Depression 1 month after mastectomy

Olivia, It's a little late now, but I'm kind of wondering why the doc only took one node....not to worry, of course...just wondering.  Probably just a regional protocal.  My DCIS was all over, but still contained within the duct  - my BS took the three sentinal nodes and one auxillary node from the cancer side, AND took one auxillary node from the healthy side. 

But like Tammy said, being as your node was clear, that is AWESOME. 

Having only the one kidney does make your extra special....and I'm sure they'd be watching you like a hawk.  I DO think you have a right to be overwhelmed.  I am just NOW beginning to be able to move on a little bit.   I can't imagine how I'd feel if I were basically starting over, and taking some major step backwards - which, in my opinion, is what you're doing. 

I'm sure you have a little time in your favor.  My BS said my cancer had probably been stewing for 4-6 years before this showed up.  I wouldn't think a couple of weeks for you to work through this, research it, get other opinions, think through it, breathe though it, pray through it - is going to cause a problem....but don't take my word for it.  I'm NO expert...just a former BC patient, you know? 

In the meantime, hug that wonderful husband of yours...hold on to him TIGHT!!!  Keep loving on that man, and let him love on you.....and I'll be praying for you...

blessings...robin

olivia,

I'm sorry that your diagnosis is not what you expected it to be and that you are facing these decisions about chemo.  I think some of the explanations in the earlier posts are a bit confusing (to me, anyway) so I hope that I can clarify a few things for you. 

You write "I guess I am really confused about the microinvasions determined to be IDC".  Here's the thing about microinvasions - they are IDC, i.e. invasive cancer.   Always.   Even the tiniest 1mm microinvasion is IDC.  So it's not that your microinvasions were determined to be IDC; it's that all microinvasions are IDC. 

What this means is that as soon as it was determined that you have microinvasions, your diagnosis was no longer DCIS.  I had only a single 1mm (0.1cm) microinvasion, and my diagnosis is Stage I, with my tumor size identified as being T1mic (microinvasion).  Stage I T1mic is usually treated similarly to DCIS but with any invasive cancer, the one major difference is that the nodes much be checked (checking the nodes is optional for those with pure DCIS) and in the future there remains a very small possibility of mets (which is something that DCIS women don't face).  In your case, you've mentioned that you have several microinvasions and that they are larger than 1mm.  When the size of an invasive tumor is more than 1mm (more than 0.1cm), it is no longer considered to be a microinvasion - it is full fledged invasive tumor.  So this means that your staging is higher than Stage I T1mic.  Depending on the size of your largest area of IDC, your staging may still be Stage I (T1a, T1b or T1c) or it may be Stage II.  With this diagnosis, your DCIS is no longer an important consideration (except that it needed to be removed).  The IDC is the more serious condition and so all treatment will be based on the pathology of the IDC. Whatever is done for the IDC will take care of the DCIS.  This is why your oncologist is focused on the IDC.

Even for those of us who have mastectomies, it is possible to have narrow or negative margins. When that happens, usually radiation is recommended, particularly if the cancer at the margin is invasive, but sometimes even if the cancer at the margin is DCIS.  In your case, you can't have radiation so it becomes very important to understand if the cancer at your margin is invasive.  The concern with invasive cancer is that even if the nodes are clear, there is a chance that some cancer cells may have moved into the rest of the body, either through the nodes (undetected by the SNB) or through the bloodstream.  This is why anyone who has invasive cancer, even just a microinvasion, has a risk of mets.  And the larger the size of the invasive tumor, the greater the chance that some cells may have escaped into the body, undetected.  This is why chemo is given - chemo is a systemic treatment.  It is used to track down and kill off cancer cells that may have moved outside of the breast.  In your case, if you have IDC near your margin, this means that some IDC might still be left against the chest wall.  These cells create a significant risk.  Given that you can't have radiation, chemo might be the only option to address this risk.  And in any case, if your area of IDC is large enough (1cm or more), or if your IDC is HER2+, then chemo will be recommended regardless.  What you need to understand from your oncologist is what your risk is to get mets.  That's the most important information that you need to decide if chemo is right for you or not.  The size of the invasive tumor, the closeness to the margin, the grade of the tumor - all those things will factor into your risk.

