Amber Marchese, star of The Real Housewives of New Jersey , is blogging about her second battle with cancer for PEOPLE. After surviving breast cancer in 2009, she discovered a lump, which turned out to be cancerous, in her right breast in April. Marchese will share updates on her treatment and how she is coping with this second round of the deadly disease with prayer, a positive outlook and the help of her family.
As I wrote last week, my scans were now complete, as was my lumpectomy – my first of several more surgeries to come. I was anxiously awaiting the scan results, which would determine my prognosis. It felt like an eternity waiting for my results. I scheduled an appointment to meet my oncologist Dr. Nissenblatt (whom I call Dr. N) to get my results.
As I drove to his office I thought back to what happened and how the last few weeks had transpired. Over the last few weeks, some days I was wracked with fear, others I glided through with no issues, almost as if my diagnosis was just an episode on TV. Seriously, this is not my reality.
Do you believe in miracles? Growing up my answer would have been no. I believed in God, but I did not believe that miracles really happened. I did not think God, his saints nor his angels had any hand down here. I suppose it was because I watched my healthy, robust father wither away and die from pancreatic cancer in less than three months. I was 19 years old. This happened despite my prayers, my asking God to heal him so we could have more time. Instead, he took my dad home on Jan. 19, 1997. It was the very first time the word cancer really meant anything to me. It rocked me to the core and made the next 10 years very difficult. It made me determined beyond measure to succeed, but, emotionally, I struggled with so much. I fell away from God and the Church.
Fast forward to 2015. My life is amazing. My children are happy and healthy. Jim and I are enjoying life, business is doing great and life couldn’t be any better. I did, however, slow down attending church, stopped praying as much and certainly did not pray the Rosary or a Novena in many years. My mind was wandering around too much, looking for instant gratifications and becoming more and more selfish. Although the words came out of my mouth that I am a Catholic, I did not have God in my life as much as I should have. I knew in my heart I had wandered from my path, even despite my first bout with breast cancer and feeling God’s miracle once before.
Then one day, as I watched a movie with my husband, I leaned back at a 45 degree angle, reached my left hand over to my right breast and simply touched it. There it was a hard lump the shape and size of a lima bean. I could move it, which was good, but it was hard, so I knew something was wrong. Ironically, this happened on Good Friday, one of Holiest days in the Catholic Church. Needless to say, I began praying again. A lot.
I was scheduled to take my scans, but oddly enough there was a miscommunication with the radiology center, my insurance and oncologist office that caused them to reschedule. I was initially furious! This was so urgent in my life. How could anyone screw up enough to have to reschedule my exams for another week away? I calmed myself, made another appointment and then put it out of my mind. I later realized the center made the new appointment on “The day of the Lord’s Accession,” again a very Holy day in the Catholic faith. I went to my scans in the morning and then took my family to mass that evening.
By then, the news of my recurrence went public and people’s prayers started pouring in. I felt so blessed beyond words that total strangers that simply know me from the Real Housewives of New Jersey care enough about me to reach out and offer prayers and blessings. I received flowers, get well cards, prayer cards, emails, DMs, you name it. I am so grateful for all of them and each one of their messages built another stone of strength around me. I realized how much love and faith truly exist in this world.
Now, I am hearing you, Lord, loud and clear.
As we were pulling into the parking lot of my oncologist, the sign read “RCCA Regional Cancer Care Associates” on the center of doors. A sign I have read easily hundreds of times and could not believe I would read a 100 more times. I signed in and sat down and began reading my Healing Power of Prayers and Spiritual Warfare Prayers books. The nurse called my name and I followed her into the room to wait for Dr. N. This was it, this was it, I was either going to hear amazing news or hear the worst news of my life.
Jim and I cracked some jokes back forth to keep the mood light; after all, there was nothing we could do at this point that would change outcome of the tests. Dr. N knocked and entered. With a big smile on his face, he told me my scans were all clear; however, the chest MRI results were not back yet! I was so happy but definitely bummed that that scan I was most concerned about – because of the chest pains I was feeling – was not in.
Dr. N told me the lump removed in 2015 was 3 mm. in size and 10 percent DCIS (early stage invasive carcinoma but contained within the ductal cells), and the rest was triple positive. This means it has receptors for estrogen, progesterone and HER-2. In simple terms, the cancer cells feed on hormones. He reiterated that I would require another surgery to get “wide margins.” This ensures that there are no lingering cancer cells that may have traveled outside the tumor, which was encapsulated. Honestly, this was the best-case scenario that one could hear after a sucky couple of weeks. I was very grateful, however; I still felt I was not in the clear until that final test result arrived.
