I learned on Tuesday that I needed a biopsy of my left breast to check out an area that my surgeon and radiologist felt warranted extra attention given my diagnosis on the right side. So this morning, I took my girls to school then headed to the radiologist's office for another biopsy.
UCSF explains the Sterotactic Core Biopsy as, "Stereotactic core biopsy was developed as an alternative to surgical biopsy. It is a less invasive way to obtain the tissue samples needed for diagnosis. This procedure requires less recovery time than does a surgical biopsy, and there is no significant scarring to the breast. Your physician, the radiologist and you may consider this type of biopsy when there is an abnormality found on a mammogram that cannot be felt."
Here is how it works in reality - you lay on a table with a hole cut out for your breast (btw, the tables are not really made for women taller than 5'8"!). While you lay there, the breast is mushed into a mammogram machine under the table while the radiologist looks at real-time views to locate the "area of interest". Once it is located and he's marked up the breast with magic marker, they make a small incision and insert a needle that is attached to a vacuum that sucks out cells from the area. Then, the cells are sent off to be X-rayed and the patient (me) gets mushed some more to stop the bleeding (try making small talk with a woman holding your boob for 15 minutes!). After all that, you go get a mammogram of the breast they just biopsied (seriously unfun). Now, this is certainly nothing like the surgical biopsy I had a few weeks ago, but really not a cake walk, either.
Afterwards, I was given directions to go home and lie down for 2 hours then rest at home the remainder of the day. So of course, I went home, decided I felt just fine, packed my bra with an ice pack and went to work. Seriously bad idea. The numbing medication wears off a couple of hours after the procedure and things get quite painful. And, if one has not been resting, you feel really bad, too. Next time, LISTEN to the resting advice.
After the procedure, my radiologist came to talk with me. He works closely with my surgeon and knows my diagnosis. I'd already told him that, if the biopsy showed anything at all, the left side would have to go with the right side. So I suppose he wanted me to have all of the information. He explained that with this type of biopsy, the collection is only a small portion of the cells. If I keep the left breast, her wants me back in 6 months and then every six months for a couple of years. And, if anything changes, a full biopsy will have to be done. Great.
With all of the advances in breast cancer treatment, it seems that the only real way to be sure it doesn't advance or come back is to have the breasts removed. I understand that mastectomies today are not as radical as in the past in terms of lymph node removal, but removing the breasts is just that. I do get that reconstruction is an option, but not immediately, at least not in my case.
Tomorrow I'm meeting with a friend of a friend who has gone through this already and decided to do a double. Reality is setting in that I probably shouldn't try to keep either breast.
Thursday, August 30, 2007
Wednesday, August 29, 2007
Telling friends and family
I'm at the point in my diagnosis that I really have to start telling my friends and family what is going on. While there are a few people who know already, it is the friends I see less frequently and the family to whom I am reluctant to tell this kind of news that I really need to address now.
I sent an email last night to the women of the mothers group I joined more than 8 years ago when my oldest was born (can it be that long ago?). We have remained in contact and pretty close over the years, even with different schools and moves and all the changes families go through over the years. These are women I admire and care for. It was unbelievably difficult to tell them that I have cancer. Another mom and a dear friend in our group was diagnosed earlier this year with breast cancer and I know, at least for me, the news was devastating. To see a friend in pain is so hard. I don't want to increase their distress but I don't want to hide what is happening either.
I ran into one of the moms a few weeks ago at the grocery store and, in that moment, I realized that I had to find a way to tell them the news and to give them the opportunity to help out if they wished. The middle of Safeway is just not the place to break this kind of news.
It is that last piece that I still need to get and accept. I will need help. I'm not very good at accepting help; never have been. My husband, and now my boss (have I mentioned that my boss is a Pastor?) feel it is impotant that I accept that I will need help through this, both with the day to day activities (soccer, school, gymnastics, groceries, etc.) and with the emotional and mental toll (therapy, really?). So, while I think about the whole "professional listener" thing, I am taking steps to ask for help with the stuff I can quantify. The Yahoo Group and calendar should be set up soon. A friend is helping me get this together and will help me add friends and family to the group to let people help me.
If I haven't said it enough, I am very grateful for the help my friends and family have offered, and I do humbly accept. I'm not as clear about the depth of my thanks in person. Thank you all for the help you have offered and the help you will provide in the coming months.
I sent an email last night to the women of the mothers group I joined more than 8 years ago when my oldest was born (can it be that long ago?). We have remained in contact and pretty close over the years, even with different schools and moves and all the changes families go through over the years. These are women I admire and care for. It was unbelievably difficult to tell them that I have cancer. Another mom and a dear friend in our group was diagnosed earlier this year with breast cancer and I know, at least for me, the news was devastating. To see a friend in pain is so hard. I don't want to increase their distress but I don't want to hide what is happening either.
I ran into one of the moms a few weeks ago at the grocery store and, in that moment, I realized that I had to find a way to tell them the news and to give them the opportunity to help out if they wished. The middle of Safeway is just not the place to break this kind of news.
It is that last piece that I still need to get and accept. I will need help. I'm not very good at accepting help; never have been. My husband, and now my boss (have I mentioned that my boss is a Pastor?) feel it is impotant that I accept that I will need help through this, both with the day to day activities (soccer, school, gymnastics, groceries, etc.) and with the emotional and mental toll (therapy, really?). So, while I think about the whole "professional listener" thing, I am taking steps to ask for help with the stuff I can quantify. The Yahoo Group and calendar should be set up soon. A friend is helping me get this together and will help me add friends and family to the group to let people help me.
If I haven't said it enough, I am very grateful for the help my friends and family have offered, and I do humbly accept. I'm not as clear about the depth of my thanks in person. Thank you all for the help you have offered and the help you will provide in the coming months.
