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Medical Forum / Diseases and Disorders / Breast Cancer / June 2008Medical Merry-Go-Round II: Re-Excision Lumpectomy
Had the rest of my bigger tumor cut out yesterday, at least I hope two's the charm. The surgery was much easier this time. I'd feel pretty good if we weren't stuck in the northern California smoke disaster. Visibility is about 100 feet, and we can smell smoke with every breath. It looks like brown pea soup fog--sunlight can't make it through. It's also stiflingly hot, but we can't run the swamp cooler because it draws in outside air. Four days so far, and no end in sight. Still, it's a relief to finally have surgery over, three months after I first felt that bigger tumor. I'm trying to start radiation ASAP, because my mom's in very bad shape, way off in Seattle. I'm forced to wonder about the repercussions of leaving town in the middle of radiation. Have any of you seen the June issue of Scientific American? It has an interesting article about breast cancer treatment advances, mostly about the new drugs. Les > Still, it's a relief to finally have surgery over, three months after > I first felt that bigger tumor. Congratulations, happy for you! :-) > I'm trying to start radiation ASAP, > because my mom's in very bad shape, way off in Seattle. I'm forced to > wonder about the repercussions of leaving town in the middle of > radiation. Your radiologist will tell you all about that during the planning phase. I was told it was ok to miss a few days here and there, and decided to go on a wonderful mini-trip in the middle of radiation. It was the first time in months I was in shape to go anywhere. Of course, it's the total dose that counts, so the days missed were tacked on to the end of the treatment period. (No free lunches! ;-) > Have any of you seen the June issue of Scientific American? It has an > interesting article about breast cancer treatment advances, mostly > about the new drugs. I saw it and it cheered me up, as I am one with a less than wonderful prognosis, benefiting from Herceptin. Ixia > Had the rest of my bigger tumor cut out yesterday, at least I hope > two's the charm. The surgery was much easier this time. I'd feel [quoted text clipped - 4 lines] > cooler because it draws in outside air. Four days so far, and no end > in sight. -------------- You actually make me glad I live in New York City! And that's no mean feat. -------------- > Still, it's a relief to finally have surgery over, three months after > I first felt that bigger tumor. I'm trying to start radiation ASAP, > because my mom's in very bad shape, way off in Seattle. I'm forced to > wonder about the repercussions of leaving town in the middle of > radiation. -------------- My personal opinion: Hey, this is life or death here. Postpone the visit till you complete your treatment. ----------------- > Have any of you seen the June issue of Scientific American? It has an > interesting article about breast cancer treatment advances, mostly > about the new drugs. ------------------ Where could I read this, please? Thanx Eva > > two's the charm. The surgery was much easier this time. I'd feel > > pretty good if we weren't stuck in the northern California smoke [quoted text clipped - 29 lines] > > Thanx Eva Eva and Ixia, Thanks for the info about radiation. I asked my doctor to get that started soon. I've been planning to wait to visit my mom till afterwards if she makes it that long. I'd only interrupt radiation to attend her funeral. Smoke seems worse today. Every breath feels like a drag on a Camel, even in the house. I understand we'd have to travel at least a hundred miles to get out of it. Eva, I checked out the June Scientific American at the library, don't know how else to get it. At least I don't have the Her-2 problem. I qualified for the Oncotype DX test, but won't get the results till mid-July. Les > Eva and Ixia, > > Thanks for the info about radiation. I asked my doctor to get that > started soon. I've been planning to wait to visit my mom till > afterwards if she makes it that long. I'd only interrupt radiation to > attend her funeral. Let's hope for the best. Perhaps you want to visit before radiation starts? My own mother lives in Europe and I would not have been able to go during chemo or late radiation, no matter what happened to her. Fortunately nothing did. I took a Monday off from radiation to travel with my daughter and see her sworn in to the NY Bar. It's one of those occasions I am going through all