I tried to keep my emotions at bay with a joyful smile on my face no matter what; however, it is so difficult sometimes. Despite trying to keep the tears back, the tears started up. I ask Dr. N, “How did this happen and why? Am I going to be fighting this for rest of my life?” I reminded him that I had a double mastectomy and that I should not have any breast left. He looked into my eyes and did something unusual: he hopped up on the exam chair and began explaining my case in great detail – he actually grabbed a pad and began to draw and explain how it happened and possibly why.
He started with my original diagnosis, which was actually two tumors, known as “multifollicular invasive ductal carcinoma.” They were located at nine o’clock and six o’clock on my right breast. The first tumor was 1.2 cm. (12 mm.), and the second was 0.8 cm. (8 mm.) with a total tumor load of 2 cm., but no DCIS. The original masses were also triple positive maintaining the same receptor characteristics as the new primary. That is what they call a single malignant cancerous mass – a “primary ”
The recurrence was only 3 mm. and located at eight o’clock. This meant the recurrence was approximately halfway between the two original tumors. Interestingly, 5 to 10 percent of women with mastectomy have a recurrence, regardless of whether they have a lumpectomy (removing only a small portion of breast tissue) or the surgery I underwent – a skin sparring bilateral mastectomy (removing both breast and the nipples). If I had my original diagnosis today, my surgery would have been much less invasive. I would have opted for a nipple sparring mastectomy despite almost similar chances of a recurrence as a lumpectomy.
My reasoning is as follows: First, aesthetically speaking, my plastic surgeon can more easily achieve symmetry with a really pretty, natural appearance when doing a double mastectomy; second, I would have sensation in that region; shird, if I had a recurrence after a mastectomy, the lump would present itself in a region that is more easily palpable – meaning the little bastard is not going to play hide and seek on me in very dense breast tissue.
Dr. N told me this tumor could have been residual disease, meaning cells that were left over from the original tumors or it could be a new primary. I did not know that all women have breast cells from their clavicle (collar bone) to the bottom of their rib cage, extending around to our backs. Ugghhh was God kidding me?! Women have breast cells that intermingle with their skin cells and their fat cells. In short, if you remove your breast, there is never a way of removing all breast cells. If the remaining breast cells are diseased, that surgery will not prevent a recurrence. Dr. N confirmed what my breast surgeon, Dr. Kearney, told me: We would need to remove more tissue to ensure there were no lingering cells.
After, I collected myself, he said it doesn’t really matter for treatment purposes because he had designed an “elegant treatment plan.” Before he told me of my treatment plan, he described how an “interdisciplinary group” reviewed my case at the Cancer Institute of New Jersey (CINJ). CINJ is one of 68 National Cancer Institute’s delivering cutting-edge cancer treatments to patients in communities across the United States. NCI centers are responsible for:
• Conducting, coordinating and promoting research and studies relating to the cause, diagnosis, treatment and prevention of cancer.
• Reviewing and approving grant applications to support promising cancer research.
• Providing training and instruction in the diagnosis and treatment of cancer.
• Assisting and promoting similar research at other public and private institutions.
• Receiving advice from cancer experts in the United States and abroad.
• Cooperating with state health agencies in the prevention, control, and eradication of cancer.
• Collecting, analyzing and disseminating the results of cancer research conducted in the United States and in other countries.
The group that reviewed my case was made up of a pathologist, other oncologists, breast surgeons and radiation oncologist, among others. They each offered their opinions for recurrence and reasonable treatments based upon their respective reasons. Despite all opinions, your oncologist remains the quarterback, the pitcher or the racecar driver. They are essential to your treatment plan. I never knew they had the ability to call together a multidisciplinary panel and to formally acquire input from peers. This group recommended a unique treatment plan for me. Sadly, there is no “standard of care” for my case because no study has been conducted which clearly established the best treatment plan for a local recurrence. This is why we need more funding for NCI centers.
I will get into my treatment plan next week, but I will close by telling you that, after an hour with him, he explained everything thoroughly and even set up an appointment with another oncologist to ensure I had a second opinion.
New research suggests that mastectomy is not superior to a lumpectomy. Breast-conserving surgery may be the better option. In my case, I could have had breast sparring and kept my nipples. Mastectomy is a big surgery, and it is painful. Do not make the decision lightly or without at least a second opinion.
NCI centers receive grants from the federal government and provide data and research essential to finding a cure for cancer. Unfortunately, their funding is being cut, grinding research to a halt. More support for these programs to understand this disease and to establish a “standard of care” is essential.
If your oncologist is not willing to sit with you and answer all of your questions, find another oncologist. It is your life, and you need to be educated.
I want to hear from you! As always, although I may not be able to answer all of you, I do read each and every one of your comments. If you have any questions or comments that you need to ask me, email me at ambermarcheseBC@gmail.com.
God bless each and every one of you,