Breast MRI Jun 6th

Magnetic Resonance Imaging (MRI) - Breast

Magnetic resonance imaging (MRI) of the breast uses a powerful magnetic field, radio waves and a computer to produce detailed pictures of the structures within the breast. It is primarily used as a supplemental tool to breast screening with mammography or ultrasound. It may be used to screen women at high risk for breast cancer, evaluate the extent of cancer following diagnosis, or further evaluate abnormalities seen on mammography. Breast MRI does not use ionizing radiation, and it is the best method for determining whether silicone breast implants have ruptured.

6/6/16 - Findings:

There is mild background breast parenchymal enhancement. The breast composition is scattered fibroglandular elements. There is an approximately 7 mm x 8 mm x 7 mm, mildly irregularly marginated, heterogeneously enhancing mass, with mixed slow progressive, plateau and washout type internal enhancement kinetics, in the anterior depth of the parenchyma of the 6:00 to 7:00 radian of the left breast (e.g., series 8003, image 136), and with a HydroMARK biopsy marker abutting its superior margin; this is the known sonographically evident recently biopsied invasive breast carcinoma.

Also noted are multiple, sub‐1 cm in mean diameter, areas of clumped nonmass enhancement, with slow progressive type internal enhancement kinetics, scattered in the anterior depth of the parenchyma of the left breast from the 6 o'clock through the 10 o'clock radians (e.g., series 8003, images 568‐614), and which are likely sites of multifocal, and possibly even mildly multicentric, DCIS. This nonmass enhancement pattern partially corresponds to the recently biopsied malignant pleomorphic segmentally distributed left_ breast calcifications seen on mammography but also suggests that the mammographically evident calcified DCIS may slightly underestimate the extent of residual DCIS in the patient's breast.

LDex Screening

http://www.breastcanceranswers.com/ldex-score-how-it-helps-to-monitor-lymphedema-risks/#.V2qJcrgrKCg

This is about an LDex.

The Beginning of Treatment

June 2, 2016 – I met with my cancer surgeon – Dr Lisa Torp.  7:45 am . . . my world changes in an instant.  Dr Torp is extremely intelligent, very compassionate and gave us every detail possible. 

She started by showing us the mammogram films.  She said my breasts are not dense at all and that helps with finding anything.  The cancer is in the inner part of the breast.  She showed the areas in the ducts that they believe the carcinoma insitu is. 

The carcinoma is less than ¼ of my breast -  not too small but not overly large.

There is a lymph node that looks abnormal – (this is not the sentinel node)

Ductal cancer – most cancers start within the milk ducts.

DCIS – I have one area of invasive cancer 9mm or (slightly less than 1 cm) (1/3 of an inch) – this is possibly the largest area of invasion.  We will not know for sure until after surgery.

Right Now I am considered Stage I.

They look at additional information – they look at the cells and the pathologist assigns a score= grade on how cells look, if they are organized or aggressive.

High grade means they are more aggressive cells and they are more disorganized

They look at breast panel or markers such as estrogen receptors.  If there is no estrogen positivity (not estrogen sensitive) this is a poor indicator and it is a more aggressive cancer. Pills would not be used for this invasive cancer.

The DCIS in the ducts showed a 5% positivity – not a strong factor – we could use pills such as tamoxifen.  This will be retested after surgery.

I have HER2 neu positivity with ER negative and PR Negative.

The cancer is considered High Grade

Although pills would not be used for the HER2 portion – there are targeted therapies for HER2 cancer.  Chemotherapy is recommended using Herceptin and possibly perjeta if the invasive portion is more than 2cm.   There are situations where HER2 is improved if chemo is before surgery.  1)  Status of the lymph node 2) abnormal ultrasound 3)  breast biopsy

We need to establish the status of the suspicious lymph node.

The lymph biopsy will show if cancer is in the body -we would treat the body first

If the lymph node comes back good then Lumpectomy with radiation – lumpectomy and radiation are linked together.

If I would get a mastectomy I may or may not need radiation

              There are situations where radiation is still needed

              2, 3, 4 cm involvement of cancer

Lymph node involvement

Aggressive types of cancer

The doctor said I am a candidate for lumpectomy right now.

