Diagnosis 4

Once again today I meet with my surgeon Dr Lambley to discuss the results of the MRI scan I had yesterday.

Tomorrow I am meant to start my chemotherapy but in this continually shifting vignette, the furniture has been moved around once again.

Dr Lambley tells me that the MRI has shown this cancer indeed requires a mastectomy of the left breast. The progress of the carcinoma is worrying enough for radiation also to be thrown into the mix.

That is not what I want to hear! Secretly, I had been hoping that with breast removal and chemo, I would not need radiation. It's the nuisance of it - the length of treatment, the never ending saga.

The reason for the MRI was so that Dr Lambley could work out whether a'simultaneous reconstruction' would have been possible at the time of mastectomy, meaning that radiation was not needed.

However, the placement and progress of this cancer means that this is not possible. The total area of the tumour is now around the 5cm mark, the size at which things are not so peachy.

Thanfully, Dr Lambley reports that the last lumpectomy showed a pretty unaffected chest muscle so far so at least this tumour has not spread any further than the breast.

However, chemo and radiation are recommended as part of what is called adjuvant therapy.

I guess somewhere in my brain, I am processing this latest punch in the face but I am strangely removed. I have surrendered myself to the process, at least for today.

I ask Dr Lambley whether I can have both breasts off as I believe being uneven is terribly uncomfortable.

He says he prefers to do that as the final step in my treatment because a double mastectomy takes much longer to heal, there's a greater risk of infection and it might mean my chemotherapy treatments are delayed. This is not an option.

My darling friend, Christine who has been through the whole kit and kiboodle of the cancer journey has schooled me on the benefits of a simultaneous nipple reconstruction.

Alas, this is not an option. I'm not entirely clear why not. It has something to do with blood flow and the fact that the nipple tends to wither away. Yuck.

So basically the scenario I am left with is this. One breast off - the sooner the better. Chemotherapy, radiation then reconstruction resulting in two breasts.

At once, I see my blissful plans of returning to refereeing in March next year disappearing in that long vapour trail of things I will be stopped from doing in the coming months. Looks like I'll have to be content being a linesman. :(

So what is left to do other than to laugh. I tell Dr Lambley that I hope he does a neat job as all the pictures I've seen of these operations look like they've been performed by Charles Manson.

"My grandfather used to call me 'Charlie'," Dr Lambley laughs.

"And make sure you lay off the alcohol the night before," I say. "I want a nice straight line."

There are diagrams drawn, and questions asked. Al wants to know if there is a chance that with chemo and mastectomy I might avoid the radiation.

"It's possible," says Dr Lambley. But I am already able to read his facial expressions: the subtle shift of a lip and a brow and I know he believes it is unlikely.

Cancer it seems, is an enemy not to be messed with and the strategy is not to take it out in half-hearted pot shots with a 9mm Browning. No. The strategy is to come at it with both guns barrelling. I am reminded again of Riley and her confrontation with the Aliens.

And so I am resigned. What can I say? Boo hoo? I am booked in for my mastectomy of the left breast for this coming Tuesday.

Instead, I focus on the positives.

I have another two weeks up my sleeve to kick up my heels - albeit one-breasted - before the demons of chemo are unleashed into my veins.

This means I can go to my friend, Mel's special restaurant opening on Friday.

It means I can enjoy Harry's 18th birthday party this Saturday and dance my booty off with 80 teenagers and embarrass my son with some solid party-porno moves.

I can go to lunch with my besties as planned on Monday.

It means I have another five days in which to enjoy the self that I have been.

I will use this time to reflect upon that self and to bid my good byes to the body that I have loved and nurtured.

I will enjoy the feeling of Nicky and Paris, droopy as they are, hanging from my chest. (We have been through a lot together, the three of us).

I will bask in the symmetry of the body God gave me.

And I will dream about the not too far off future where, salined but perhaps more streamlined, I'll come sprinting down the home strait, running like the wind.

The Diagnosis: Part 2

I discover a new type of anxiety. It's nothing like I felt the first time I went abseiling (off a building at UQ in the dead of night, with a group of half-wit students), or diving or skydiving.

It's nothing like that fortnight I spent, unable to see, with stitches to both my eyes thanks to a car accident.

It's not even like the time I was swept off the airbed I was riding down the swollen gorges of the Obi Obi in Maleny and had only the forefinger and thumb of a fellow traveller to cling to until I was rescued. (I spent that night freezing and beating off the leeches. Apparently a rescue helicopter was despatched but we weren't found).

It's like the anxiety you feel when your child goes missing, that abyss between knowing and not-knowing.

It's Friday, September 30 and Al and I are once again sitting in front of Dr Lambley. After the usual greetings he procures 3 pieces of A4 paper which have just been faxed through.

Literally hot off the presses are the results of my pathology.

He interprets what he reads as his eyes scan the pages.

He seems surprised.

He had thought it was a ductile carcinoma he says, but it's lobular and unusual. Only 1 in 10 breast cancer cases, it seems.

The good news is that it's hormone receptive which means I shall have access to an extra layer of treatment.

