BREAST CANCER JOURNEY: An Introduction

As I begin sharing my breast cancer journey, I want to emphasize that I'm talking as a breast cancer patient; I'm still learning about the diagnosis, the treatment, and the breast cancer itself. Though my clinical education background gave me some prior exposure to the knowledge, but I'm not a doctor nor a healthcare professional. Everything I share comes from my own understanding after conversations to the oncology team and hours spent reading researches. I may misunderstand things or make mistake, and I welcome any healthy discussion as part of this learning process.

I briefly mentioned in this post that I've been diagnosed with Stage 2A Breast Cancer.  The systematic therapy plan I'm following includes two years of injectable hormonal therapy alongside five years of daily oral medication.

Looking back, I struggled to  pinpoint clear symptoms or any warning signs before the diagnosis because—honestly, I didn't notice anything alarming. My breasts looked normal. I never felt the distinct lump like many associate with breast cancer patients. The only thing I was aware of was a small, 1 cm breast cyst—and let me go back to February 2024. 

At that time, I went for a Breast Ultrasound (Sonogram) after noticing a small faint purplish bruise on the lower side of my right breast—it looked like a tiny bump from a mosquito bite, and I felt a slight sting when I pressed the bruise. I'd actually noticed the small bruise weeks earlier, but at the time, my body was  already overwhelmed by another serious health issue; sudden loss of appetite and unintentional weight loss of 20 kilograms within few weeks. I also experienced shortness of breath. My mind was clouded, I could barely gather the energy to help myself. Hence it took time for me to visit the doctor. When I finally did, the ultrasound confirmed it was a breast cyst. My doctor reassured me that it was benign and likely to disappear on its own given its small size. Since I was about to start the treatment for Tuberculous Pleurisy, he advised me to  focus on that first. I'll share more about Tuberculous Pleurisy later.

14 months later, after completing treatment and recovering from Tuberculous Pleurisy, I returned for a follow-up ultrasound. Just as predicted, the cyst had dissapeared. But in a different spot—at the 12 o'clock position of my right breast, opposite where the cyst had been—a solid mass appeared.

I was shocked. I knew "mass" meant tumor—and tumor falls into two categories; benign or malignant. Still I tried to stay calm. It could still be benign, I told myself.

That diagnosis made me think, "Could those strange sensations and usual discomfort I'd been feeling in my right breast before my periods over the past few months have been a sign?" 

From late 2024 into early 2025, I'd noticed unusual tightness and discomfort on my right breast in the days leading up to menstruation. Premenstrual symptoms is common, but this felt sharper and somewhat more intense—enough to wake me at night.  Yet I hesitated to assume the worst. After all, I also had two keloid scars around that area due to chest cavity tube insertions through Water-sealed Drainage (WSD) during the treatment for Tuberculous Pleurisy on March until May 2024, and they brought their own itching, tightness, and sometimes burning sensation. I couldn't tell if I was sensing something real—a genuine symptom, or if my anxiety about delaying my follow-up untrasound was making me connect unrelated dots.

I should mention, when I first started taking medicine for my health issues, my periods stopped completely for three months—a condition called Secondary Amenorrhea. I was still in that phase during the ultrasound I took on February 2024. My cycle returned back to normal in the evening I was discharged from the hospital after my first Water-sealed Drainage (WSD) procedure. Periods resumed regularly afterward, though bleeding shortened to just 3–4 days, unlike my usual 5–7 days before the illness. From what I've read, these menstrual changes aren't directly linked to breast cancer risk. What might contribute, however, is that I started my periods at age 11. Early menarche alone doesn't determine fate—but it does add to a cumulative risk profile alongside family history, genetics, lifestyle, childbirth timing, and breast density. Beginning menstruation young means longer lifetime exposure to estrogen and progesterone, hormones that stimulate breast cell growth. It also extends the window when breast tissue remains in a rapidly dividing, immature state—potentially increasing vulnerability to cellular changes over decades. Here is one of the recent researches we can read.

Then came March 2025, just days before Eid al-Fitr. A friend shared that she's been diagnosed with breast cancer and needed surgery. Her news shook me. I'd already planned a follow-up ultrasound, and the news encouraged me to not delay it any longer. 

What followed is now part of my story. I underwent a LUMPECTOMY with excisional biopsy to remove the mass. And then the pathology report that changed everything.

AFTER LUMPECTOMY: Excisional Biopsy

Following LUMPECTOMY—Excisional Biopsy, Anatomical Pathology revealed that I had Invasive Breast Cancer, NST (No Special Type), Grade 1, with an associated DCIS (Ductal Carcinoma In Situ) component, Grade II.

