Unlike many doctors, my surgeon, Dr. C, isn’t condescending at all. Au contraire, she speaks to me as if I have a medical degree or a doctorate in biology, spieling scientific lingo while I breathlessly scribble words I can’t spell, let alone define, like a hapless cub reporter.
So when she used cozy terms like “itty bitty” to describe the amount of cancerous cells left behind by the last surgery, I was instantly comforted, at least by my ability to grasp what she was saying.
“We’ll just re-excise to get out that teeny-weeny bit of breast tissue that’s near the skin,” she said. “We can do it at the same time as the sentinel lymph node biopsy.”
It was only several days later that I realized we were talking about a second lumpectomy.
The first one wasn’t bad. I never even needed pain pills; ice was good enough for the fairly minimal pain. Sure, the side of my breast now has a three-inch long shallow trough, the same size as if I’d pressed the length of my index finger against a sand castle. But I have ample breast tissue – you might call it a chubby-wubby amount. So surely I could spare an itty-bitty bit more.
But being near the skin isn’t the same as being on top of the skin. The plan is for a second incision with the attendant risk for infection, a new wound to heal, etc.
It’s not the worst thing in the world by far. I’ve already met several women who had to have a mastectomy instead of a second lumpectomy because they just didn’t have enough breast tissue to keep digging it out.
But it means that Thursday’s excursion to the Alta Bates OR will include at least two surgical procedures – three if they find cancer in the sentinel lymph nodes and have to take out the axillary lymph nodes.
Showing posts with label invasive ductal carcinoma. Show all posts
Showing posts with label invasive ductal carcinoma. Show all posts
Wednesday, September 1, 2010
Wednesday, August 18, 2010
Information overload: Pathology report
"Here's your pathology report, which is basically your breast cancer report card," Dr C said as we gazed at the three pages of single-spaced gobblety-gook. Mark and I had come to her office for the post-op visit.
Bottom line: I think I got a C+ or maybe a B-. Everything was sort of mid-range -- "not as good as it could be, but not as bad either," she said.
The tumor's "histologic grade composite (Nottingham)" was "II, tubule formation 3, nuclear grade 2, mitoses 1."
"Of course, you remember mitosis from high school biology," she said.
Mark nodded agreeably while I looked at her slack-jawed. Of course, I don't.
"Mitosis is the process of cell division." She went on to explain about spindle apparatus, chromosone centers, receptive nuclei and skewed arms, while I waited impatiently for the bell to ring so I could get to the cafeteria and strained to hear if that was "Band on the Run" coming in over the loudspeaker before the principal's announcement.
Anyway, my overall grade of II (on a scale of I to III) means that my chromosones are acting a little funky - bent arms, skewed. Grade I would mean they were normal; Grade III is seriously messed up. If I'm getting this right, the rate of cell division is mildly abnormal, and the way they're doing it is wacky.
The docs looked to see if any tumor cells were roaming around elsewhere in my breast and didn't see any, which was good. That was my favorite sentence of the report, and the only one in clear English: "The remainder of the breast is effectively unremarkable." Yay!!!! I'm thrilled to be unremarkable!
There definitely is some ductal carcinoma in situ - which she describes as "itty bitty and not super aggressive" and a tiny bit of additional invasive ductal carcinoma near the skin, so she will do a re-excision when I have the lymph node biopsy to get out every last bad cell.
Both estrogen and progesterone receptors were not just positive, but strongly positive, which means they will be treatable with tamoxifen. She mentioned taking it daily for 5 years.
HER2 status hasn't yet been determined, we should get a report on that soon.
She was totally supportive of my going to UCSF for a second opinion and gave me a referral.
Chemo still unknown based on the Oncotype DX score. But whether I have chemo or not, I definitely must have radiation. It will be every weekday for 6 to 8 weeks. Without radiation, there is a 30% chance that the cancer will return in that breast.
What are my risks for recurrence? They're highest in the first five years, she said, so I will be under "increased surveillance" with more frequent mammograms and at least an annual breast MRI (ugh, claustrophobia alert!).
She thinks I should stop eating soy at least until I'm on tamoxifen which would block its estrogen-like effects.
The lymph node biopsy will be Thursday, Sept. 2.
Bottom line: I think I got a C+ or maybe a B-. Everything was sort of mid-range -- "not as good as it could be, but not as bad either," she said.
The tumor's "histologic grade composite (Nottingham)" was "II, tubule formation 3, nuclear grade 2, mitoses 1."
"Of course, you remember mitosis from high school biology," she said.
Mark nodded agreeably while I looked at her slack-jawed. Of course, I don't.
"Mitosis is the process of cell division." She went on to explain about spindle apparatus, chromosone centers, receptive nuclei and skewed arms, while I waited impatiently for the bell to ring so I could get to the cafeteria and strained to hear if that was "Band on the Run" coming in over the loudspeaker before the principal's announcement.
Anyway, my overall grade of II (on a scale of I to III) means that my chromosones are acting a little funky - bent arms, skewed. Grade I would mean they were normal; Grade III is seriously messed up. If I'm getting this right, the rate of cell division is mildly abnormal, and the way they're doing it is wacky.
The docs looked to see if any tumor cells were roaming around elsewhere in my breast and didn't see any, which was good. That was my favorite sentence of the report, and the only one in clear English: "The remainder of the breast is effectively unremarkable." Yay!!!! I'm thrilled to be unremarkable!