The other good news is that it is what's called "node negative" - that is, it has not spread to the lymph nodes.

The bad news is that I will need to return to hospital next Wednesday to have more removed.

The bad news is that he says I will need chemotherapy.

For the first time I hear the term "Medical oncologist".

At this point I notice a subversion of the principles of time. It seems my life is heading rapidly in a new direction. But I must wait until Wednesday to know what my treatment options are. Time is fast but it is slow. I feel as if I am suspended in a different reality.

Appointments are made and we leave.

Al asks me if I want to go to the local bar, Elysium, where it is our habit to catch up with friends every Friday evening. I don't want to go home so we meet 'Burglar' and Natalie, Greg and the Dowlings.

Yet again, I find myself talking about the subject but now there's a new 'C' word eating away at my thoughts.

Afterwards, we pick Ben up from home and go to my sister Nicky's for dinner. My mum and dad are there.

We talk about my situation. Here is what I've learned.

I have what is described by the pathologist as a (classic) invasive lobular carcinoma.

It is larger than it looked either by palpation or ultrasound: in fact, it's roughly double the size. It has 3 tubules, 2 nuclei and 1 mitoses.

It is node negative and is 80% Estrogen receptive.

Invasive lobular cancers represent 1:10 breast cancer cases. They form in your milk glands and therefore, usually do not present as lumps. They present as a thickening of the breast.

When these cancers break out of the lobule, they do so in single file then invade the surrounding tissue in a web-like manner.

At this point it hits me that cancer is an animate, living thing. It is like a life form within a life form. For a moment I am fascinated. In a way, there is a certain fecundity to this phenomena - a pressing forward.

This is the beginning of my understanding of why this disease is usually paired with imagery of battle. These cells are not indiscriminate. They have shape and pattern. They advance in formation, gathering strength with each advance.

I have an enemy within: it is living and breathing.

My friend Mary was diagnosed with breast cancer in 2008. She has already given me this to work with: to imagine these cells as 'Aliens'. She became a fan of Sigourney Weaver. She visualised beating these bastards. Already, I hate these fuckers.

And it's important I understand them. I begin my research and start with understanding the risk factors.

Of these, I suspect only one and only because my grandmother died of stomach cancer.

Inherited genetic cancer syndrome: this is a rare, inherited condition called hereditary diffuse gastric cancer syndrome which increases the risk of both gastric (stomach) cancers and invasive lobular carcinomas.

I have no medical background but that's my intuition. So far, it's been spot on.

In a way, this makes me feel better. It makes me realise that I cannot blame my diet or my lifestyle. I cannot blame my desire for nice-smelling armpits or my love of a rump steak.

I cannot blame underwire bras or those soccer balls I took on my (plentiful) chest.

I cannot blame Mortein or mobile phones, Mr Cadbury, Bundaberg Sugar or Johnny Walker.

I can't even blame Julia Gillard (although, of course, I'd love to).

There is no interplay of myth and mystery here, no hocus pocus nor sleight of hand. It is simply science.

It has happened and there is no way left but forward...

CLOSE ON DOOR: as it REVEALS an inhuman silhouette standing there.

It is Ripley, WEARING TWO TONS OF HARDENED STEEL. THE POWER LOADER.
She lifts the arms horizontally beside her and stomps out...the massive feet CRASH-
CLANGING on the deck. She stops midway to the Queen.

RIPLEY
Get away from her, you bitch!

TIGHT ON QUEEN: as it hisses with pure lethality. Newt looks out of the flooring at Ripley

Ripley moves the arms up for combat, both in swinging positions and takes two steps.
The Queen screeches and charges. WALLOP! A roundhouse from one great hydraulic
arm catches the creature on its hideous skull, slamming it onto the deck. The Queen gets
up and Ripley hits it again with the other arm, sending it sliding into some heavy cargo boxes.

The alien rights itself, standing in a lethal stance. It hisses violently, clearly really pissed off.

Ripley swings around, positioning herself toward the Queen.

RIPLEY
(screaming)
Come on!

The Diagnosis: Part 1

On Monday, 19 September 2011, I celebrated my 48th birthday and by Friday, 23 September, I had been diagnosed with early stage breast cancer and it is with an attempt at a clinical, third-party objectivity that I've been keeping track of what's happened to me so far.

In the ensuing issues of this blog, I hope that my experience will help you or someone you know in dealing with the ramifications and repercussions of what is one of the more indiscriminating diseases in the world.

In 2011, it's estimated that around 14,300 women and men in Australia will be diagnosed with breast cancer with 75% of cases developing in women aged over 50. The KNOWN risk factors are:

- Being a woman
- Getting older
- Inheriting a faulty gene that increases the risk
- Having a strong family history of breast cancer.

Of these, I have all but one.

My journey begins around the second week of June 2011 when for the first time in my life, I get the flu. I put it down to the increasing virulence of the germ and batten down to fighting it. But the cold hangs around.

This concerns me, a tiny bit. Generally, I've had the constitution of an ox. In Year 12, to my great embarrassment, I was one of two kids to receive a special citation for perfect attendance: I did not have a single day sick in five years of senior schooling.