this yucky treatment in order to be alive for! :-) I asked nicely for an early morning Friday treatment and a late afternoon Tuesday treatment in order to fit in the trip. Depending on how your tissues react, your doctor may want you to take a few days break in treatment. Also, radiation is cumulative and the effect will continue to build for several days to a week after treatment is over. > Smoke seems worse today. Every breath feels like a drag on a Camel, > even in the house. I understand we'd have to travel at least a > hundred miles to get out of it. > > Eva, I checked out the June Scientific American at the library, don't > know how else to get it. http://www.sciam.com/article.cfm?id=gaining-ground-on-breast-cancer Ixia [quoting downwinder] > Eva, I checked out the June Scientific American at the library, don't > know how else to get it. http://www.sciam.com/article.cfm?id=gaining-ground-on-breast-cancer ---------------- Thanks! Wow! What an encouraging article. Looks like there will be a lot more options for us in the future. Eva > [quoting downwinder]> Eva, I checked out the June Scientific American at the library, don't > > know how else to get it. [quoted text clipped - 6 lines] > > Eva :-) I have a great oncologist, who pretty much spoke that article to me last year. However, I was totally shell-shocked - hearing that the tumor was grade 3 and positive for "everything" did nothing for my listening skills. I started treatment within a few weeks of diagnosis, and developed a major case of chemo-brain. That didn't help either. I'm grateful that it has pretty much lifted and I can think clearly again. Breast cancer really sucks, but it's great to know that there are actually options out there. That's it - I'm renewing my magazine subscriptions AND buying new clothes ;-) Ixia > > "Ixia" <ixiaviridifl...@gmail.com> wrote in message > [quoted text clipped - 25 lines] > > Ixia There's not enough time to travel to Seattle to see my mom and it's too expensive. We both live two hours from the nearest airport so it's an all day deal. Have a doctor visit next week, and I'm hoping for a radiologist appointment the week after. I do love my mom, we have long phone conversations all the time. I'm really dreading her death, and am upset that I can't go help her. I do dream of that clean, cool air. The smoke is supposed to be five times healthy levels indefinitely, and it's getting hotter every day. Ixia, when you say your tumor was grade 3, which of the three grades do you mean? Mine was 3 tubules, 2 nuclear, 1 mitoses = 6 SBR, moderately differentiated. No doctor will elaborate, but I'm interpreting this to mean an ugly but slow-growing cancer. What was the verdict on your lymph nodes? Did you get the Oncotype DX test? I won't take chemo unless I get a high recurrence score. Both the radiology doctors in my town are reputed to have rotten personalities, no word on their competence. I hope I have better luck with the oncologist; so much has gone wrong already. I have a very strong body, but sometimes have doubts about my spirit. Les > Ixia, when you say your tumor was grade 3, which of the three grades > do you mean? I mean "high grade" as in "cells being far removed from normal cells". "High grade" cancer cells are more likely to be fast growing and to spread. > Mine was 3 tubules, 2 nuclear, 1 mitoses = 6 SBR, > moderately differentiated. No doctor will elaborate, but I'm > interpreting this to mean an ugly but slow-growing cancer. Slow growing is good, and "moderately differentiated" is better than "highly differentiated", (far from normal). > What was > the verdict on your lymph nodes? 2 lymph nodes showed positive on a scan at the time of diagnosis. At the time of surgery (after months of chemo) no cancer was found in either breast or lymph nodes. Finally some good news! > Did you get the Oncotype DX test? I > won't take chemo unless I get a high recurrence score. No, it was clear from the start that I needed chemo - one large tumor, one smaller. 