"She's Not Operable"
As a fast-growing and aggressive cancer, the earliest possible diagnosis for Inflammatory Breast Cancer (IBC) is at Stage 3B. There is no Stage 1 or 2 and tumors rarely show up as lumps, instead presenting as diffuse and web-like invaders that often permeate the entire breast. Shortly before my first diagnosis, I lifted my breast and a lattice-like shape, several inches in length and resembling a fence, bulged beneath the surface. Had I known it was cancer, I might have fainted on the spot. I nearly did a few weeks later when I learned the tumor measured a terrifying 13 centimeters.
Women diagnosed at Stage 3 are usually eligible for a radical mastectomy while those diagnosed at Stage 4 typically do not undergo surgery because it does not offer treatment benefit. With the good fortune of a pair of Stage 3B diagnoses, I was eager to get into the operating room on both occasions. After all, these breasts had tried to kill me. The horrors of watching cancer cells multiply with abandon on my chest, creating the engorged and obscene appearance of IBC, resulted in zero indecision. I wanted them gone.
During chemo, periodic MRIs, scans or ultrasounds are ordered to provide some indication about the effectiveness of the treatment. Although no one knows for certain until you get to surgery, the procedures provide a reasonable idea of how well the therapy is working.
Three months after I started chemo for the second cancer, I traveled to Houston for an MRI. Chemo had proven so effective during my first cancer experience that I wasn’t worried about it working for the second. The breast didn’t look great but its overall appearance had significantly improved since beginning treatment.
My cousin, who is an oncologist, accompanied me to the follow-up appointment. We chatted casually as we waited for the doctor (who wasn’t my usual provider) to review the results. I confidently awaited the good news.
The doctor entered the room and made small-talk with my cousin before getting to the point.
“She’s not operable,” he announced, almost casually. My insides turned to lava. The chair threatened to dissolve and drop me to the floor.
It had never occurred to me that I might not be a candidate for mastectomy and living with a grotesque breast seemed like an unbearable torment, not to mention the implications of a treatment that wasn’t working. Before cancer, I never imagined begging someone for a mastectomy. Now I desperately wanted this monstrous, cancer-filled beast severed from my body.
The oncologist explained that they weren’t yet seeing a good response to chemo, or at least not as much as they had hoped. By that point, I had endured 11 rounds of Abraxane, a potent chemo drug that is typically used for more advanced disease. I wondered what other options would be available. If things didn’t turn around, surgery would be off the table.
In moments of high stress, I am sometimes unable to process a conversation and words feel clunky, like cars fitted with square tires. They land with a thud in an empty room in my brain, devoid of context. So it was as I departed the exam room that day, numb and unable to form a coherent thought.
Later that afternoon, the surgeon calmly clarified that she still believed we would make it to surgery. Her large brown eyes filled with compassion, she noted that I still had a lot of chemo ahead and only in rare cases had it not worked well enough to conclude with a mastectomy. Although she meant it as a comfort, I had already been diagnosed twice with the unthinkable and had become accustomed to unusual things happening. In my world, checking the box for “rare” turned out not to be so rare. Nonetheless, her earnest explanation and genuine warmth gave me the confidence to carry on.
On the return flight to Phoenix, I couldn’t wait to be strapped to the chemo pole, feeling more determined than ever. That toxic brew was going to get the job done.