Tuesday, August 28, 2007
Statistics and Breast Cancer
According to the Northern California Cancer Center (http://cancer.stanford.edu/features/research_news/nccc-report.html), rates for breast cancer in all races/ethnicities have declined since 2000, and more dramatically since 2003. Among white women in Santa Clara County, the rates are 154 per 100,000 women.
I recently learned that I'm one of the 154.
With no family history of breast cancer, no personal history of smoking, a lean body type, successful nursing of my first child for more than 3 years, and a vegan diet for more than 20 years, I never expected to fit into that statistic. According to the American Cancer Society, my risk factors are that a) I'm female and b) I gave birth to my first after age 30.
Yet, with all of that, I now find myself with T1c cancer, meaning I'm Stage 1, but the cancer is invasive and the largest of the tumors is over 1cm. At the end of September I'll be having a mastectomy and sentinal node biopsy.
I suppose I should back up. I've been having mammograms every year for the past 5 years, ever since one doctor felt a little lump in my left breast. It turned out that the left breast was fine, but the right breast had a small bit of microcalcification. So, every year after that, I had a mammogram and the radiologists would check the 2002 films to confirm no changes. There never were any, until this June.
Following my annual mammogram, I was called back for more views, ultrasound and 3D ultrasound of both breasts. During that visit, the radiologist looked at everything and said he'd like to look at it a bit more closely and would send a report to my gynecologist. A week later my gynecologist 's nurse called me to say that the radiologist called their office and left a message, which he apparently never does, so it would be a good idea to meet with a surgeon to see if a biopsy was needed. When I met with the surgeon 2 weeks later, it wasn't a question of "if" but "what kind" of biopsy would be done.
On August 7th, my 41st birthday, I had an excisional biopsy of my right breast. At the end, I asked the surgeon how it looked and she replied, "mostly ok". With that noncommital response, I decided to just try not to think about it for the next 7 days until the results came back. The surgeon's office called 2 days after sugery asking me to come in the next day with my husband. So much for the "mostly".
The initial pathology was optimistic. Very early stage 1; 3 very small tumors, all DCIS (Ductal Carcinoma in Situ). It could be resolved with either breast conservation surgery and radiation, or mastectomy with no further treatment. The surgeon assured me it was 100% curable and to just spend the next few days thinking about which surgical option would work best for me. She expected the final pathology to come back the next week.
The final pathology came back almost 3 weeks later, and things have changed a bit. There were no clean margins in the biopsy, meaning the whole 2x2x1 inch tissue sample was cancerous. The cancer is not only DCIS, but also IDC (invasive ductal carcinoma) and the largest of the 3 tumors measures 1.1cm. This all means that mastectomy is the only surgical option, and I will be having a biopsy of the left breast on August 30 to see if it will be a double or single. It also means a sentinal node biopsy during the mastectomy. Following the mastectomy, I'll meet with an oncologist to go over the remaining treatment options which, at this point, appear to be: Chemo, Tamoxifen, and potentially some other hormone blockers (adjuvent therapies).
So there we are. Random breast cancer.
I recently learned that I'm one of the 154.
With no family history of breast cancer, no personal history of smoking, a lean body type, successful nursing of my first child for more than 3 years, and a vegan diet for more than 20 years, I never expected to fit into that statistic. According to the American Cancer Society, my risk factors are that a) I'm female and b) I gave birth to my first after age 30.
Yet, with all of that, I now find myself with T1c cancer, meaning I'm Stage 1, but the cancer is invasive and the largest of the tumors is over 1cm. At the end of September I'll be having a mastectomy and sentinal node biopsy.
I suppose I should back up. I've been having mammograms every year for the past 5 years, ever since one doctor felt a little lump in my left breast. It turned out that the left breast was fine, but the right breast had a small bit of microcalcification. So, every year after that, I had a mammogram and the radiologists would check the 2002 films to confirm no changes. There never were any, until this June.
Following my annual mammogram, I was called back for more views, ultrasound and 3D ultrasound of both breasts. During that visit, the radiologist looked at everything and said he'd like to look at it a bit more closely and would send a report to my gynecologist. A week later my gynecologist 's nurse called me to say that the radiologist called their office and left a message, which he apparently never does, so it would be a good idea to meet with a surgeon to see if a biopsy was needed. When I met with the surgeon 2 weeks later, it wasn't a question of "if" but "what kind" of biopsy would be done.
On August 7th, my 41st birthday, I had an excisional biopsy of my right breast. At the end, I asked the surgeon how it looked and she replied, "mostly ok". With that noncommital response, I decided to just try not to think about it for the next 7 days until the results came back. The surgeon's office called 2 days after sugery asking me to come in the next day with my husband. So much for the "mostly".
The initial pathology was optimistic. Very early stage 1; 3 very small tumors, all DCIS (Ductal Carcinoma in Situ). It could be resolved with either breast conservation surgery and radiation, or mastectomy with no further treatment. The surgeon assured me it was 100% curable and to just spend the next few days thinking about which surgical option would work best for me. She expected the final pathology to come back the next week.
The final pathology came back almost 3 weeks later, and things have changed a bit. There were no clean margins in the biopsy, meaning the whole 2x2x1 inch tissue sample was cancerous. The cancer is not only DCIS, but also IDC (invasive ductal carcinoma) and the largest of the 3 tumors measures 1.1cm. This all means that mastectomy is the only surgical option, and I will be having a biopsy of the left breast on August 30 to see if it will be a double or single. It also means a sentinal node biopsy during the mastectomy. Following the mastectomy, I'll meet with an oncologist to go over the remaining treatment options which, at this point, appear to be: Chemo, Tamoxifen, and potentially some other hormone blockers (adjuvent therapies).
So there we are. Random breast cancer.
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