2 positive lymph nodes. Strongly estrogen, progesterone and HER2 positive. The only good news was that no mets were seen. > Both the radiology doctors in my town are reputed to have rotten > personalities, no word on their competence. They don't have to be charming, but to be able to design a decent treatment plan. Technicians will give you your actual, day to day. It pays to be on good terms with them, they see lots of people getting radiation, and can help ease you through treatment. Along with the nurse, mine were life and sanity savers. > I hope I have better luck > with the oncologist; Again, (s)he does not need to be charming - mine is not, I would not want her as a friend. What she has is both an interest in and a lot of experience with breast cancer, she goes to meetings, takes part in trials, is well respected by her peers, stays on top of both cutting edge treatment and the tried and true. She has professional pride: no patient of hers is allowed to do poorly! You just buckle up and get with the program ;-) My family, the nurses and support staff gave comfort and tenderness, the oncologist was tough as nails. I have not followed /all/ her advice, but I both show her and tell her that I value her skill, knowledge, expertise, and so on. I'm very grateful to her for being "theoretically cured" at this point. I did not hope for that last year, but she did and she won :-D >so much has gone wrong already. Yes, I'm sorry. Some things will always go wrong, as nothing and no- one is perfect. But, it's very hard to take it in stride in a situation as stressful and filled with uncertainties as this. > I have a very > strong body, That's a great advantage. I don't particularly, and had difficulties with treatment. >but sometimes have doubts about my spirit. I practice "healthy thinking" the exact same way I eat a healthy diet: I don't allow myself to wallow in negativity, gloom and doom, cynicism and so on, but counteract with pleasant, positive activities. I stay away from conversations, people, situations and so on who bring me down - no matter how well intentioned they may be. Misery loves company, but is not going to get mine :-) You'll do great Les. In a few moths radiation will be over, next year this time we'll both be busy with other things than breast cancer :-) Ixia > > Ixia, when you say your tumor was grade 3, which of the three grades > > do you mean? [quoted text clipped - 76 lines] > > Ixia Ixia, Thanks for the encouragement, but I still feel myself sliding. My sisters in Utah want me to get radiation there, because I'm a Nevada nuke test downwinder and spent my first 12 years being bombarded with fallout. According to Susan Love's Breast Book, radiation treatment must consider previous radiation exposure. My sisters say Utah MDs know how to treat downwinders. It's hard to imagine that happening here. My surgeon said I'm getting max full-breast radiation, period. She drew a total blank when I pointed out that I grew up playing in fallout. In case of recurrence, you can't get radiation on a previously irradiated breast, right? My whole body is previously irradiated. Only a fellow downwinder understands our horror of radiation. I had to psyche myself up for weeks just to get a scam-o-gram, and was furious to learn they were all worthless. At the moment, I don't see how I'll summon the will power to even walk into the radiation place. My neighbor had the radiation doctor I'm assigned to. She said that if you ask her a question, she grunts and waves her hand and that's it. I'm so tired of being afraid. Les > Ixia, > > Thanks for the encouragement, but I still feel myself sliding. My > sisters in Utah want me to get radiation there, because I'm a Nevada > nuke test downwinder and spent my first 12 years being bombarded with > fallout. My radiation oncologist has a Ph.D nurse-practitioner on staff, who is very helpful. She has the in-depht knowledge i lack when I want to investigate deeply. She also has the ear of the radiation oncologists. Find out if there is someone like that you can ask for help to sort things out. Next I would write down the questions you still have, as clearly and to the point as possible, and ask your oncologist for specific answers. Stick with it until you have answers that make sense. If you still wonder, your sisters can perhaps do some legwork and find a nuclear oncologist team or medical researcher who have investigated the effects of fallout on your cohort in Nevada. You may want to contact them for an expert opinion. > According to Susan Love's Breast Book, radiation treatment > must consider previous radiation exposure. My sisters say Utah MDs > know how to treat downwinders. It's hard to imagine that happening > here. My surgeon said I'm getting max full-breast radiation, period. > She drew a total blank when I pointed out that I grew up playing in > fallout. Well, yes, she's a surgeon, not a radiation oncologist. You need answers from the radiation oncology team. >In case of recurrence, you can't get radiation on a > previously irradiated breast, right? My whole body is previously > irradiated. 