New, scared, and sleepy

WhiteTiger · July 2014

wrenn - Thank you. Yes we have that in common.

WhiteTiger · July 2014

farmerlucy - You've been so kind to me, I shouldn't be asking. But the word "lumpectomy" hit me sort as my having made a big fuss about nothing. It's been niggling me. No doctor said lumpectomy. But does it go by size or something? I mean, should I be calmer if it's smaller?

WhiteTiger · July 2014

whatnow - Thank you for that encouragement. Sorry to hear that you went through it alone. Maybe your calendar looked like mine - arrows and X's everywhere. I bought white-out just so I could read it.

Tomboy · July 2014

some times they call a lumpectomy a "segmental mastectomy" so don't be alarmed. its just more scientific surrounding. And i guess it would depend on what they saw in there once you are opened up, about how much tissue they would take. sometimes it can be alot. that is why sometimes you will hear of some women having a re-incision a few days or weeks later, because they could not get clear margins. can you remind me again, what your biopsy path report discovered?

farmerlucy · July 2014

You ask anything you want anytime and we'll all do our best to help you. You have definitely not made a big fuss over nothing. This can be a big scary deal. It was for me. I'm not sure what the doctors would technically call the procedure that discovered your cancer, but lumpectomy (sometimes called partial mastectomy) is when they remove the tumor from the breast but not all (virtually all) the breast tissue. Size does matter for staging purposes. (Look on the main pages of BCO for info about staging). There are three parts to determining the stage. First is tumor size, the second part is whether or not it has spread to the lymph nodes, and 3. Whether or not it has spread to other parts of your body's. You will know the size from the pathology report, you will know about the nodes after the sentinel node surgery, the CT scan will probably be the lasts piece of the puzzle to know if it has gone to other parts of the body. Once you know your stage your doctor will be able to tell you how likely it will be that the cancer comes back and more importantly determine your treatment.

WhiteTiger · July 2014

That's great, farmerlucy, thank you.

WhiteTiger · July 2014

kathec - my biopsy path report. That must the 2 pages of code that I got in the mail. But - biopsy? Um, it was plastic surgery (reduction) and he discovered cancer - well if he sent that off for testing I guess it's a biopsy. Let me go find those papers and see if I can figure them out.

wrenn · July 2014

white tiger, can you post your pathology report here? It will helpthe women here who are familiar with terminology sort things for you.

WhiteTiger · July 2014

PATHOLOGY REPORT June 9 2014

(parts are snipped)

Bilateral breast hypertrophy

SPECIMEN

A. RIGHT BREAST, MASTECTOMY

B. LEFT BREAST, MASTECTOMY

C. LEFT BREAST, NIPPLE:

FROZEN SECTION DIAGNOSIS

B: LEFT BREAST:

- Invasive carcinoma, margins grossly free of tumour (closest -posterior margin, approx. 3 mm way)

GROSS DESCRIPTION

A. Specimen is labelled 'RIGHT BREAST' It consists of an unoriented, nipple sparing, simple mastectomy specimen weighing 1080 grams and measuring 20 x 18 x 5 cm (8 x 7 x 2 in.) . The tissue area missing at the nipple measures 2.3 x 2.3 cm. (1 x 1 in.) <snip>

B. Specimen is labelled 'LEFT BREAST". The specimen consists of a simple mastectomy specimen weighing 680 grams (24 oz) and measuring medial to lateral 19 cm (7"), superior to inferior 10 cm (4"), anterior to posterior 4 cm (1.5"). On the skin surface the area at the nipple measures 2.5 x 1.5 cm (1"x0.6") (nipple submitted separately). The skin surface appears grossly unremarkable. The specimen is inked black. <snip about slices>

C. Specimen is labelled 'LEFT NIPPLE". It consists of an irregular piece of skin with nipple measuring 4 x 2.2 x 0.3 cm. (1.5" x 0.9" x 0.1") <snip>

=======

Does that tell you anything besides sizes?

WhiteTiger · July 2014

more pathology to come, having cup of tea and flexing fingers. next chapter: Diagnosis

wrenn · July 2014

Good that you had clear margins.

Tomboy · July 2014

sizes aint helping pathology would say things like lcis, dcis, idc, ilc, grade, appearance of involved tissue, it would have been inked before it was removed, because that would have oriented it for them, it would have said time to formalin fixed, it would have a tremendous amoint of information from the pathologist, and i dont even know why they are talking about nipples if you still have them on your body. have you already had the bilateralmastectomy. there is just not something right here. and it would definatelt have given all dimensions of the tumor itself. and it would have mentioned already what sort of positivity or negativity was involved, so they would know how to treat. any mention of lymph nodes? this is a grossly uninformative example of a pathology report, sounds more like the surgeons note who removed the breast tissue, that you said left the nipple intact, so i dont know why the mention of them. its not a path report.

wrenn · July 2014

Kathec, It's just the first part (gross description) . It names Invasive carcinoma.

Tomboy · July 2014

thanks wrenn! she posted while i was still peckin!! two fingers only!

