Sunday, August 23, 2009

TMI-Not For the Squeamish

You were warned!

Let me just say that (to paraphrase Mark Twain), the rumors of my death (or impending death) are greatly exaggerated!

Read on at your own peril.

Here's what's going on:

In April, I had a "suspicious" mammogram that was followed up with ultrasound. A small calcification that they had been following for years (since 2002?) appeared to be growing. It was pinpointed and I was referred to a surgeon. A stereotactic biopsy was performed. The diagnosis was atypical ductal hyperplasia (ADH) and though it appeared non-malignant, a lumpectomy was recommended because ADH can lead to other more serious things.

I had the lumpectomy. Pathology report came back showing ductal carcinoma in situ (DCIS) of about 2 mm, stage 0 (that's zero, and ironically, about the size of a size 0 (US) knitting needle) cancer, non-invasive, right at the edge of the surgical site.

A second surgery was performed a month later to obtain "clean margins," which were, indeed, clean. An MRI follow-up confirmed that there were no remaining malignant cells.

The next recommendation was for a very intense, short-term radiation treatment (brachytherapy) in which a balloon catheter is implanted and a radioactive seed the size of a grain of rice is inserted 2 times a day for 5 days. This is to prevent recurrence. The device was inserted, and I was facing 10 days (in this heat) without showers and/or deodorant. A CT last Friday revealed that there was insufficient tissue between the catheter and the skin to prevent burning to the skin. The device was removed and I was referred for "traditional" radiation.

I saw the radiologist last Wednesday, and asked point blank, "Why am I doing this?"

Since the answer wasn't definitive. . .

Right now, I am weighing my options. There is no reason to rush and several good reasons to wait. DCIS has about a 5-10% recurrence rate after 10 years no matter what treatment is employed. If I have radiation now, and it recurs, I may not be a candidate for further radiation. Medical options (Tamoxifen) to prevent recurrence are available. I am meeting with a medical oncologist to discuss them in a week.

Never mind that being zapped 33 times that close to my heart, lung, and ribcage scares the bejeezus out of me.

Keep a good thought, please, but don't worry. I am bigger than this!

And let me just add for those women who dislike the discomfort of a mammogram--I didn't feel anything, nada, zero, zilch! Find something 2 mm in diameter. It's about the thickness of a pencil lead. Smaller than a BB, a lot! Bigger than a poppy seed, but not much. Would you have felt that through layers of skin and fat? I didn't! And probably would not, even if I had known exactly where to feel.

Don't put off routine tests!



Hi Ann,

Thank you for the update. It clarifies everythng so well. Being the smart gal you are, I know your take charge way and so much info the best you can get, will satisfy you in the end. you will be able to live with your decision and carry on as you always have. I think in time you will notice in yourself a shift, that you did not expect, a place that you will find peace about this whole interlude, and being a helpful hand for others in the same or similar situation. So,to go with the flow is not a bad idea,but you know that already.

You are doing well, Ann and keep on "trucking", I'm with you all the way, Rita

Your knitting is just beautiful, I love that blue blanket, and marvel at your ability.
glad you're doing well --- I hope you have good insurance!
Ann, you are being very smart ( and very brave, as this is a big diagnosis to swallow). You are absolutely right in your thoughts about the radiation treatments now, vs the potential need later. Yes, radiation to the breast does indirectly expose the heart, lungs, don't forget the esophagus. My mom has to have frequent esophageal dilatation as a result of her breast radiation but a small price to pay for her 20 years and still going of life afterward. Nevertheless it's something to consider.
Thank you for keeping us informed. We care about you and are more concerned when you don't tell us what's going on as we can sense it's something.
Hope the med. oncologist has good news this week.
Ann, never say this is TMI - we all need to know as much as possible about such an important subject. Thank you for sharing your situation with us all, and for reinforcing the need for all of us to keep on getting mammograms. Holding good thoughts for you,
I had come to my own conclusion about what was going on based on what you had been saying in your blogs. We survivors of this plague can read between the lines since we've been through something similar and know the signals.
Trust your instincts--after getting as much good information as you can. I've survived it all-surgeries, chemo, radiation--to deal with Stage IIIB. The side effects are a trade-off, which I accept since I was not expected to survive my breast cancer.
That was nearly 13 years ago. Still here.
Amen, sister! Your case sounds very similar to mine, except mine was found to be cancerous after the biopsy and I *did* have the traditional radiation treatments after my lumpectomy. Am now on Tamoxifen. So glad things worked out well for you, and good luck in the future.

Just had a follow-up mammogram and ultrasound today, in fact. ;-)
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