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Medical Forum / Diseases and Disorders / Breast Cancer / July 2004Oh... crap.
Hi guys. Brief history: lumpectomy left breast 11/00. 42 y.o., Stage 3A or b? Don't remember. 16 of 24 positive nodes, 6 cm. tumor shrunk with adriamycin/cytoxin chemo for 6 months, pre-surgery. Radiation post surgery, 28 treatments. Alrighty then! Back to business. Fast forward to 2004. 7/12/04: I had an MRI ordered by my surgeon because she felt 'hard edge' at surgery site. It was a BIRADS classification 4. Report says in part, "1 cm posterior and a few mm superior to the lumpectomy site there is an irregularly shaped 6 mm mass-like area of enhancement which is considered suspicious for malignancy." Now I get a biopsy. Again. Please don't get me wrong. I am grateful for every day I have lived since surgery, and feel fortunate that most of those days I have felt pretty good, actually. But now I find myself right back at the place I was in February 2000, only this time I'm scared s***less about a diagnosis of recurrence. Tests, waiting, fear, tests, waiting, fear... it's a constant cycle which I suppose is the price we pay as cancer survivors. So many of you here are so logical and positive in your approach to the disease and are dealing with so much more, that I'm almost ashamed to say that mentally, I feel like I'm in purgatory. Like if I don't keep busy, I'll go out of my mind with stress. I'm the one who kept my cancer to myself first time around because I couldn't stand the thought of everyone I knew treating me like porcelain. So you guys please get ready to be my support system again, if need be. I'm sorry if I sound selfish or whiny. I just read the MRI report and I'm not in such a good place right now... But I do feel better after getting this off my... Writing this out. (that was almost a *really* bad pun...) kaci Kaci...you have a lot of company in "purgatory" and some days when my fear takes a bad hold of me, I think I have crossed over into Hell! Also, who are all those people who are supposed to be treating us like porcelain since we have had bc?? Has not been "my" experience but I guess it is for the best. I no longer am concerned about trying to put on the brave face for the rest of the world. When I need a good cry, I cry and when I need to give vent to my feelings I do. What is most important is that we find the strength whether it is in a support group, our loved ones, and/or prayer to withstand the battle and not give up. Take care, Bea > Kaci...you have a lot of company in "purgatory" and some days when my > fear takes a bad hold of me, I think I have crossed over into Hell! Hi Bea. LOL! I know the feeling. > Also, who are all those people who are supposed to be treating us like > porcelain since we have had bc?? Has not been "my" experience but I > guess it is for the best. Noooo.... that was just *my* perception of what would happen if I were to tell friends and acquaintances that I had bc. An irrational one? Possibly. One nurse I had when I first started getting treated always had a visibly sympathetic tone with me and it was depressing. I know she meant no harm but it simply rubbed me the wrong way. She acted like I was going to keel over at any moment, and it was about that time that I decided the fewer people who know about my illness, the better. > I no longer am concerned about trying to put on the brave face for the > rest of the world. When I need a good cry, I cry and when I need to > give vent to my feelings I do. Same here. Just wish I could choose my spots better. When I got my MRI results yesterday, I started blubbering right in the doctor's office to my great embarrassment (I haven't spoken to my onc. or surgeon yet). But I felt better afterward. And today's a new day. On another note, I could really relate to an earlier thread that talked about not always being able to be a "good" cancer patient, and the rejection of words like "courageous", "battle" "warrior", etc. used to describe us and our situation. At times I don't feel any of those things. What is most important is that we find > the strength whether it is in a support group, our loved ones, and/or > prayer to withstand the battle and not give up. You got that right. Though I consider myself a Christian, right now I am having some problems in the area of faith. Since the underlying theme of religions seems to be "do good and good will come to you," when I see children, infants sometimes, undergoing chemo it makes me wonder why them? What sin has a child committed in their short time on Earth that should warrant this being visited on them? But that's another TAN, I guess... kaci Kaci wrote: << Since the underlying theme of religions seems to be "do good and good will come to you," >> It depends on the religion. << when I see children, infants sometimes, undergoing chemo it makes me wonder why them? What sin has a child committed in their short time on Earth that should warrant this being visited on them? But that's another TAN, I guess... >> You might want to read the book, WHEN BAD THINGS HAPPEN TO GOOD PEOPLE by Rabbi (?) Kushner, which was a best seller several years ago which addresses the above question to others of all faiths besides his own. It should help you better understand that question in terms of religion--faith, etc. > Hi guys. Brief history: lumpectomy left breast 11/00. 