WhiteTiger · July 2014

Pathology Report cont'd page 2

DIAGNOSIS

A. RIGHT BREAST, (NIPPLE SPARING MASTECTOMY):

DUCTAL CARCINOMMA IN-SITU (DCIS)

DCIS TYPE: PREDOMINANTLY SOLID

MICROINVASION: ABSENT

DCIS GRADE: GRADE III OUT OF III

DCIS ASSOCIATED NECROSIS: PRESENT

DCIS IS PRESENT IN: 8 OUT OF 27 SLIDES

THE LARGEST FOCUS OF DCIS MEASURES 2.5 CM

DCIS SPANS AN AREA MEASURING: 5 CM

DISTRIBUTION OF CALCIFICATIONS: BENIGN TISSUE, DCIS

DCIS DISTANCE TO THE CLOSES MARGIN(S): DCIS IS AT >1 CM POSTERIOR, HOWEVER DCIS IS PRESENT IN THE AREA BENEATH THE NIPPLE (PLEASE NOTE THAT THIS IS A NIPPLE SPARING MASTECTOMY)

REMAINING BREAST TISSUE: LOBULAR INTRAEPITHELIAL NEOPLASIA, PROLIFERATIVE FIBROCYSTIC CHANGES, SKIN WITH SEBORRHEIC KERATOSIS.

LYMPH NODE: ONE BENIGN LYMPH NODE (0/1), INTRAMAMMARY.

-RECEPTOR STUDIES PERFORMED ON DCIS ARE AS FOLLOWS (TWO BLOCKS TESTED)

-ER (SP1, RABBIT MONOCLONAL ANTIBODY; VENTANA): NEGATIVE, LESS THAN 1% OF CELLS STAINING.

-PR (1E2: RABBIT MONOCLONAL ANTIBODY, VENTANA), NEGATIVE, LESS THAN 1% OF CELLS STAINING.

-HER2 (4B5; VENTANA): POSITIVE, SCORE 3+

========

Going to bed now. Thank you so much for your help.

Next chapter is Left Breast - invasive ductal carcinoma, nos, tumor size 3.1 cm (1.2").

wrenn · July 2014

That's a lot of typing. Thank you for doing it. I am sure you will get more answers tomorrow. Sleep well.

WhiteTiger · July 2014

Pathology Report cont'd page 3

B. LEFT BREAST, MASTECTOMY

TUMOR TYPE: INVASIVE DUCTAL CARCINOMA, NOS

TUMOR SIZE: 3.1 CM (1.2")

NOTTINGHAM GRADE (SCORES = MITOSIS/TUBULES/ATYPIA): GRADE II OUT III (2/3/2)

DUCTAL CARCINOMA IN-SITU (DCIS): PRESENT

DCIS TYPE AND GRADE: GRADE II OUT OF III, SOLID TYPE

DCIS ASSOCIATED NECROSIS: PRESENT

DCIS DISTRIBUTION: ADMIXED WITH INVASIVE CARCINOMA

PERCENTAGE OF DCIS IN THE MAIN MASS: <25%

LYMPHOVASCULAR INVASION: PRESENT

DISTRIBUTION OF CALCIFICATIONS: BENIGN AND MALIGNANT TISSUE

DCIS DISTANCE TO THE CLOSEST MARGIN(S): 0.3 CM (0.1") POSTERIOR

SKIN INVOLVEMENT: NO

REMAINING BREAST TISSUE: ATYPICAL DUCTAL HYPERPLASIA, LOBULAR INTRAEPITHELIAL NEOPLASIA, PROLIFERATIVE FIBROCYSTIC CHANGES

LYMPH NODES: NO LYMPH NODES IDENTIFIED

RECEPTOR STUDIES PERFORMED ON INVASIVE CARCINOMA.

ER (SP1; RABBIT MONOCLONAL ANTIBODY; VENTANA) POSITIVE, STRONG INTENSITY, >90% OF CELLS

PR (1E2; RABBIT MONOCLONAL ANTIBODY; VENTANA): POSITIVE, STRONG INTENSITY, >90% OF CELLS

HER2 (4B5; VENTANA): SCORE 1+ TO 2+. A FISH STUDY TO FOLLOW.

=======

To be continued. Next chapter: Left breast nipple benign.

WhiteTiger · July 2014

Pathology Report cont'd page 4

C. LEFT BREAST, NIPPLE.

-BENIGN

COMMENT: Controls are satisfactory. Percentages are approximate. E-cadherin stains x 4 are confirmatory.

American Society of Clinical Oncology / College of American Pathologists guideline recommendations for human epidermal growth factor receptor 2 testing in breast cancer.

Consensus recommendations on estrogen receptor testing in breast cancer by immunohistochemistry.

=======

End of Path Report.

WhiteTiger · July 2014

There, that's a job done, the path report. The only thing I have to do now is get it out of my system how terrifying that was to type. I had to get up close and personal with all those horrible words - and for me it got that all the words were horrible. Even at the beginning "Gross Description" - who are they calling gross! Every line of it set me off. I'm dizzy. It's 7am Friday now. I won't be around much during the day but if you have anything to say I'll respond in the evening.

