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The Results (so far)

14 Aug

The Breast Blog #11

The Results.

August 10, 2011 and August 14, 2011

The long wait is over and the results are now in.  And the winner is….

Just kidding.   I don’t like to categorize things as “winning” or “losing.”  There is a glass half-full and a glass half-empty way of looking at everything.  The pathology results are: they did find ductal carcinoma in situ (DCIS) in my right breast.  The good news is this is the earliest stage of breast cancer and is highly treatable.

My gut reaction upon hearing the news was, surprisingly, that I was not surprised.  I actually found myself  a little calm and definitely relieved to finally have a diagnosis.  The surgeon herself called me.  I suspect she’s used to people being a little more teary.

Of course we don’t yet know about the left breast.  But now that I have a cancer diagnosis, apparently there is a program that will pay for me to have an MRI so that we can have a better idea of what we’re dealing with.  And I am happy to report that my doctor went out of her way to squeeze me in for an appointment the next day (during her lunchtime!) so that I could ask the myriad questions I have about the diagnosis and we could decide what to do.

The day I got the news was an exquisitely beautiful day weather-wise, and I found myself feeling quite happy.  And the following day, the day of my doctor appointment, was also really beautiful.  I truly enjoyed my appointment with her.  After she used an ultrasound to check the placement of the titanium marker placed within my breast during the stereotactic biopsy, we went into her office to talk about the diagnosis and the upcoming surgery next Monday (August 22nd) for the second biopsy (on the left breast) and a lumpectomy (on the right.)  She has a beautiful peaceful office and we sat side by side at a round table.  I had the opportunity to ask the 25 questions I had (yes, literally 25) and we went through them pretty quickly.  (However, even though I wrote my questions down, I still forgot one or two.  A friend had suggested bringing a tape recorder and I do concur that that is a very good idea.)  Then she gave me one of her books that she authored (The Healing Consciousness: A Doctor’s Journey to Healing,) a rose crystal heart with a pouch, and a big hug.  I really do like this woman.  How many doctors give their patients hugs, I ask you.  My kind of doctor.  (And she’s a top notch, well-known surgeon as well.  Dr. Beth DuPree’s skin-sparing mastectomies with plastic surgeon Robert Skalicky, D.O. were featured live on the Internet in October 1999.)

Those of you who were waiting to hear the news of my biopsy, are no doubt aware that I waited several days to post this news.  I allowed myself time to sit with it and digest it.

When I got the news, at first I did a flurry of research on DCIS.  But then I realized I needed to get off the laptop and sit outside and “be” a bit.  I also was feeling called to review my dreams again, because they give me a lot of guidance and information.  I cancelled two appointments I had later that day and truly gave myself some space.  I did not answer most calls or text messages.  I sat out on my porch and enjoyed the breezes, the wind chimes, the sun and the puffy clouds.  In the evening, I laid out on my massage table, played healing music, and invited angels and guides to be with me. I think all this helped me to retain a feeling of calmness.

Later the next day, after the doctor appointment, I swam for the first time since the biopsy.  I returned the calls of a few very dear friends.  But then I began to once again do research, and the news about the lumpectomy began to sink in.  My breasts as I had come to know them, were about to change.  My body was going to be operated on.  I was going to get an MRI.  I was going to be lying down in a tunnel while loud noises whirred around me.  I was going to get my first ever chest x-ray (and I am nervous about radiation.)  I was going to get anesthesia for the first time.  I was going to have scalpels cut into my tender breast tissue.  I was going to get more information about whether or not there were other spots of cancer.  I had to decide whether or not I was going to get radiation therapy along with the lumpectomy.  My calmness began to evaporate as all this began to sink in and I began to stress about the details.  An email from a friend (a cancer survivor) said, “I do get the sense to remind you to ‘breathe’. With so much going on during your days and nights I can imagine a contraction building in your chest…(no surprise..:)…and your gut… (no surprise..;)”

Thank you, Joyce.  Somehow I was unaware that I’d forgotten to breathe and that I was indeed getting stressed and anxious.  I know all these spiritual and healing tools and techniques – breathing, prayer, meditation, toning, tai chi, walking, journeying, art, etc. – and yet when I am in the midst of my fear, I can’t seem to focus on any of these tools!  Apparently I needed a friend to remind me to breathe.  So I breathed, and the next day I asked a friend to go to the shore with me.  Being in the water, bobbing in the gentle ocean, feeling the support and love of all that healing salty water, feeling the sweet sun upon me, lying on the sand… it was JUST what I needed.