From a letter sent to my PCP:

“Clinical stage I hormone receptor negative her 2 positive left breast cancer .

She may actually be stage two as she has a palpable left axillary mass and clinically suspicious axillary lymph node on ultrasound. Staging significantly impacts decision making about neoadjuvant chemotherapy versus surgery as her first intervention”

So a battery of tests begins to help with my treatment plan:

Ldex screening – helps monitor lymphedema risks

http://www.breastcanceranswers.com/ldex-score-how-it-helps-to-monitor-lymphedema-risks/#.V2qJcrgrKCg

Chest Xray EKG and Blood work.

June 6^th – Breast MRI

June 8^th – Genetics Appointment

June 9^th – Lymph Node biopsy for the suspicious lymph node (not the Sentinel)

June 10^th – CT Scans, Bone Scans

June 13^th – Echocardiogram

June 15^th – First Oncologist appointment

June 17^th – Port placement.

Health 2015/2016 Recap

I will recap this year of 2016.  First of all I have had pain in my body for many years.  Whiplash at age 19, dislocated kneecap, torn ligaments, wear and tear of getting older.  That over 50 number !~  I’ve also had a history of sinus issues and asthma.  In May of 2014 I had sinus surgery.  In December 2015 – the week between Christmas and New Years, I had a horrible earache.  I went back to the Dr who performed my sinus surgery and he prescribed steroids and Bactrim (a sulfa antibiotic). 

A few days into taking the medications, I experienced severe pain that radiated from my forehead, down my spine, down my sides and front of my body.  I tried to withstand the pain but at 2 am, I relinquished and asked hubby to take me to the emergency room.  They gave me painkillers.  The emergency room is basically triage so the doctor thought I had the flu.  Hubby had mentioned that both he and our son had body aches as well.  I know how my body feels, and it wasn’t the flu.

I followed up with my family doctor as instructed.  Since the two medications were the only differences they said I probably had a reaction to the Bactrim.  I stopped taking the Bactrim and the pain subsided.  I had lab tests done and due to whatever the Bactrim did to my body, all of my numbers were elevated.

It was a New Year and I decided it was going to be a Year of changes.  I was tired of experiencing inflammation in my body.  Tired of the pain.  I try as much as possible to stay away from even OTC medications.  I researched types of foods to lower my inflammation.  I researched and am using essential oils.  I knew I had to lose weight.  I had been losing weight but decided I needed an amp up in that department.  I decided to join the Pinnacle Weight Loss program.  As of today I have lost 33 lbs since January.

I also was experiencing terrible pain in my left arm.  Visit to my doctor again.  My decision – physical therapy or go to an orthopedic doctor.   The whole month of March I went to Physical therapy.  I also was going to my chiropractor, Dr Bob.  He had provided me with the most relief of any of my pain I had been experiencing.   My range of motion was restored, however I still had pain running down my arm and the top of my shoulder.  Dr Bob advised it was an impingement. 

May 19, 2016    Next step, going to an Orthopedic doctor, I had an MRI on my shoulder and the results were partially torn rotator cuff.  The Orthopedic doctor advised that we would see how my arm healed especially since the possibility that the Radiologist felt that 85% chance I had breast cancer.

May 31, 2016 – Appointment with my rheumatologist– I had appointments with the rheumatologist – through more lab work and testing, Rheumatoid arthritis was ruled out, however through Xrays, I have osteo arthritis in my clavicle and spine along with my degenerating discs C2-C 7 – (which pretty much covers the cervical discs).  I also have an impinged shoulder.

The rest of my health now takes a backseat . . .     Now the "C" word . . . (sorry for the backtrack. .. there is a reason)

One of the Hardest Parts - Wait

Wait

verb \ˈwāt\

Simple Definition of wait

: to stay in a place until an expected event happens, until someone arrives, until it is your turn to do something, etc.

: to not do something until something else happens

: to remain in a state in which you expect or hope that something will happen soon

Biopsy May 20, 2016 - I was told I would have the results the next day.   Then they realized it was the weekend coming up.  I would have to wait until Monday.