I know I thought that I had read it but I had only skimmed it and had no intention of getting any closer. But I was in panic all night and couldn't figure out why. Duh. Then I realized I gotta finish this Path Report or the panic won't go. So now it's worse but it will go, I hope.

There was also my natural resistance to putting anything personal on-line. I have to assume I've just published this to the FBI, CIA, hacker kids, etc. But there's no other way, really. I think I have an oncologist but I don't know his name. And anything that avoids doctors is better.

Thank you for your help.

farmerlucy · July 2014

Whew that was a chore. There are certain words I hate - tumor and cancer are two of them! I guess I need to learn to not let them have power over me. I'd say this was a very thorough pathology report. I'm impressed. Looks like your left breast is the most problematic. It sounds like the tests that have been done along with the ones ordered are exactly what you need. IMHO I think you are in good hands and are getting very good care. Oh and "gross" appears on all pathology report - it means "overall" not anything derogatory.

Tomboy · July 2014

wow! you are an unusual woman! sounds like you have to totally different types! triple negative in one breast, and positive in the other! sounds like you will be getting chemo because of the invasive part of it, maybe/ maybe not herceptin, i was a 2+ by both tests, but they wanted me to do it, even tho i was equivocal. and they will probably want you on anti hormonals after. very good that it was not in your nodes though. thank you for taking all the time you did. with all that mixed up stuff, i don't know why they wouldnt be happy to give you double mastectomies. if you go to to the top of the page and click on your profile, they will ask you some questions, so that all the info that is at the bottom of each of our pages, will show up there, so you never have to type it again! Sorry that you have found yourself in this place, but glad you found your way to BCO, there is good information here. you can look to the search funtion drop down menu, to find out more about each thing that yuo have, and the women here are very knowledgeable, too. Keep up the good work, White tiger!

wrenn · July 2014

wow, that was a lot of typing. Although it was scary for you to do that it might help to have it acknowledged. There it is on paper what you are dealing with. It also helps the women here with similar diagnoses to help you.

I would be sure to talk to surgeons or oncologists about your anxiety issues. I have PTSD too and it helped that my doctor told me to take ativan or clonazepam as needed. I didn't actually need it that much but it was good to know it was there.

This is a nightmare for all of us so you are not alone. Stay connected here. Take care of yourself.

WhiteTiger · July 2014

I filled in the Dx questions as best I could but only used the Left Breast info - should I do another with Rt Breast? Or would that erase the first one? Spooky stuff.

WhiteTiger · July 2014

*** I got the cat !!!! ***

She under the bed now, of course, but she did case the joint briefly. I put a fleece blanket under the edge of the mattress and she dragged it in. With the a/c, that floor must be cold.

The trip was 9am to 3pm. Whew!

wrenn · July 2014

I think you can click on "add diagnosis" but not sure. It was a while ago that i did it. Make sure you "save". Yours isn't showing.

At first glance the forum topics look overwhelming but you can narrow it down to people with similar diagnosis. It is also good to check in with the same types of surgery or august surgery group....or september rads group to follow along with your treatment at the same time as others. It is a lot of information but will fall into place. Not a fun place to be but the best place for what you are going through. hang in there.

wrenn · July 2014

I got a cat a few days before finding the cancer. So glad I did.....someone to talk to when no one is around. :-)

You can add more information under "signature" in your profile since it looks like there is only room for 1 Dx that I can see. My extra info is in "signature".

farmerlucy · July 2014

Hooray! What kind of cat is she? Have you selected a name or did she come with one? So excited for you! We got three barn kitties from the humane society about two months ago, but as far as I can tell only one is still around. They are feral so we only see them on our kitty cam.

Good job loading in your profile info.

WhiteTiger · July 2014

She's a small Russian Blue, to which I am not allergic! A lifetime's dream come true; I have a cat. There's a slight worry - we got her yesterday from the SPCA in NY and, of course, she's been hanging out with cats that I *am* allergic to. This morning I woke with red eyes almost swollen shut. But I know myself - that's not how my allergies go. So I'm hoping she's only carrying shedding from her friends, which she will wash off,right?

It was a 6 hour drive to get her. I've got what I need to start off a cat-home but extra-specials will have to wait. The SPCA lady said I could wipe her (the cat) down with Baby Wipes. I only have Handi-Wipes and (a) cat took one look an disappeared; and (b) she would be licking the remainder, maybe it would make her sick. I will try a facecloth. There are "traction" gloves for grooming but I can't afford that now.

I think you can see her here, with her kittens (long adopted) - she the Mama, 2yo, Claudia

https://drpem3xzef3kf.cloudfront.net/photos/pets/2...

Tomboy · July 2014

oooooh!!!! she is sooo beautiful! i want one so badly, but i cant have one where i live! i know having one would help me tremendously, to not be so sad and worried all the time. thank you for sharing the picture, can we see more, as she gets comfy in your home? so happy for you, white tige!

wrenn · July 2014

what a beautiful cat...and perfect timing. My cat was from our SPCA and he has rescued me. Hoping for the same with your new friend.

New, scared, and sleepy

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