There definitely is some ductal carcinoma in situ - which she describes as "itty bitty and not super aggressive" and a tiny bit of additional invasive ductal carcinoma near the skin, so she will do a re-excision when I have the lymph node biopsy to get out every last bad cell.
Both estrogen and progesterone receptors were not just positive, but strongly positive, which means they will be treatable with tamoxifen. She mentioned taking it daily for 5 years.
HER2 status hasn't yet been determined, we should get a report on that soon.
She was totally supportive of my going to UCSF for a second opinion and gave me a referral.
Chemo still unknown based on the Oncotype DX score. But whether I have chemo or not, I definitely must have radiation. It will be every weekday for 6 to 8 weeks. Without radiation, there is a 30% chance that the cancer will return in that breast.
What are my risks for recurrence? They're highest in the first five years, she said, so I will be under "increased surveillance" with more frequent mammograms and at least an annual breast MRI (ugh, claustrophobia alert!).
She thinks I should stop eating soy at least until I'm on tamoxifen which would block its estrogen-like effects.
The lymph node biopsy will be Thursday, Sept. 2.
Saturday, August 14, 2010
Getting the news
My hands were shaking, but my reporter's instincts kicked in. I grabbed my laptop and took the crappiest. notes. ever. as Dr. C delivered the news over the cell phone I'd been clutching in my sweaty palm all morning.
Biopsy results were in for the lump in my right breast. "The pathologist sees evidence of invasive ductal carcinoma." She paused a moment and then put it super-simply, in case I hadn't grokked those words. "That means you have breast cancer."
She quickly moved on to "the good news." The tumor was small, only 1 cm. (A day later, when the final pathology report was in, she upped that to 2 cm.) It was still being tested to see if it was positive for estrogen receptors and progesterone receptors; the pathologist thought it likely would be. If so, that might mean I could be treated with hormone blockers, rather than chemotherapy.
They think they removed all of it -- "got clear margins" -- but there is a chance there are still some cancerous cells near the skin that she would remove in a future procedure.
There are still some other unknowns. Has it spread to the lymph nodes? Since it's an invasive cancer, they need to check for that by doing a sentinel lymph node biopsy - another surgery under general anesthesia in which she'd made a small incision in my armpit and then remove one, two or three sentinel nodes. I asked if the pathologist who read my breast MRI had spotted anything on my lymph nodes and wriggled with automatic teacher's-pet pleasure when she said, "Good question." The answer wasn't entirely reassuring: "He noted that your lymph nodes were prominent but there was no sign of malignancy. They could have enlarged in reaction to the two needle biopsies you had earlier."
Since I'd spent the past week taking an accelerated medical course at Google U, I immediately asked about whether the lymph-node surgery could trigger lymphodema - a painful, debilitating and permanent condition in which your arm swells up with lymphatic fluid. (Warning: Do NOT read the Wikipedia entry on this, and do NOT look at the gruesome photographs therein.) She said the risk was only 3%, since she's be removing very few nodes.
She paused and said, "You're taking this remarkably well."
I mumbled something lame. "Well, what else can I do?" (Later, I thought of a few things: Cry, scream, throw things, curse at her, curse at the universe, etc.)
Next she'll send the cells they extracted for a test called Oncotype DX, which looks at 21 different gene types present in the tumor. The results will help determine if I should have chemo or not.
She wrapped up with the ultimate good news (and her cell phone number). "This is 100% surviveable. It's just a matter of jumping through hoops to get the appropriate treatment."
Biopsy results were in for the lump in my right breast. "The pathologist sees evidence of invasive ductal carcinoma." She paused a moment and then put it super-simply, in case I hadn't grokked those words. "That means you have breast cancer."
She quickly moved on to "the good news." The tumor was small, only 1 cm. (A day later, when the final pathology report was in, she upped that to 2 cm.) It was still being tested to see if it was positive for estrogen receptors and progesterone receptors; the pathologist thought it likely would be. If so, that might mean I could be treated with hormone blockers, rather than chemotherapy.
They think they removed all of it -- "got clear margins" -- but there is a chance there are still some cancerous cells near the skin that she would remove in a future procedure.
There are still some other unknowns. Has it spread to the lymph nodes? Since it's an invasive cancer, they need to check for that by doing a sentinel lymph node biopsy - another surgery under general anesthesia in which she'd made a small incision in my armpit and then remove one, two or three sentinel nodes. I asked if the pathologist who read my breast MRI had spotted anything on my lymph nodes and wriggled with automatic teacher's-pet pleasure when she said, "Good question." The answer wasn't entirely reassuring: "He noted that your lymph nodes were prominent but there was no sign of malignancy. They could have enlarged in reaction to the two needle biopsies you had earlier."
Since I'd spent the past week taking an accelerated medical course at Google U, I immediately asked about whether the lymph-node surgery could trigger lymphodema - a painful, debilitating and permanent condition in which your arm swells up with lymphatic fluid. (Warning: Do NOT read the Wikipedia entry on this, and do NOT look at the gruesome photographs therein.) She said the risk was only 3%, since she's be removing very few nodes.
She paused and said, "You're taking this remarkably well."
I mumbled something lame. "Well, what else can I do?" (Later, I thought of a few things: Cry, scream, throw things, curse at her, curse at the universe, etc.)
Next she'll send the cells they extracted for a test called Oncotype DX, which looks at 21 different gene types present in the tumor. The results will help determine if I should have chemo or not.
She wrapped up with the ultimate good news (and her cell phone number). "This is 100% surviveable. It's just a matter of jumping through hoops to get the appropriate treatment."
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