One last point of clarification.  DCIS cancer cells are confined to the milk ducts.  When these cells grow and multiply, as cancer cells tend to do, because they are confined to the duct, the cancer tends to spread out within the ductal system of the breast. Because milk ducts are totally enclosed and confined to the breast, DCIS cancer cells cannot move outside of the breast.  IDC develops from DCIS cancer cells. The cells undergo one final biological change, which allows the cells to break a hole in the duct.  As soon as a cancer cells moves out from the duct into the breast tissue, it is no longer a DCIS cancer cell, it is now an IDC cancer cell.  It's the same cell, but it has evolved from being non-invasive to being invasive.  A microinvasion happens when just a few cells - an area of 1mm in size or less - break through the duct wall.  So invasiveness isn't determined by the size of the palpable mass; it's determined by the biological features of the cancer cell and the location of the cancer cell outside of the duct.  As soon as even a single cancer cell has undergone this biological change and moved outside of the duct, it has the capability of moving throughout the breast tissue, into the nodes or into the bloodstream.  DCIS cancer cells do not have that capability.

olivia, a diagnosis of Stage I or Stage II is early stage BC and it is very survivable, but it is different than pure DCIS.  I'm sure that some of what I've written is probably very concerning to you, but it's important that you understand that you don't have DCIS and you don't have DCIS with a microinvasion, you have IDC. Because this is a DCIS forum, the discussion up to this point in this thread has focused more on the DCIS aspects of your diagnosis than on the IDC. But as you make your treatment decisions, it is the differences in your diagnosis vs. DCIS that are critical for you to understand, particularly with regard to hormone therapy and chemo.  The rationale for these treatments for you, with your diagnosis, is very different than it would be for someone with pure DCIS. 

I hope that I haven't scared you - that was certainly not my intent.  The fact is that with the appropriate treatment, your diagnosis has an excellent prognosis.  But I worry that by posting here in the DCIS forum, you may not be getting a full appreciation of some of the risks that you may need to address with appropriate treatments.  You might find out more about what others with a similar diagnosis have been doing if you post some of your questions and concerns in the IDC forum.   

Here is some information about staging.  This will explain why your diagnosis is not DCIS.  DCIS is always Stage 0 and for those of us who have even just one microinvasion, the diagnosis is moved up to Stage I:

TNM Definitions
AJCC Stage Groupings

Primary tumor (T)

• TX: Primary tumor cannot be assessed
• T0: No evidence of primary tumor
• Tis: Intraductal carcinoma, lobular carcinoma in situ, or Paget disease of the nipple with no associated invasion of normal breast tissue
  • Tis (DCIS): Ductal carcinoma in situ
  • Tis (LCIS): Lobular carcinoma in situ
  • Tis (Paget): Paget disease of the nipple with no tumor.  [Note: Paget disease associated with a tumor is classified according to the size of the tumor.]
• T1: Tumor not larger than 2.0 cm in greatest dimension
  • T1mic: Microinvasion not larger than 0.1 cm in greatest dimension
  • T1a: Tumor larger than 0.1 cm but not larger than 0.5 cm in greatest dimension
  • T1b: Tumor larger than 0.5 cm but not larger than 1.0 cm in greatest dimension
  • T1c: Tumor larger than 1.0 cm but not larger than 2.0 cm in greatest dimension
• T2: Tumor larger than 2.0 cm but not larger than 5.0 cm in greatest dimension
• T3: Tumor larger than 5.0 cm in greatest dimension
• T4: Tumor of any size with direct extension to (a) chest wall or (b) skin, only as described below
  • T4a: Extension to chest wall, not including pectoralis muscle
  • T4b: Edema (including peau d'orange) or ulceration of the skin of the breast, or satellite skin nodules confined to the same breast
  • T4c: Both T4a and T4b
  • T4d: Inflammatory carcinoma