The day after that was filled with good stuff.  Another good friend had very, very generously offered me a few acupuncture sessions, gratis.  (Bless you, Andie.)[1]  And while lying on the table with lots of very fine needles tucked gently into my skin, touching just the right areas to help adjust the flow of energy in my body, I had my first big emotional release since the diagnosis.  I didn’t indulge in full-blown wailing since my friend was right outside the door.  (Interesting how I still have this “protective” habit.  I did not want to distress her, but actually I didn’t want her coming in to offer comfort either.)  My body was wracked with silent sobs and one little keen escaped my lips.  I needed that emotional release, I know I did.  And I seemed to be experiencing other releases as well as my legs continued to “jump” while I was lying there resting.  (Oftentimes these “jumps” and jolts and mini-spasms happen when I am lying on my back receiving any kind of healing ministrations.)

After that I bought a couple sports bras.  I was told I would need them for support post-surgery.  Then I headed over to my friend Mel’s.  She’s another cancer survivor and a long-time dear friend.  Her path through cancer was a spiritual adventure and she emerged not only physically healthier, but more confident than I’ve ever seen her.  I was meeting with her so she could offer some insights to my dreams and also help coach me with regard to my diet.  (I’d already begun making big changes.  After the diagnosis, I began a vegetarian diet and I cut out all junk food.)

Then after my time with Mel, I went home to begin cooking a healthy meal for me and my friend, Cindee.  (Brown rice with chlorella, tofu sautéed with turmeric, garlic and an organic non-salt seasoning, and black beans over a bed of fresh arugula; homemade coleslaw; and local corn on the cob.)  We ate together, talked, howled at the rising full moon, and had the delicious pleasure of watching a movie outside, in the yard, moon shining brightly, with a bowl of home-popped and seasoned popcorn and the company of my housemate and his lady friend and her son.  I noticed one remaining lone firefly flickering off and on in front of the screen.

I had two full and delightful days filled with friends and Nature.  It was good for me to stop isolating and to get away from my obsessive thoughts.  I need to remember this balance.  Time alone is critically important.  And time with friends is essential, too.  Time in my home is cozy, and time “out in the world” helps shift my energy so I don’t become too despondent.  Balance, balance, balance.

Okay, now it’s time to return to the educational portion of this blog.

So… “Ductal carcinoma in situ (DCIS)

is the most common type of non-invasive breast cancer. Ductal means that the cancer starts inside the milk ducts, carcinoma refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs, and in situ means “in its original place.” DCIS is called “non-invasive” because it hasn’t spread beyond the milk duct into any normal surrounding breast tissue. DCIS isn’t life-threatening, but having DCIS can increase the risk of developing an invasive breast cancer later on.

When you have had DCIS, you are at higher risk for the cancer coming back or for developing a new breast cancer than a person who has never had breast cancer before. Most recurrences happen within the 5 to 10 years after initial diagnosis. The chances of a recurrence are under 30%.

Women who have breast-conserving surgery (lumpectomy) for DCIS without radiation therapy have about a 25% to 30% chance of having a recurrence at some point in the future. Including radiation therapy in the treatment plan after surgery drops the risk of recurrence to about 15%. If breast cancer does come back after earlier DCIS treatment, the recurrence is non-invasive (DCIS again) about half the time and invasive about half the time. (DCIS itself is NOT invasive.)

