Awaiting Biopsy - birads 5, newbie w/few questions

kbt · January 2017

Hello and thank you for such a wonderful, informative site. I have a few questions that I have been unable to find answers elsewhere. Hoping someone can help. I will apologize in advance for the long post.

On January 6 I went to a PA at my PCP for a follow up after having a bad stomach bug (basically a chat to see if I was ok). At that time she reminded me it was time for my annual mammogram. The scheduler suggested the new 3D mammogram since I have level 4 dense breast, and to call my insurance to see if they would approve. A migraine Mon-Tue kept me from calling until Wednesday, 1/12. I called they approved. While taking a shower I felt a large lump on my left breast around the 1:00 area of my breast, finger width away from my nipple. When I called to schedule I informed the Breast Center and they said I would need to call dr to get them to order diagnostic mammo. I did and mammogram and ultrasound scheduled for 1/24 (earliest available). In meantime breast was warm to touch, had a small pink area around nipple and some skin changes; called to see PCP. Went and she said "it is probably just a cyst" but you have the tests scheduled and I will call after with results. Went for appt. and radiologist came in after US tech was finished. He did more US and showed me the mass on the screen. At the time he told me it was a "suspicious mass with swollen/involved lymph nodes" wanted to see me for a US guided biopsy the next week. Earliest was 2/9. Biopsy scheduler said dr wasn't done dictating report but that I would get a copy and if any openings came up before 2/9 she would call.

No call from PCP (as she said she would after mammo). No call from breast center, so I went to get a copy of the report myself. Report says:

Mammogram: "ill-defined spiculated mass....poorly circumscribed on standard and tomosynthesis images. Also noted are some enlarged lymph nodes just superior to the spiculated mass low in axillary.

US: "shadowing irregular poorly circumscribed mass...from 12-130. Although multiple measurements are provided by tech, the exact size is hard to ascertain due to the poorly circumscribed margins...concerned that it measures up to at least 4-5cm (2in). Again noted are some enlarged low left axillary lymph nodes with cortical thickening.

Impression: "...consistent very concerning for invasive mammary carcinoma...with some involved lymph nodes.... BI-RADS Code 5: Highly Suggestive of Malignancy (that part is all caps). It says again recommend US guided biopsy for diagnosis. And it states I will get a letter reflecting findings (I have yet to receive this letter or a call).

I understand the odds of it being malignant and I am hopeful and prayerful I will be in the 5% that it is benign. However, I am also a realist.

I have contacted Breast Center and my PCP about an early date for my biopsy to no avail. So I am resigned to the wait. I did get bumped to the 8th, which the scheduler said means I will get results on Fri rather than having to wait until Monday. This is where my questions come:

Will the biopsy tell the type of cancer or just yay or nay? Do you know if they can biopsy part of the swollen lymph? How soon after getting report (if positive for malignancy) will I see a specialist? I am prepared to ask these questions day of to the dr...just want an idea or ballpark of others' experiences. I know some had biopsy day of screening (I wish I was one of those, cause the wait is the worst).

Thanks again,

Worried in NC

Zaranth · January 2017

A biopsy will tell you what kind of cancer it is as well as give a better idea of the size. It will also tell you what grade it is (meaning how fast it is growing), and it will indicate if it is positive or negative for estrogen/progestin receptors as well as whether is it positive/negative for HER2 (a protein). During a biopsy they will have to take samples of each tumor (if you have more than one like I did), but I had no lymph node involvement so I don't know if they will biopsy those at the same time or send you for a sentinel lymph node biopsy where they inject a dye that, during surgery, will show which lymph nodes are involved. The sentinel lymph node biopsy is done the day before you are scheduled for whatever surgery they decide you need (lumpectomy or mastectomy), and I found it quite painful. They inject the dye fairly close to the nipple, and it burns quite bad for a few seconds, then you wait for an hour, then they put you into the large circular scanner and you have to hold your arms over your head for about 25 minutes while the machine rotates around you and takes many images. The big benefit of this procedure is it is less invasive, and the surgeon will know exactly which nodes are involved so may actually remove less nodes in the end. I can't say how long it will take for you to get in for a biopsy etc. as I live in a different part of the world than you, but I can tell you that from when the mammogram found something suspicious I waited only a week for the ultrasound, another week for the biopsy, then I was in to see a surgeon in about a week and a half. I was in for a double mastectomy about a month and a half after it all started but that's because my surgeon is proactive about booking surgery times. He told me he books the times not knowing who will need them, but knowing someone will so I didn't have to wait long. I have talked to other women in different cities who had to wait several weeks for surgery and other tests so it will depend on availability where you are.

kbt · January 2017

Thank you, all your answers helped immensely. I will ask about the node biopsy you mentioned as an addendum to my questions.