Regional lymph nodes (N)

• NX: Regional lymph nodes cannot be assessed (e.g., previously removed)
• N0: No regional lymph node metastasis
• N1: Metastasis to movable ipsilateral axillary lymph node(s)
• N2: Metastasis to ipsilateral axillary lymph node(s) fixed or matted, or in clinically apparent* ipsilateral internal mammary nodes in the absence of clinically evident lymph node metastasis
  • N2a: Metastasis in ipsilateral axillary lymph nodes fixed to one another (matted) or to other structures
  • N2b: Metastasis only in clinically apparent* ipsilateral internal mammary nodes and in the absence of clinically evident axillary lymph node metastasis
• N3: Metastasis in ipsilateral infraclavicular lymph node(s) with or without axillary lymph node involvement, or in clinically apparent* ipsilateral internal mammary lymph node(s) and in the presence of clinically evident axillary lymph node metastasis; or, metastasis in ipsilateral supraclavicular lymph node(s) with or without axillary or internal mammary lymph node involvement
  • N3a: Metastasis in ipsilateral infraclavicular lymph node(s)
  • N3b: Metastasis in ipsilateral internal mammary lymph node(s) and axillary lymph node(s)
  • N3c: Metastasis in ipsilateral supraclavicular lymph node(s)

  • Distant metastasis (M)

    • MX: Presence of distant metastasis cannot be assessed
    • M0: No distant metastasis
    • M1: Distant metastasis

    • AJCC Stage Groupings

      Stage 0

      • Tis, N0, M0

      Stage I

      • T1*, N0, M0

      Stage IIA

      • T0, N1, M0
      • T1*, N1, M0
      • T2, N0, M0

      Stage IIB

      • T2, N1, M0
      • T3, N0, M0

      Stage IIIA

      • T0, N2, M0
      • T1*, N2, M0
      • T2, N2, M0
      • T3, N1, M0
      • T3, N2, M0

      Stage IIIB

      • T4, N0, M0
      • T4, N1, M0
      • T4, N2, M0

      Stage IIIC**

      • Any T, N3, M0

      Stage IV

      • Any T, Any N, M1

      * [Note: T1 includes T1mic.]

    • And here are drawings that show how cells evolve from being normal to becoming DCIS and then IDC.  http://www.breastcancer.org/pictures/types/dcis/dcis_range.jsp

    • 

Olivia - still thinking of you....and wow!  Beesie, on behalf of Olivia, thank you for all of that info.  You can sure tell you've been dealing with this a whole lot longer than we have been.....

blessings.....robin

Jen - 

Last week you were 2 1/2 weeks out and feeling some up and down - how are you doing???  Sorry I feel like I have been a board hog. You reached back and I did not ask how you doing, this is overwhelming.

Let us know -- I know we all agree this is a long process but together we can get through it!

Olivia 

Olivia, just to clarify, I wasn't suggesting that your posts have been unclear.  I realize that you don't have all the information yet about your diagnosis and pathology, and I appreciate that you are still on the learning curve.  We've all been there!

I posted to try to give you some more information about your diagnosis, based on what you know so far.  From what you've been told by your doctors, it's clear that your diagnosis is no longer DCIS; it's IDC.  Of course you still have the DCIS that you had originally but most women who have IDC have DCIS too - the thing is that once you have IDC, the DCIS really doesn't count for much and it's often just ignored. 

That's also why I suggested that you might want to post about your situation in the IDC forum.  Here in the DCIS forum, most of us don't have to make the decisions that you face; even when we do, the factors that we need to consider are quite different than what you have to consider.  For example, the risk/benefit considerations for someone with DCIS who is deciding on whether or not to take Tamoxifen would be very different than the risk/benefit considerations that face you as you make this decision.  On the IDC forum, you're likely to find women who've faced similar decisions to what you face and they can help, explaining how they made their decisions, what they were told by their doctors, etc..   It's not that the support here isn't great, but I think you might find the information on the IDC forum even more helpful to you as you climb your learning curve.

