on the patio. My husband, my mom, my best friend, my aunt, my children. They were laughing and everyone was talking at the same time.
Despite the fact that they were all grown adults, I found myself wishing that I could keep them safe just a little while longer. But that simply was not possible. I looked tenderly at all of them before I began. This had been such a wonderful day, and I was about to spoil it for everyone.
I took a deep breath and began. As my husband had held me when we first learned the news, I now held them as they cried.
I attended appointments with a local surgeon and then specialists at Stanford. The choices I was told I needed to make seemed to overwhelm me.
Lumpectomy versus mastectomy. Sentinel node biopsy versus complete lymph node dissection. Chemotherapy, radiation therapy, genetic testing. Too many decisions to make while a sinister threat lay in wait, poised to strike at one wrong move. How could I possibly decide?
My emotions fluctuated moment to moment, sometimes second by second. One moment I felt brave and invincible, convinced that I could beat this disease, although I knew that it wouldn’t be easy. Then just as quickly, I was consumed with fear. My heart beat so rapidly and pounded so hard within my chest that it took my breath away. My stomach churned and my hands shook. Next, anger would overtake me, and I was angry with everything, my voice taking on an edge that I detest. Then, I would find myself laughing as I always do, my optimism rising to the surface like a helium balloon in flight.
I couldn’t eat. When nighttime fell, I would find myself lying awake until the early morning hours. When I finally did fall asleep, I would wake every few minutes, sometimes lying awake until dawn. Then I would roll out of bed to face another day. I knew that this emotional roller coaster couldn’t continue. I had to make some decisions — and soon.
I’ve always taken pride in knowing that if I didn’t have an answer, I could find one. Knowledge is power. And if I ever needed power, I needed it desperately at that time.
From the moment of my diagnosis, I began to look for answers. I logged onto the Internet. I talked with doctors. I called the American Cancer Society. I talked with survivors.
What would I have to endure? How would I fare?
Could I survive?
One step at a time
I quickly realized that having cancer was a bigger problem than I’d ever faced. After several agonizing weeks and many sleepless nights, I realized that big problems were much like a big meal. And a big meal cannot be consumed in one bite, but only one bite at a time.
So, first things first. Surgery could not wait. Several weeks had passed since my diagnosis. Should I have a lumpectomy (also called a partial mastectomy) or mastectomy? The lumpectomy would remove the tumor and some of the surrounding healthy tissue. A mastectomy would completely remove the breast.
My surgeon, Dr. Christopher Hudlin, and the specialists at Stanford agreed on one thing: There would be no differences in my chances for survival between a lumpectomy or mastectomy. However, if I chose a lumpectomy, then I would definitely have to have radiation treatments. But even with a mastectomy, if the cancer had spread, I could still face the need for radiation treatments.
I chose the lumpectomy. For me, a mastectomy seemed too radical. Since the more radical procedure did not insure a better chance for survival, I could not find a reason to subject my body to any more punishment that it would need to endure.
My next decision: Sentinel node biopsy or lymph node dissection?
Lymph node dissection is the more traditional approach to sampling the lymph nodes near the affected breast. The surgeon removes as many nodes as he feels necessary — sometimes dozens — to be examined by a pathologist to determine if the cancer has spread. Removing so many lymph nodes can cause some post-surgical side effects.
The sentinel node dissection is a newer procedure. The surgeon seeks out the “sentinel nodes,” the first lymph nodes into which a tumor drains, the ones most likely to contain cancer cells. Then, only those nodes are removed and examined by the pathologist.
I chose the sentinel node biopsy.
Now that those decisions had been made, the first “bite” had been taken.
Worst fears realized
One week after surgery, I sat in Dr. Hudlin’s office. My good friend, Robbie, accompanied me. The nurse came in to take my vitals and then she handed me the pathology report. My stomach dropped as I read it.
The tumor was 2.5 centimeters, Stage II, Grade 3, HER-2/neu-positive, ER/PR-negative. Translation: Real trouble.
It was aggressive and the cancer had already spread. The cancer was not only in my breast, but also in two of the four lymph nodes removed.
It was not as good as I’d hoped, and as bad as I’d feared. From the moment of my diagnosis, I had this “knowing” call it women’s intuition, call it a premonition, but I just knew the cancer was aggressive and had already spread. For once, I wish I had been wrong.
Dr. Hudlin entered the room and examined my incisions. There was an incision under my arm where the lymph nodes had been removed. Another incision crossed the top of my breast. The dye used for the sentinel node biopsy had tinted the skin of my breast bright blue — Smurf blue, I joked. Dr. Hudlin smiled and informed me that the discoloration would remain for some time.
Then, we began to discuss the biopsy results and treatment options. He encouraged me to remain optimistic. He left the room to call the oncologist and schedule my first appointment.
Tears rolled down Robbie’s cheeks. She apologized for crying when she’d come to be my emotional support. I realized then that the task of being my friend during this ordeal would be a tough one, and I admired her for being at my side when my own family couldn’t be present.
I hugged her and thanked her for crying so that I didn’t have to. Little did she know, that night I cried a river of tears.