According to the American Cancer Society, about 60,000 cases of DCIS are diagnosed in the United States each year, accounting for about 1 out of every 5 new breast cancer cases.”  http://www.breastcancer.org/symptoms/types/dcis/

Pathology Report

  1. I discovered that I had had an “8 gauge mammotome stereotactic biopsy.”

A breast biopsy using the Mammotome® Biopsy System can help a doctor make a highly accurate breast cancer diagnosis without the need for open breast biopsy surgery. Through the use of computer imaging (x-ray, ultrasound, and MRI), a breast abnormality can be clearly identified and mapped, even in its earliest stages. Digital imaging enables a physician to guide the Mammotome probe to gently collect tissue samples through one small ¼-inch incision.

With the Mammotome Biopsy System, a breast biopsy can be performed in an outpatient setting or a doctor’s office under local anesthesia. A doctor can make a precise analysis with minimal pain, scarring and recovery time. The entire procedure generally takes less than an hour, and patients can return to their normal daily activities immediately afterward.  (Cindy’s note: There were, in fact, some restrictions.  No lifting or massaging or vacuuming for 2-3 days and no swimming for a week.)  http://www.breastbiopsy.com/

  1. They discovered “Ductal carcinoma in-situ with lobular extension.”

Well, I’m trying to figure out what that “lobular extension” part means, but so far all sites are too technical for this layperson.  It sounds to me like it is starting to extend out into surrounding tissue, but then it wouldn’t be in-situ.  So I’m confused.  I will have to add this to the list of questions to ask my doctor.

  1. The “architectural pattern” is “comedo, solid.”

“Comedo type DCIS (also referred to as Comedocarcinoma) tends to be more aggressive than the non-comedo types of DCIS.  Pathologists are able to easily distinguish between comedo type DCIS and other non-comedo types when examining the cells under a microscope because comedo type DCIS tends to plug the center of the breast ducts with necrosis (dead cells).  When necrosis is associated with cancer, it often means that the cancer is able to grow quickly.  Necrosis is often seen with microcalcifications (tiny calcium deposits that can indicate cancer).” http://www.imaginis.com/breast-health/ductal-carcinoma-in-situ-dcis-3

  1. “Nuclear grade II-III”

Nuclear grade refers to the size and shape of the nucleus in tumor cells and the percentage of tumor cells that are dividing….  Based on the microscopic appearance of cancer cells, pathologists commonly describe tumor grade by four degrees of severity: Grades 1, 2, 3, and 4. The cells of Grade 1 tumors resemble normal cells, and tend to grow and multiply slowly. Grade 1 tumors are generally considered the least aggressive in behavior.  Conversely, the cells of Grade 3 or Grade 4 tumors do not look like normal cells of the same type. Grade 3 and 4 tumors tend to grow rapidly and spread faster than tumors with a lower grade.”  http://www.cancer.gov/cancertopics/factsheet/detection/tumor-grade

  1. “Necrosis: present, central”

See #3 above.

  1. “Tumor size (aggregate): 0.55 cm”

This is considered relatively small.

  1. “Tumor is present in four out of sixteen submitted tissue cores.”

I assume this is not bad.

  1. At the time of my doctor appointment, they had not yet determined “hormone receptor” status.

“Estrogen and Progesterone receptor status tests will show whether or not one or both of those hormones fuel your tumor. Cancer that is hormone-sensitive is slightly slower growing and has a better chance of responding to hormone-suppression treatment, than cancer that is hormone receptor negative. Hormone-negative cancer will respond to other kinds of treatment, and hormone-suppression may not be needed.”  http://breastcancer.about.com/od/diagnosis/p/hormone_status.htm

  1. The pathology report also did not reveal HER2 status.

“HER2, which is also called HER2/neu, and HER-2, is the acronym for human epidermal growth factor receptor 2. Knowing your HER2 status is an important part of your diagnosis.  HER2 is a gene that sends control signals to your cells, telling them to grow, divide, and make repairs. A healthy breast cell has 2 copies of the HER2 gene. Some kinds of breast cancer get started when a breast cell has more than 2 copies of that gene, and those copies start over-producing the HER2 protein. As a result, the affected cells grow and divide much too quickly.”  http://breastcancer.about.com/od/diagnosis/p/her2_diagnosis.htm

If HR2 status is positive, there is a better overall outcome as the cancer may respond well to hormonal therapy.