42 y.o., Stage > 3A or b? Don't remember. 16 of 24 positive nodes, 6 cm. tumor shrunk [quoted text clipped - 6 lines] > there is an irregularly shaped 6 mm mass-like area of enhancement > which is considered suspicious for malignancy." Oh, what a pain. One could look on the bright side, you may have a treatable local recurrence, which, while it is like sliding down a snake back to near the start of this game, isn't as bad as having distant metastases which puts you in a different game altogether. One might argue that the fact it -hasn't- shown up anywhere else by the time recurrence on the original site was found, suggests it is less likely to ever do so. Tim Jackson > One could look on the bright side, you may have a treatable local > recurrence, which, while it is like sliding down a snake back to near the > start of this game, isn't as bad as having distant metastases which puts you > in a different game altogether. One might argue that the fact it -hasn't- > shown up anywhere else by the time recurrence on the original site was > found, suggests it is less likely to ever do so. I guess I'll know soon. I'm still hoping there is a chance that this is fat necrosis or scar tissue. But if not, I'll deal... it's what we do. Thanks, Tim, for the words of encouragement. kaci Yes, like Tim said a local recurrence is very treatable, keeps us posted.  SignatureALEXANDRA KOFFMAN > > > One could look on the bright side, you may have a treatable local [quoted text clipped - 12 lines] > do. Thanks, Tim, for the words of encouragement. > kaci Hi Kaci--sorry that you are dealing with this. I have a good friend and colleague who recently had a lumpectomy and will have both chemo and rads for a cm tumor. She had 30 nodes removed but fortunately only one was positive. Dr. had thought more would be since positive node was 3 cm. Interestingly, at initial consultation the surgeon told her that her chances of recurrence were much greater with lumpectomy although chance of overall survival were about the same. She trusted the dr. and asked what he'd recommend. He said lumpectomy. I am not sure how much he 'heard' her when she told him she didn't care if he took the breast. She would have been fine with the mastectomy. However, this was the first time he had ever met her. She is a beautiful woman and she put her complete trust in him. I am guessing he recommended lumpectomy w/rads based more on stats and fact that what he thought would be least interfering emotionally. However, it seems to me there is no sure way to predict overall survival between the two methods. If there is greater likelihood of recurrence with lumpectomy, how can they validly compare overall survival results between those who had mastectomy. They are not comparing treatment techniques. Latest research is now showing that those who have mastectomy along with chemo and rads reduce their risk of recurrence even further... .<< Tests, waiting, fear, tests, waiting, fear... it's a constant cycle which I suppose is the price we pay as cancer survivors. So many of you here are so logical and positive in your approach to the disease and are dealing with so much more, that I'm almost ashamed to say that mentally, I feel like I'm in purgatory >> Kaci, I hear 'ya. I am not sure that the dr's take this into account when recommending the less aggressive treatment--only immediate reaction(s). I do understand your concerns and fears. My best thoughts are with you and hope that latest treatment(s) will take care of this completely for you. {{{Hugs}}} That is why I choose mastectomy, I didn't want to deal with a local recurrence although it doesn't effect survival. I agree that some woman who choose lumpectomy don't heat the part about recurrence. Alex wrote: << That is why I choose mastectomy, I didn't want to deal with a local recurrence although it doesn't effect survival. >> That's what we are told the stats indicate but no one person is a statistic. It doesn't make sense. Does that mean that even with mastectomy we get recurrences elsewhere at same rate with same outcome? > However, it seems to me there is no sure way to predict overall survival > between the two methods. If there is greater likelihood of recurrence with > lumpectomy, how can they validly compare overall survival results between those > who had mastectomy. They are not comparing treatment techniques. Latest > research is now showing that those who have mastectomy along with chemo and > rads reduce their risk of recurrence even further... Hi Kaye. I have been doing some reading on tumor recurrence rates of lumpectomy vs. mastectomy, and what I've found varies, at best. Stats seem to vary by age of the study, and a lot of information available on the web goes back to the early '90s. Recent data is more difficult to find for the layman. For instance I read one article that said there's a 15% chance of recurrence with lumpectomy vs. 1% with mastectomy; others say recurrence and survival rates are "about the same" if clear margins with lumpectomy were achieved. Still other statistics say that with the stage and grade of tumor I had there is a 36% chance or less I'll still be here two years from now. Info on the specificity of MRI differs as well. The accuracy of diagnostic MRI of the breast apparently has improved greatly in recent