‘Dose dense’ regimen
Several days later, I found myself in the office of Stockton oncologist Dr. Prasad Dighe. He’s a small-statured man with caramel-colored skin, white hair and kind eyes. He is soft-spoken and gentle. He introduced himself, and then asked my permission to examine my post-surgical wounds. Once the exam was complete, he addressed treatment.
I’d been doing a lot of research prior to my appointment. But nothing prepared me for the reality of the treatment I was about to face. I’d arrived at his office ready to battle the enemy. I felt confident and ready to begin. But I quickly realized how daunting a battle against cancer could be.
Dr. Dighe explained that with chemotherapy and radiation treatment, my chances for five-year survival could be as high as 80 percent. He continued to explain that they used to tell patients that if they survived five years without the cancer returning, they were cured. Now, because long-term studies have shown that cancer can return 10, 20 or 30 years after diagnosis, they no longer speak in terms of cure. They simply cannot successfully predict who will have a recurrence and who will not.
I felt panic rise in my chest. Five years? Only 80 percent? Dear God, I’m only 49 years old!
Dr. Dighe recommended that in light of the aggressive nature of the cancer, I needed to consider a “dose dense” regimen of chemotherapy. The same chemotherapy drugs are used as in conventional treatment for breast cancer: four treatments of combined Adriamycin and Cytoxan, followed by four treatments of Taxol. But, dose-dense chemotherapy treatments are given every two weeks instead of the conventional treatment of every three weeks.
The upside is that the treatments are over in four months instead of six months, and the quickened pace doesn’t give the cancer cells time to recoup. The downside is the treatments are so close together that it doesn’t give the patient time to recover, and patients battle low blood counts, fatigue and weakness. White blood cells (cells crucial to fighting infection) and red blood cells (a drop in red blood cells causes anemia) are killed along with cancer cells. However, declining blood counts can be boosted by injections that stimulate cell production.
Chemotherapy kills all fast-growing cells, including hair follicles. Dr. Dighe said I would begin to lose my hair two weeks after my first treatment. The nausea and vomiting normally associated with chemotherapy — the result of fast-growing cells lining the stomach and intestines being knocked off by the chemo — could be controlled with new anti-emetic medication.
After the completion of chemotherapy, I would be given six weeks of daily radiation treatments followed by at least six months of weekly IV infusions of a monoclonal antibody therapy called Herceptin.
A false bravado
As I tried to understand all the information Dr. Dighe presented, my head began to spin. He warned me that the next few months would be difficult, but he felt that the outcome and recovery should be my focus. The confidence that I’d carried in with me like a shield into battle seemed to disappear, and the unrelenting fear that I’d been feeling for weeks crept back in. When I asked him about continuing to work, he stated that the dose-dense chemotherapy would leave me too weak to work.
I was given the option of choosing the standard treatment. With standard treatment, I should still be able to work and earn a living. But how could I choose between being able to pay my mortgage and a treatment offering the best odds of survival? I had accepted the fact that I had cancer. I had resigned to myself to having chemo. How much more of my life did I have to give up?
Suddenly, I felt overwhelmed. I didn’t know how to handle this. I was left facing a monster that I did not know how to confront. For the first time in my life, I didn’t know how to fight. Any other enemy that I’ve faced in my life, I’ve known how to approach, how to battle, how to win. But this … this was simply too much.
As the thoughts swirled, I stared at my hands folded limply in my lap. I fought hard to control the tears that threatened to spill from my eyes. Dr. Dighe stood quietly at my side, patiently waiting for me to answer. Resignation filled me as I realized that I needed to take whatever measures were necessary to save my life and increase my chances of living to be a very old woman. I had to choose the more aggressive therapy. My life depended on it.
I sighed, then I looked up at him and smiled weakly — false bravado was better than nothing.
“When do we begin?”
For more than a year, Theresa Larson, the News-Sentinel's director of administration, has been fighting breast cancer. This is the story of her ordeal.
Types of breast cancer
Ductal carcinoma in situ: Cancer confined to ducts of breast
Lobular carcinoma in situ: Cancer confined to lobules of breast
Invasive ductal carcinoma: Accounts for 80 percent of all breast cancers. Begins in duct of breast, but invades fatty tissues of breast and may invade lymphatic channels, blood vessels and spread to other parts of body
Invasive lobular carcinoma: Accounts for 10 to 15 percent of invasive breast cancers. Starts in milk producing glands and can spread beyond breast to other parts of body
Medullary carcinoma: Accounts for five percent of breast cancers. This special type of invasive cancer has well-defined distinct borders between tumor and normal breast tissue, large cancer cells and presence of immune system cells at edges of tumor
Colloid carcinoma: Rare type of invasive ductal breast cancer formed by mucus-producing cancer cells
Tubular carcinoma: Special type of invasive ductal breast cancer and accounts for two percent of all breast cancers
Inflammatory breast cancer: Accounts for one percent of invasive breast cancers. The skin of affected breast is red, warm to the touch and may thicken to consistency of orange peel
Sources: “Breast Cancer Treatment Guide,” American Cancer Society, National Comprehensive Cancer Network
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