Will keep everyone posted.

marie5890 · January 2017

kbt,

Sending good thoughts your way, as it looks like you are taking on this journey no one wants.

If you think this may be helpful This is a link to the "just diagnosed" forum and to a thread of ideas and suggestions to "get prepared". Just some practical things you can do and get some ducks in a row.

Sending good thoughts

kbt · January 2017

Thank you Marie, yes I have bookmarked that forum page and will be printing it out. It is an excellent reference!

Thanks for the positive thoughts as well!

kbt · February 2017

Due to physical changes in my breast: a middle finger wide indentation left of the lump, another dime-size indentation and color change (it looks bruised) north of my nipple. They have moved my biopsy to this Thursday. Glad I'll be getting in sooner.

Thank you all for this forum, it has really helped knowing others are in this same waiting game.

marie5890 · February 2017

The waiting REALLY sucks.

Beatmon · February 2017

The waiting truly is crap...you can't help but worry. Most of us will tell you that it helps when you know what you are facing and to have a plan in place. Hopefully you will be in that lucky 5%

kbt · February 2017

Yes, the waiting is the worst! Thanks Beatmon and Marie! They have promised results by Monday...then I can know what/how to proceed. I am unfortunately not a "fly by the seat of my pants" kinda girl, so wanting to plan is almost a compulsion.

Again love this group!

kbt · February 2017

The Breast Center nurse coordinator called me this evening. Part of the information I knew, the tumor is 5cm. It is Invasive Ductal Carcinoma, it may be a combination of lobular and ductal carcinoma, only got a partial pathology report. It is HER- and ER/PR+. Don't have a stage or grade yet, but she does suspect that it is in at least 2 lymph nodes. I will get the full report Monday.

They will call me Monday with the appointment with the breast surgeon, who will act as my navigator/coordinator. She said he will send me for MRI and possibly other tests (may do lymph node biopsy or wait and do sentinel lymph node biopsy at surgery time), as well as send me to a genetic counselor which will run the genetic testing and speak to me about options regarding genetic tests. She said it may be as long as a week before I see the surgeon. Apparently, I am the 4th diagnosis this week.

marie5890 · February 2017

Kbt,

Sorry to hear what seemed was going to happen.

Know you are not alone. Don't be afraid to ask for a prescription for an anti-anxiety med if you need one. Most of the women who have been very much against taking them, admit, that when one is Dx-ed with cancer, it's a god-send.

You are going to be throw a lot of information in the coming days and weeks. You are going to need to be as calm and level headed as you can be, because there will be decisions to make. Anti-Anxiety meds can help with that, so talk with your doctor about it.

Keep breathing. Im sure you realize that there are a boat load of women here who have and are on the same journey. It's a sisterhood no one wants to be a part of, but it's a real sisterhood.

kbt · February 2017

Marie,

Thank you. Yes, I am pretty calm right now probably because I suspected the diagnosis. Or heck, I could be in shock....lol!

They are going to give a book or something to keep up with all my "stuff". And I am printing off the pathology brochure/leaflet provided here, it seems to be a good place to report or write stuff. I also like the binder suggested in the "Just diagnosed". This site and the sisterhood here have already been a great help with the useful links and information. All of these have helped me know what to ask and know the lingo.

I am quitting smoking and my doctor has given me Wellbutrin which is supposed to help with anxiety too. I friend also gave me two Xanax, which I am saving until I "really" need it. Going to take my sister with me to the next appointment to help me remember what all the surgeon says and help me remember to ask my questions. She was awesome at the biopsy, by bringing me a coffee and cinnamon roll and helping me stay calm beforehand.

Mamasha · February 2017

kbt,

When we read your messages, we all know exactly how terrible the waiting is....especially the weekends. It's hard to keep busy because all we think about is the next appointment. I remember waking up at 5am after only falling asleep at 2....which only my my time thinking about the dx longer. So this will probably be the worse weekend and then each will get a little bit better. Like all the ladies tell you, once you have a plan you focus on that. Maybe go to your sister's house to break up the day. For me, I cried only at home. I wish I could give you a hug and tell you my surgery was only last month but I feel so much better than that first weekend after dx. I promise YOU will too!

kbt · February 2017

Mamasha thank you. Seems like we are in similar boats with diagnosis. Praying for a good outcome on your surgery. Just knowing this support is here and the encouraging words from everyone has helped.

So far haven't cried, but have a feeling they will come and trying to do like you and only cry at home (but not in front of my son).

Virtual hugs to you as well. And again thank you for just being here with a reply.

Kimberly

MinusTwo · February 2017

kbt - sorry you've had to join this club. You're welcome to join us on the 'stop smoking' thread. There is no judgment because we all know what you're going through.

Awaiting Biopsy - birads 5, newbie w/few questions

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