Breast Cancer Tumour Subtypes

I went to the BCNA’s ‘Offering Strategies to deal with uncertainty and anxiety’ conference. The take-away for me was Dr Nicole McCarthy’s summary of breast cancer subtypes which I’ve summarised below. I knew the various subtypes but did not know the naming of them Luminal A/B. So, here it is for others:

Breast Cancer tumour subtypes
Luminal A: ER+ and/or PR+ and HER2- (42-59% prevalence)
Luminal B: ER+ and/or PR+ and HER2+ (6-19%)
HER2 overexpressing: ER- and/or PR- but HER2+ (7-12%)
Triple negative/basal-like: negative for all three (above), cytokeratin 5/6 + and/or HER1+ (15-20%)

*Key
ER: (o)estrogen receptor
PR: progesterone receptor
HER: Human epidermal growth factor receptor

I was very interested to hear about this:
Oncotype DX assay (USA): first breast cancer test that provides individual, quantitative assessment of the likelihood of disease reoccurrence. This test would be useful for women who are node negative and making a decision around undergoing chemotherapy or not.

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The story of my portacath insertion

My portacath scar itches on occasion and recently I’ve bothered to oil it in the hope its puckered, red edges might fade. I thought I’d share a story from my portacath insertion:

“Welcome!” My interventional radiologist boomed into the waiting area and stood looking down at me on the trolley. He was warm, in his mid-forties with a camp manner.
“Welcome,” he said again, then went through an explanation of the pending procedure for fitting me with a portacath.
I piped in, “There’s a letter from the anaesthetist who did my lumpectomy about drugs to avoid. I get intensely nauseous.”
“I’ve read it and don’t worry because I’m sending you into a twilight zone. You’re not going under a GA. Most people don’t wake with nausea. You’re actually conscious and able to speak with me; you just won’t remember anything you’ve said.”
“Great! But I want to know what I’ve said.”
“Yes, I’ve had some interesting conversations,” he mused.
I was suddenly apprehensive: what if I say odd and embarrassing things?
He left and I returned to reading a book on brain plasticity that I couldn’t put down by Norman Doidge M.D., The Brain That Changes Itself (2007). I was reading Dr Doidge’s chapter on pain where he told the story of the neurologist, Dr Ramachandran, a renaissance man of many passions who’d assisted an amputee patient Phillip Martinez to successfully ‘amputate’ a phantom limb by fooling the patient’s brain to ‘see’ his amputated hand move using a mirror box. The intense pain of Phillip’s frozen elbow disappeared after one month.
Medical memoirs and readable medical books interested me in general but my growing fears about Felix’s development made me seek out stories of atypical learners and about people whose behaviour or brain functioning made them appear ‘retarded’ or different but then later on as adults functioned well in terms of communicating their intellect or thoughts and could fit in with normal society.
Five trolleys were lined up side-by-side with no screen between us. I was on the far right. If you looked down the row of men and women dressed in white theatre gowns and covered in white blankets I glimpsed a shimmering aura of emotion; almost physical in its presence. A young man held his body stiffly. He grimaced when he moved his back. He stared straight up into the ceiling. The woman next to me had a round face. She was wearing a loosely knitted beanie and peered about with curiosity as if she sat at a party and hadn’t been introduced to anyone yet. I avoided eye contact so I could read.
“What are you here for?” she said as way of introduction.
“I’m getting a portacath put in.”
“I came here to get mine out.”
Then I was interested. “What did you have it for?”
“Breast cancer.”
“Who’s your oncologist?”
She had the same one as mine, and said that she thought the oncologist was “lovely and always dressed nice”.
I agreed with her.
She told me about the alleged side effects, but then said, “I didn’t experience any of them apart from tiredness.”
“You’re lucky. I hope I have the same run as you.”
“Yeah,” she said. The woman was likely somebody’s grandmother and I could see her sharing a sponge cake with a child and pouring pretend tea into plastic cups for as long as the child wanted to play the game.
My sprightly radiologist swung into view. He and a surgical nurse wheeled me down a short corridor toward the theatre. I checked the doctor’s name on my identification wrist band.
“There’s a different doctor’s name on my tag here.” I pointed to my left wrist.
“Yes, Dr _____. He’s operating in the other theatre. There have been some changes to the roster of patients. You can have him if you like.”
“No, I like you.” And I did.
“Good, I like you too.” The radiologist was someone who could be described as neat. He had well combed short hair with a smattering of greys. Tight skin over a toned face with an aquiline nose and intelligent eyes.
The atmosphere in the room was mirthful. My name replaced the previous patient – another woman – on the computer display screen, which hovered about the table.
“Someone’s been knitting in here,” said a young male nurse. He untangled a black, rubber slinky with a probe on the end that clipped onto a person’s toe or finger to measure the oxygen levels in their blood.
I was shaking. My nerves were swamped — again — like they’d been the day I had my CT scan.
The anaesthetist who sedated me for my lumpectomy wrote a letter suggesting TIV (Total Intravenous Anaesthesia) to reduce post-operative nausea. For days after the lumpectomy I’d experienced waves of intense I’m going to vomit surges. Being on my back again about to be put under and operated on, even for a minor operation like a portacath, made me fearful.
Later on another anaesthetist, my only female one, got the cocktail right and informed me that the days of nausea after my lumpectomy were likely due to a reaction to the anti-emetics, not the anaesthetics. Some you just cannot win.
The radiologist inserted a ten centimetre pin cushion under my skin above my left breast: sewn in place the portacath’s tail threaded up over my left clavicle and into my jugular vein. Chemotherapy would deliver its chemical power straight into my heart.