So folks, the upshot as I understand it is that I have Stage 0 cancer, which means it is highly treatable, and if treated properly, the five-year survival rate is 100%.  According to my surgeon, the information received from Pathology thus far (using the Van Nays Prognostic Index) shows that I have 6.5 – 8 (based on a 1-12 scale) which reflects a medium chance of a faster-growing, slightly more aggressive DCIS and that the recommendation is generally a lumpectomy plus radiation therapy, as opposed to only a lumpectomy (lower on the index) or a complete mastectomy (9-12 on the index.)

On Tuesday I receive my first MRI, a chest x-ray (unfortunately, mandatory so that they can be sure ahead of time there are no serious heart or lung problems,) and pre-testing (blood draws/testing) for the surgery.

“What is a Breast MRI?
Magnetic resonance imaging (MRI) is a noninvasive imaging technique that uses no compression, x-rays, or radiation. An MRI creates a detailed picture of the internal architecture of your breast tissue. Most MRI machines produce a digital image, which a radiologist can examine on a computer, or print out for study. This type of image can be done with or without the use of contrast agent.

Why Are Breast MRIs Used As Part of a Diagnostic Workup?
You’ve already had a mammogram, and perhaps an ultrasound and a biopsy. A breast MRI might also be done for some patients, to get more information about your cancer, or to see if tumors are responding to treatment. Mammograms are much less expensive than MRIs, and are good at detecting DCIS as well as calcifications. Breast MRI can image both breasts at once, and works well even with dense breast tissue. It is good at finding invasive breast cancer, imaging around breast implants, and detecting possible spread of cancer beyond the primary tumor. A breast MRI is also effective at finding unsuspected cancer in the other breast, which would allow for early treatment of both tumor sites at once. For women at high risk of breast cancer, an MRI would be a good way to fully screen the breasts and axilla.”  Breastcancer.about.com

I am hoping and praying for a clear MRI and a benign condition in my left breast.   I am praying that the HER2 and hormone receptor statuses are optimal.   If such is not the case, I’m sure I will be strongly encouraged to get radiation therapy, and/or drugs (to address the hormone receptor issue), and/or a mastectomy.

I desperately want to avoid a mastectomy, if at all possible.  What I am realizing is that IF there is more going on than is currently indicated, I probably need to ask the hospital to postpone the surgery a week or so, so that I have the time to come to a place of peace about my treatment options and make the right decisions for me.

I did read somewhere the following:

“Note: Though DCIS is a serious condition requiring careful attention, it is not an emergency medical situation. Women have a sufficient period of time to educate themselves and weigh all possible treatment and reconstructive options before any decisions need to be made. Women should maintain an open dialogue with their physicians to best understand the disease and the variety of treatment options.”  (I’m sorry but I forgot to write down the website.)

I have to remember that I HAVE THE RIGHT to make my own choices.  And this takes time.  I will, of course, educate myself as much as possible, ask questions of doctors and former breast cancer patients, and look at my dreams.  I will sit in silence and take walks and play music and give myself a bit of time to receive some divine guidance.  These are important decisions and not to be rushed into.

If you feel inclined, I’d be grateful for a “blessing of my breasts.”  And feel free to send some loving, healing energy my way.  And, of course, to all the dear people on this planet struggling with whatever are their particular issues.

I am aware that this is a growth opportunity for me.  I hope to change and grow and evolve throughout this process.   I hope to become more healthy – physically, mentally, emotionally, and spiritually.  If I succeed in that, then “it’s all good.”

May you be well!

Peace be with you.

Cindy


[1] Andrea Deardorff, Inner Garden Acupuncture.  (I recommend her highly.  And please don’t ask for any free sessions!!!)

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