Dear Doctor, My cancer has spread.

A week had passed since the mastectomy, there was still no follow up appointment arranged. “Call them and find out what’s going on! Maybe they have forgotten to make your appointment?” I urged.

The consultant had definitely said that she wanted to see my friend in one week. The plan was to take off the dressings, check the wounds and get the results of the sentinel node biopsy (the first lymph node in the armpit).

That afternoon a letter came with an appointment booked for the following week. We decided they must not be worried about the results if it can wait until next week. That same afternoon my friend got a call from the clinic asking why she missed her appointment. She told them the appointment had been sent for next week. The surgeon wasn’t very happy and asked if we could come in the next day. The NHS at it’s finest, we joked.

My friend looked at me, “What if she’s calling me in urgently because it’s bad news?”.

“Surely they wouldn’t have made the appointment for next week if that was the case. She must really want to take the dressings off and not leave them another week.” I reassured her.

We arrived at clinic the next day, we waited until we were the last ones left to be seen. We kept debating whether it was good or bad that they called us in the way that they did. It seemed too disorganised to be bad news. To call us in the day before and slot us in at lunchtime was strange though, hopefully it’s just a wound check I kept telling myself. Our other friend S was due to join us for lunch but she hadn’t arrived before we were called in.

The surgeon was in a good mood. That seemed to be another good sign, but it was almost too much of a good mood. She checked the wound and reassured us that it was healing nicely. It was the first time my friend had seen it without bandages. The nurse and consultant both discussed how well it the operation had gone.

The consultant emerged from the cubicle. “Ok get your gown back on and we can discuss your results.” She avoided eye contact with me. Something in her voice told me at that moment, it wasn’t good news. Not because she said it worryingly but more because she was acting too cheerful. We had gotten to know her a bit by now and she was not being her usual self. My heart sank.

We all sat down.

“You will be pleased to know we got all the breast tissue and had good margins around the lump. The lump however was much bigger than we thought. We had seen 2cm on the ultrasound scan. In reality it was double the size at 4cm.

Another positive was we were told on the original biopsy your cancer was grade 3, the most aggressive grade, now we have the full results your cancer was actually only a grade 2. You were Herceptin positive weren’t you?”

I jumped in, “No we were told Herceptin negative.”

My friend looked blankly at me. The consultant flicked through the notes for a few moments in silence.

“Oh yes, you were Herceptin negative, that’s ok. Oh and also your lymph node came back positive, your cancer unfortunately has spread.”

She just casually dropped it in there right at the end.

“What do you mean?” My friend asked.

“Well the scan had told us your lymph nodes in the armpit were clear. When we sent the node off to the lab it has come back positive. We really weren’t expecting it to spread this fast. I am so very sorry.”

“I just had a feeling it was bad news, I just knew it.” My friend started to cry. We gathered around her.

I asked the surgeon what this news meant. How would we know how far it had spread? What was the next step? How will this affect the egg preservation process that was due to start this week? I was overflowing with questions and I was feeling angry.

We had trusted them when they reassured us we had plenty of time. They had made us feel that we were being too hasty in trying to get treatment started. Now they were telling us it had already spread and they had no idea of the extent.

We were faced with new treatment options. We could either get the rest of the lymph nodes removed as soon as possible and then start chemo after six weeks. Or we could start chemo straight away and not have the lymph nodes removed at all.

Another big decision expected to be made by a person with minimal information.

Again I stepped in. I asked what the success rates of each were and the risks of each. She discussed it briefly.

We decided on the operation and the consultant agreed that although research was emerging that taking all the lymph nodes out wasn’t actually affecting survival rates much, the team had suggested with her age to go for the operation then chemo.

“What if it has spread past the armpit? How will we know?” I asked.

“I’m sure it won’t have passed more than a few nodes, don’t worry. We can discuss that after the next results.”

I for one wasn’t filled with confidence anymore. We had no choice but to go along with it.

The plan was agreed and we got up to leave. The consultant looked at us with a smile, “Would you mind if my colleague had a look at your mastectomy before you go?”

“Errmm yeah ok” my friend replied.

She went out and came back with a middle aged man. He came over and said hello and the consultant opened my friends gown so we could all see the scar. It was possibly one of the most awkward situations so far. He smiled and said yes it was a very good job. My friend shrugged her shoulders and thanked him. What else do you say to stranger who is stood directly in front of you observing your breast. They both left the room in conversation with each other. We were left alone.

I looked outside the room. S was sitting waiting so I went out to get her. We told her what had happened. The three of us just sat there. All starting to say something and then stopping. There really weren’t any right words to say. We didn’t know what this news meant for the future.

Another operation.

Another delay to the chemotherapy.

Another wait for results.

Another bad news day.

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