years but there are still enough "false positives" and "false negatives" for it not to be relied upon as a standalone tool. With all this surfing and trying to interpret medical terminology, I come away from it overwhelmed and mostly with a sense of impending doom. All the more difficult to wrap my mind around since, at this moment, I feel fine. And if this "mass like enhancement" does turn out to be cancer, it raises the question of why, if clear margins were achieved at surgery (which my surgeon said was the case) did it return? If it is residual tumor, how did it survive radiation, chemo, and 3 years of tamoxifen? That would make it particularly aggressive, no? Ay yi yi, my brain hurts :) kaci > Hi Kaye. I have been doing some reading on tumor recurrence rates of > lumpectomy vs. mastectomy, and what I've found varies, at best. Stats [quoted text clipped - 6 lines] > statistics say that with the stage and grade of tumor I had there is a > 36% chance or less I'll still be here two years from now. There are two things here - recurrence and survival. Recurrence includes local recurrence (down the snake back to start) and distant metastases (mostly fatal). The stats. I believe say that there is higher risk of -local- recurrence with lumpectomy than with mastectomy, but that the overall survival rates are indistinguishable. Personally, if I were a woman and past my nubile years, and the cancer was anything but the smallest, with what I know now I'd be inclined to opt for mastectomy. We all hate losing bits of our body, wherever they are ( I know how long it took me to come to terms with losing a finger joint), but there is a simplicity about mastectomy - cutting along the dotted lines rather than through the bulk tissue, which makes healing simpler, complications such as local recurrence less likely, and prosthesis simpler. Your last statistic was no doubt true at the time of surgery. However now you are 4 years down the line your chance of escaping metastases is improving. As a large part of the cohort has now probably relapsed or died, the chances for the survivors have improved - for example if 50% have progressed, then your chances of long term survival will have risen from 36 in 100 to 36 in 50, or 72%. OK that's simple-minded extrapolation of statistics, and the reality is more complicated, but it is true that after the first couple of years the rate of recurrence goes down steadily. Tim Jackson << And if this "mass like enhancement" does turn out to be cancer, it raises the question of why, if clear margins were achieved at surgery (which my surgeon said was the case) did it return? If it is residual tumor, how did it survive radiation, chemo, and 3 years of tamoxifen? That would make it particularly aggressive, no? >> In response to the last part--well, perhaps. There are alot of unknowns about cancer. Some theories indicate that it lies dormant. Others indicate that it is very slow growing and not yet detectable. However, as far as the effectiveness of chemo--when someone does have metastatic disease and is given chemo, sometimes the chemo works to get rid of some but not all of the cells. Chemo works best on those cells dividing quickly. Perhaps they don't all divide at the same rate and it works less well against those that were slow growing. We are all given the same chemo--or most of us--as standard. From what I have come to understand is that one size does not fit all. In other words the chemo may not have been effective for all the involved cells. Then there is also the possibility that something interfered with the effectiveness of the chemo or radiation at the time those had been initially given. Or it worked for awhile--long enough to make it/them dormant but didn't kill or completely get rid of them. > And if this "mass like enhancement" does turn out > to be cancer, it raises the question of why, if clear margins were > achieved at surgery (which my surgeon said was the case) did it > return? If it is residual tumor, how did it survive radiation, chemo, > and 3 years of tamoxifen? That would make it particularly aggressive, > no? Not particularly, more it makes it particularly lucky. Perhaps there was a microscopic tumour in the residual tissue. There is a gap between the largest tumour that chemotherapy can destroy completely, and the smallest one that can be detected from outside the body. Chemo works best of the parts of the tumour that have a good blood supply, other parts can escape. It is -very- good at killing individual cells and tiny tumours, and at reducing the size of larger tumours, a bit like peeling an onion. Radiation kills a high percentage of the cancer cells, but not all of them. Tamoxifen only attacks the commonest genetic pathway, (ER overexpression) but there are many others, so it only halves the risk. Finally, your immune system is quite good at picking off odd free-floating cancer cells, but doesn't mount a mass defence against what is mostly your own proteins, and is easily overwhelmed. It's all about getting the numbers of cancer cells down to a level that the immune system can cope with. So there is always the small possibility that the odd fragment can dodge all the bullets you fired at it, and live to fight another day. It happens to a significant minority. Tim Jackson |
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