(((Hugs!))) 

Olivia, it seems that I have offended you, and for that I am sorry.  When I read your posts, it appeared that you had some questions about your pathology; all I was trying to do was offer information that might help you with those questions.  As I read your posts and your questions, it certainly never occurred to me that you weren't bright and educated.  All of us, when we are first thrown into this world of breast cancer, have a steep learning curve, and that has nothing to do with intelligence.  I was diagnosed over 4 years ago and I continue to learn new things about DCIS and about breast cancer from other women on this site.  

Please understand as well that I was in no way suggesting that you leave the DCIS forum.  Rather, in reading about some of the decisions that you've said you face, I suggested that you are more likely to find women who've had to make those same decisions in the IDC forum, and their experiences might be helpful to you.  I do think that you would benefit from posting about your situation in the IDC forum but of course that entirely up to you (it was just a suggestion) and of course it doesn't mean that you have to leave the DCIS forum.  I appreciate that you get a lot of support from some of the women here and I know how important that is to all of us as we go through this journey.

My apologies again if I offended you.  That certainly was not my intent; my intent was simply to offer information and suggestions that might help you as you grapple with the tough decisions ahead.  All the best to you.  

Mom, yeah, I can't believe I said that either....OR that I was rubbing my breasts....thankfully, it was just my husband and my three kids there.....along with my pastor, of course....who then excused himself to "just step outside to give us family time"...ha!   This was SO not my nature.  Before BC, we never even used the word "boob" in our house!!!!    I am THAT much of a prude....

blessings....robin

LadyOD and Olivia...thinking of you both today......

I have found that work and I just don't agree with each other....I taught yesterday...and fortunately, it was my travel day - I taught at two schools.  I had enough time between the two (which included my lunch AND plan time) to stop by home for a little bit and I took a 30 minute nap!  But my arms, my armpits, and sides, my ribs....everything hurt all last night.  Even today I can feel it.  It's not the same as it was after my first full day back, either.  It's so weird.  I just hope and pray this isn't my new normal.  There is no way I can keep this up.  Thankfully my full days are not consecutive..(I know I didn't spell that right, but I'm too lazy to look it up...sorry). 

Do you all find that your arms and wrists hurt more now?  It's so odd....I used to have a lot of fibromyalgia symptoms after I had a pinched nerve in my neck (and subsequent herniated disk), but after a while, they resolved (after several years!!).  Every once in awhile, they flare up, but this has been constant.  I have those "trigger, sensitive spots" in my arms now (again), too...

I don't understand it....sigh.

I'm really falling apart now...ha!  Hit that half-century mark, and whammy!!  (and here I was always so proud of my age, because no one could tell it!!)

Hope you all are doing ok....praying for you!!

blessings..robin

Robin and Mom -

When the technician injected the dye for the sentinel node he told me to rub my breast.  I must have had a strange look on my face because he said, really you have to rub your breast.  When I was brought back to pre-op my husband was there and I told him, they want me rubbing my breast. He chuckled and said, are you sure?? I said yes, they said massage it.

Jennifer,

Can't wait to hear from you and how you are feeling?? Prayers and hugs to you!

Olivia 

Jennifer,

You are awesome - I do not think I could focus my eyes after three days. I think I was so drugged up everything was blurring.  The nurse would ask me to read something, I had no clue what it said. I just memorized what they wanted me to say - LOL.  

Gentle Hug to you -- )

I think we all understand the depression. It hits us all differently and at times out of nowhere, but we are here for you whenever you need someone.  

Olivia 

Olivia - I would have given him an odd look too!  My dh would have found that very funny and I am sure offered to 'help' me out! Ha.

Jennifer - so glad you made it through.  I am sure sadness is so very normal right now.  I know you are a week ahead of me but I am expecting those very same feelings.  Let them out.  Keeping it all in is not good.  You know people here will 'listen' and totally get what you are feeling.  Good news regarding your nodes too!

ahh, I've over-slept and have to wake the boys for school.  Dh is in DC for the week so i am flying solo.

k