We were going to the Poconos to celebrate our 30th Wedding Anniversary.  I enjoyed the outdoors and the hikes, dinner out with hubby and being in nature.

Monday - May 23, 2016 - I was promised a call around 4 pm.  Everyone is Waiting~  

I received a call - the results were not back in yet.

Tuesday - May 24, 2016 - Our actually 30th Wedding Anniversary

They called with my results around 4:30 pm.  

"FOLLOW-UP POSTBIOPSY - 5/24/2016

Stereotactic core needle biopsy of calcifications and ultrasound-guided core

needle biopsy of a nodule left breast were performed on your patient by my

associate, Dr. XXXXX, on 05/20/2016. The patient tolerated the procedure

well. On my phone conversation with her today, she reported no significant

complication post biopsy.

The final pathology diagnosis of left stereotactic biopsy of calcifications

unfortunately revealed high-grade ductal carcinoma in situ. The

ultrasound-guided core needle biopsy of the left breast nodule revealed

high-grade invasive ductal carcinoma. The pathology report was explained to

the patient. She took the news fairly well although obviously she was

disappointed with the positive results."

That Nasty"C" word

Routine Mammogram - May 10, 2016 . . . 5:30 pm
Or so I thought.  I go to my mammograms faithfully.  It was recommended I go every 2 years, so time flew by and I hadn't had one since 2011 !~   So unlike me.   I went to Tristan's and the usual, get in the gown, let the mammogram machine do its thing.  I went and sat in the waiting room.  The technician comes out and says "the doctor wants some closer views".  Okay,  I trot back into the room.  This time, I was really squished.  Go back to the waiting room.  I've never had an irregular mammogram.  The technician comes back out and says, the doctor wants an ultrasound.  You can wait 45 minutes or come back again.  Feeling a little anxious.  I said I will wait.
Ultrasound complete.  The technician comes out and says the doctor wants to meet with you.  I am getting anxious.
I go into the room where the doctor is sitting, and he has a very serious look on his face.  He says from what I am seeing it is 85% sure that you have cancer.  I am sorry.    No - not the "C" word.  It can't be.  I bat back a few tears and ask what is next.  He advised that my PCP will be notified and they will want to do a biopsy.
I get back home after 7:30 pm.  John asks what took so long and I break the news to him.  He said he as so sorry and hugged me tightly.

I patiently wait for a call that I am scheduled for a biopsy. The call comes - it is scheduled for Friday May 20th at 8 a.m and will take 3 hours.


Biopsy # 1 - Left Breast - May 20, 2016
I am prescribed to have two Biopsies - one of the calcifications and one of the lesion/tumor

Stereotactic Core Needle Biospy -

Stereotactic breast biopsy uses mammography – a specific type of breast imaging that uses low-dose x-rays – to help locate a breast lump or abnormality and remove a tissue sample for examination under a microscope. It’s less invasive than surgical biopsy, leaves little to no scarring and can be an excellent way to evaluate calcium deposits or tiny masses that are not visible on ultrasound.

Biopsy # 2 - Left Breast

ultrasound-guided core biopsy of the hypoechoic nodule. Following

ultrasound biopsy and ultrasound-guided clip deployment, digital

mammographic images of the left breast were obtained to assess position of

both clips. ultrasound-guided core biopsy of the hypoechoic nodule. Following

ultrasound biopsy and ultrasound-guided clip deployment, digital

mammographic images of the left breast were obtained to assess position of

both clips.

Beginning of My Journey

Cancer Cannot . . .

Cancer isn't prejudice

It doesn't discriminate from me to you;

It changes life in one split second,

But here's what it cannot do.....

It cannot take our courage or strength

Our willingness to persevere;

It cannot take our spirit or faith,

Our Hope that a cure is near.

It cannot take our persistence or patience,

Our ability to walk with pride;

It can't take our self-respect,

As we fight for every stride.

It cannot take our sights or dreams,

Our wishes it cannot shatter;

It can't take our memories,

Our account for what matters.

It cannot take our integrity or mind

Our willingness to feel alive;

It can't take our continuous

Our belief that we WILL SURVIVE

~ Unknown