Breast Cancer, NST (No Special Type), Grade 1

Cancer cells have broken through the wall of the milk duct and invaded the surrounding breast tissue. This suggests that it has the potential to spread beyond the breast—though not always. From what I also learned, the NST (No Special Type) is the most common type of invasive breast cancer. According to some research, it accounts about 75% of  occurrences of breast cancer, and has no unusual features when examined under a microscope. The cancer cells found in my breast was Grade 1 (Low Grade), meaning they resemble normal breast cells in appearance and grow slowly. Among invasive malignancies, this is the least agressive grade and—Thank God—generally has the best prognosis.

DCIS (Ductal Carcinoma In Situ) component, Grade II

These are abnormal cells still confined within the milk ducts and haven't invaded surrounding tissue yet. In this context, we can think of DCIS—which is considered "pre-invasive" or Stage 0 cancer—as the "origin point" or the area where the invasive cancer most likely began before breaking through the duct wall. These DCIS cells were Grade II (Intermediate);  they appeared moderately normal and grew at a medium speed—not as slow as Grade I nor as rapid as Grade III.

Conclusion

It's a treatable, early-stage of breast cancer.

AFTER MASTECTOMY

Following MASTECTOMY, Anatomical Pathology revealed that it was DCIS present alongside chronic granulomatous mastitis caused by a foreign body in the right breast.

DCIS (Ductal Carcinoma In Situ)

As mentioned previously, this is a pre-invasive condition where abnormal cells are confined  within the milk ducts and haven't invaded surrounding tissue yet. It's not the same as invasive cancer but it's considered a precursor that it could potentially develop into invasive cancer if left untreated. In my case, DCIS was found alongside invasive Grade 1 cancer.

Chronic Granulomatous Mastitis due to Foreign Body

This is a benign inflammatory condition and completely separate from my cancer. Granulomatous Mastitis means my immune system formed a small clusters of immune cells (granulomas) in response to something perceived as "foreign".

Conclusion

The oncology team advised that special treatment for this is not needed since my whole right breast have been removed.

IHC (IMMUNOHISTOCHEMISTRY)

Immunohistochemistry (IHC) is a laboratory technique used in pathology to detect specific proteins (biomarkers) in tissue samples by using antibodies that bind to these proteins. In breast cancer, IHC is performed on tumor tissue obtained through biopsy or surgical resection to identify protein expression patterns that guide diagnosis, prognosis, and treatment decisions. This journal explained the significance of immunohistochemistry in breast cancer.

Hormone Receptors (ER/PR)

If positive → the cancer grows in response to hormones. The treatment that works well is usually hormonal therapy. 

ER+ (>80%) and PR+ (>80%)

My cancer cells have abundant receptors for estrogen and progesterone. This means the cancer is hormone-driven and hormone-responsive.

HER2 Protein

If positive→the cancer has too much HER2 and grows aggressively. Effective treatment is Anti-HER2 medicines.

HER2-negative (+1)

My cancer doesn't overexpress the HER2 protein, which means it lacks the aggressive growth signals associated with HER2-positive cancers. HER2-negative status in hormone receptor-positive disease generally indicates a more indolent (slower-growing) biology.

Ki-67

It shows how fast the cancer cells are dividing. High level result means that it's a faster-growing cancer which often needing chemotherapy.

Ki-67 <20%

A Ki-67 below 20% is considered low proliferation—meaning my cancer cells are dividing slowly. Thankfully, research consistently shows that low Ki-67 correlates with better long-term outcomes and lower recurrence risk, especially in hormone receptor-positive disease.

For Triple-negative (no ER, PR, or HER2), the treatment usually needs chemotherapy. Newer immunotherapy options may help as well.

Conclusion

IHC testing tells doctors what makes our cancer grow so they can pick treatments that specifically target those features—making therapy more effective and personalized. In my case, based on the IHC test result above, the systematic therapy plan that works best for me is indeed a hormonal therapy.

Zoladex or Goserelin 3.6 mg dose is the standard for monthly hormonal therapy. It's commonly used for hormone receptor-positive breast cancer in premenopausal women whose ovaries still produce estrogen. It induces a temporary medical menopause with symptoms may include hot flashes, mood changes, and bone thinning. Fertility usually returns after stopping treatment, or in my case—hopefully, after 2 years of hormonal therapy.

Nateran or Exemestane 25 mg blocks an enzyme called aromatase, which the body uses to make estrogen after menopause, and is used for early-stage of hormone receptor-positive breast cancer as adjuvant therapy after surgery.

Hormonal therapies like Zoladex (Goserelin) and Nateran (Exemestane) can cause bone thinning and increase osteoporosis risk so calcium suplements is needed to support bone and dental health.

𝓐𝓶𝓶𝓪 𝓝𝓲𝓪