Through my early working years, I amassed a fortune in untaken sick days - I was never sick. I mean NEVER.

In part, you'd put this down to the fact that I'm a serial exerciser and a health nut. I've lived a moderate life and tried to take good care of myself as best I can.

You could also put it down to good genes - my great-grandmother is rumoured to have died at 110.

So yes, getting the Flu is a tiny sign.

But there are other clues. Normally a person with a zest for life, I have started to feel fatigued. I have difficulty getting up in the mornings.

I also find my old allergies have reappeared with a vengeance. Everything seems to make me sneeze. I have a sinus infection that doesn't seem to want to go away.

With some strange prescience, my husband, Al, observes: "You always seem to be sick these days, Bronnie."

Nonetheless I'm feeling fit. I'm running 10km twice a week. I'm refereeing and playing soccer nearly all day on Saturdays. Sick, schmick.

It's the sinuses that drive me batty. So in early July I take myself to the doctor and ask for the full suite of medical tests. .

She's happy to give me the referrals but when we get to the breasts, there's a disagreement.

I ask the doctor for a referral for an ultrasound to which she replies that a mammogram is adequate and I could have it done for free at Breastscreen Queensland.

"No," I say. "I am happy to pay for it." The doctor seems to roll her eyes and mumbles something like: "Well, I suppose, if you're rich."

I have the referrals but as it happens, my work gathers momentum and I find July and August slipping away.

In late August I finally manage to get to my blood test and by early September, I know that all is well in that department. My cholesterol is pleasingly low and apparently liver, kidney and lung function are fantastic. There's an issue with my haemoglobin - but I've been battling anaemia for years.

In the meantime - something alarming occurs with my left breast. At what clinicians will identify as 'ten o'clock', my breast is raised and sinewy. Google tells me not to be alarmed as breast changes are common in peri-menopausal women. But I have the referrals! My intuition tells me not to delay.

I have a mammogram and an ultrasound which uncovers a suspicious lump. It's a Friday though an I have to rush off to a meeting. I opt to return the following Wednesday for the biopsy.

In the ensuing days I try not to worry. I keep feeling the dodgy spot on my breast, imagining it growing.

My birthday comes. I realise how many friends I have. I feel sentimental and maudlin.

Two days later, it's time for my appointment.

The doctor numbs the breast with a local anaesthetic. A needle is inserted into the lump and a small tissue sample is pinched with a device that makes a noise like a staple gun being released.

In smaller lumps in harder to get to places, a needle is used and is dug in to the spot, over and over. It hurts.

That afternoon, I go for a walk with my friend, Lyndal. We don't go far - maybe five kilometres. But I'm puffing. I observe that I must be stressed. Since the biopsy my heart rate is elevated.

That night, I go to my usual Trivia Night with my close bunch of friends. We come second and win the bottle of wine :)

Now I must wait some more for the biopsy results. Two days move like molten lava as I await the bewitching hour. I don't know what to think. I stay cheerful and positive. I joke to my family about being nice to me as I'll be dead soon.

I make cracks about finally getting the flat chest I want.

I go to the gym as usual. I go for walks. I keep working.

When the doctor calls me in, my mind is a blank. She's a chinese lady and not given to jocularity so I think nothing of her stern expression until she says: "The News is Not Good."

We jump to words like 'radiation' and 'chemotheraphy'. Still, I'm not panicking. I'm watching events unfold in the third person.

We waste no time. That afternoon I'm the last appointment with the only local breast surgeon. His name is Dr Justin Lambley. He's in his mid-thirties, slightly built and with a gentle manner. He has three young children aged 5, 3 and 1.

Dr Lambley asks me how I found the lump. He looks at the ultrasound and comments on how small the lump is. He congratulates me on finding it.

He has me undress and feels my breasts. After the examination, he draws a diagram explaining what happens with a cancer.

He tells me I'll need a lumpectomy which may include the removal of one or more lymph nodes.

He says I'll also need radiation.

He knows this simply from looking at the ultrasound.

But what about that mammogram?

He places the mammogram screens on the light box. There is no sign of any abnormality.

My take home message today then is this: If you are a woman with breasts:

1. Check your breasts regularly.
2. If you are aged 40+ have regular screening.
3. Insist on an ultrasound.

In Australia, they cost around $300 up front but you receive about $130 back on Medicare, give or take a few bucks. What's $170? Is it worth your life?

The appointment with the surgeson is over. He directs me to the hospital where I must fill in the forms for my operation the following Tuesday.

As Alan and I leave we observe that we've received as close to good news as possible. The lump is small. It's early stages.

That night we go out for dinner with friends where we joke about breast reconstruction. Underneath the laughter, there is an undercurrent.

I can feel the tug of something inevitable.

As I leave the restaurant I receive a text message to tell me a good friend is by her mother's death bed in hospital. Her mum will die at 9 am the next day.

I realise that on Monday, my eldest son will turn 18. (On Sunday, Alan and I will toast the last day of his childhood with a glass of champagne).

I think about living and dying. I think about growing old.