Second Pathology Report - We met with Doc Doering on Tuesday, September 23. He had received the report that very morning as the lab had been running behind. The results were not what we wanted to hear. But, of course, what we wanted was the best possible. Instead, it brought news that was more statistically-likely.

Despite the initial imaging showing only a 2 mm area and Doering taking more than that, the margins were not clear, indicating it has spread further along the ducts in all directions. A node also showed some cancer present. So it has spread beyond the breast - although the amount was low, so possibly no further than those nodes.

What now? - In regard to the primary site, the options are the same as they were before - remove more in a second surgery or a mastectomy. Gloria decided on the former - which was also Doering’s recommendation. This will be done this coming Tuesday, September 30.

If that produces clear margins, that is the end of surgery. If it does not, then a mastectomy is called for.

The Future - If for no other reason than the HER2 situation, chemotherapy will be needed, so Doering will be putting in a port which will allow injections to go directly into a major vein, as well as doing the more extensive lumpectomy surgery on Tuesday.

The Port - The type of cancer she has this time is very responsive to chemotherapy. In addition, because the underarm lymph nodes were positive for cancer cells, there is an elevated likelihood that some cancer cells may have escaped the immediate area. For these two reasons, she will be getting chemotherapy to seek them out wherever they may have wandered.

Precisely what will be prescribed, we won't know until we speak with oncologist Dr. Koeneke (kir-nick-ee) at the start of those treatments. While some chemo-based therapies involve items taken by mouth, others don't do well passing through the digestive system. The very purpose of that system is to deconstruct what we eat into the basic molecules our bodies need. But chemo therapy drugs are not foods and to pull them apart is to destroy their effectiveness.

It is also true that some of these drugs are intentionally toxic. Cancer cells tend to be faster growing than normal cells. This means they have elevated nourishment needs, so they consume a disproportionate amount of these poisons, precipitating their own demise. But if these compounds are taken orally, the digestive system will get a high dose, putting a dent in Gloria’s appetite for her oh-so-coveted cinnamon rolls.

So drugs that cannot be taken orally or via an injection are placed in the port with its access to a main vein. They then go to her heart and on to be distributed by the circulatory system to every nook and cranny of her body.

The loose end of the tubing is threaded under the flesh upward to near the top of the shoulder where it then turns inward and enters the large vein beneath. It is then threaded downward some distance toward her heart.

To deliver a drug, a numbing agent is first applied to the skin over the window. A hollow needle is then used to pierce first the skin and then the Port-a-Cath's silicon window. The drug is then sent into the needle to flow first into the Port-a-Cath’s cavity and then down the thin tube into the vein.

Occasionally, there is a problem with a Port-a-Cath - such as it turning over. But they can generally be left in place for as long as needed.

Will radiation be needed? - Because cancers are life threatening, we are inclined to think of them as rather robust cells wreaking havoc. In reality, the changes that resulted in the improper functioning of those cells means that they often aren’t very good at those things cells need to do, making them particularly vulnerable in various ways. So while radiation scrambles the DNA in both normal and cancerous cells, the former often recover, while the cancerous cells often lack this ability and die. This is one reason why radiation is so often used in cancer treatments.

Will radiation be called for here? It's too early to tell.

Malta Trip - Some were aware that we have a trip to Malta planned for October. Again, with Doering’s concurrence, that is still a "go!"

Alerting Friends and Relatives - During her 2022 cancer encounter, Gloria commented, "It's harder for me to explain all the details to people than it is to just go through with the treatment.”

Part of that has to do with how the human mind works. Not all that long ago, a diagnosis of cancer was a death sentence, making for a pretty emotional situation. Even though overall survival rates for all cancers are now about 70% and for someone in Gloria's situation the figure is better than 90%, it is still emotional. Whether victim, loved one or an acquaintance, being reminded of one's mortality is disconcerting and conversations can be awkward.

So when I volunteered to inform friends and family, she didn't hesitate. Her response was for me to do just that and get on with it.

But as far as feeling all down and depressed, she’s not. As I saw in 2022, she's a "get on with it" person.

She does not have an aversion to talking about it. It does not occupy all her thoughts. Yes, she has a rare moment now and again, but she sleeps and eats well, has completed multiple columns since this all began and, in general, has pretty much carried on as normal.

When to Share - One question that immediately came up when we learned of this new cancer was when to share this news. In 2022, the situation was different. We did not have any immediate special plans pending, so Gloria began treatment immediately and the first message was written just prior to her initial lumpectomy.

This time was different in two regards. The new one appeared to be much smaller, and so we hoped, even less troublesome, and unlike last time, we had pending plans. When Gloria's first husband Jerome died, she discovered first hand that even good friends sometimes felt awkward around her as they worried about what to say. Since sharing this recent news immediately had no upside, she decided to wait, telling only daughters Mariya and Katie and their spouses.

A few more words from Gloria from three years ago apply today as well as they did then:

We chose not to share this with anyone until we knew more because I felt it would cause needless angst. As you can imagine, I’ve had several bouts of angst myself, but ... we don’t see any signs that it’s more than another one of those things we go through in life. But for me, by far the worst part is the waiting and being in limbo and I saw no point in having others go through that as well.

So, this is much like when I fly - I always have some vague anxiety about flying, but that is always tempered with a “Let’s get on with it” disposition.