1) Giving radiation treatment to /previously treated/ tissues is different from 2) Giving radiation treatment to /previously exposed tissues/. You have to ask a radiation oncology team to explain if/how your / previous fallout exposure/ will affect a breast cancer radiation treatment plan. I personally was told that I am now "maxed out" regarding radiation / treatment/ to my left chest. My radiologist recommended mastectomy for that reason - if I have a new tumor in the same area, he will not be able to /use radiation as a treatment/. (As far as I know they can still use x-rays and/or other radiation as /diagnostic tools./ ) > Only a fellow downwinder understands our horror of radiation. I had > to psyche myself up for weeks just to get a scam-o-gram, and was [quoted text clipped - 4 lines] > if you ask her a question, she grunts and waves her hand and that's > it. I'm so tired of being afraid. Don't accept grunts and waves. Write down your questions /in advance/, bring your spouse or other trusted person along and ask them to write down/record the answers and information you get. Read these pages: http://www.breastcancer.org/treatment/radiation/index.jsp Here: http://www.breastcancer.org/treatment/radiation/when_appropriate.jsp "Keep in mind that most women (about 70%) do not need radiation after mastectomy. When radiation is NOT an option Radiation is not an option for you if: You have already had radiation to that area of the body. You have a connective tissue disease, such as scleroderma or vasculitis, which makes you extra-sensitive to the side effects of radiation. You are pregnant and so should not have radiation therapy. You are not willing to commit to the daily schedule of radiation therapy, or distance makes it impossible. Can radiation therapy be repeated to the same area again? Full-dose radiation is usually given only once to a particular part of the body. Your normal tissues can safely tolerate a limited amount of radiation. Your radiation oncologist knows how to pick the right dose of radiation to accomplish two things: reach the maximum therapeutic dose—the amount that's likely to destroy cancer cells, and avoid or minimize side effects to the normal tissue. After radiation is over, the normal tissues heal and get back to normal. But because you have received about as much radiation as your healthy cells can safely handle, it is not possible to treat this area again with another full dose of radiation. If cancer returns to the same breast area, depending on the radiation dose you already received, you may or may not be able to receive a limited amount of additional radiation treatment in that same area. Your doctor will know what the limits are, and together you can decide if this is a good treatment option for you. It's important to note that this information refers to treating the SAME part of the body a second time. If cancer should occur elsewhere in your body, outside the treated breast, radiation can be used to its full effect." Ixia >> Mine was 3 tubules, 2 nuclear, 1 mitoses = 6 SBR, >> moderately differentiated. No doctor will elaborate, but I'm >> interpreting this to mean an ugly but slow-growing cancer. >> > Slow growing is good, and "moderately differentiated" is better than > "highly differentiated", (far from normal). No. Highly differentiated is good, poorly differentiated is bad. As the foetus develops, normal cells differentiate from round blobby embryonic stem cells into bone cells, nerve cells, skin cells, blood cells etc. that have quite distinctive appearances. When cells become cancerous the DNA is mutated and they lose some of their specific features, their differentiation. In extreme cases where DNA damage is extensive, it is impossible to tell under a microscope from what tissue the cells originated. These are "poorly differentiated" cells and tend to represent a more aggressive cancer. Tim Jackson > >> Mine was 3 tubules, 2 nuclear, 1 mitoses = 6 SBR, > >> moderately differentiated. No doctor will elaborate, but I'm [quoted text clipped - 14 lines] > originated. These are "poorly differentiated" cells and tend to > represent a more aggressive cancer. Thank you for cleaning up my language. http://www.breastcancer.org/symptoms/path_report/the_cancer/grade.jsp "There are three cancer grades: Grade 1 (Low Grade or Well Differentiated): Grade 1 cancer cells still look a lot like normal cells. They are usually slowgrowing. Grade 2 (Intermediate/Moderate Grade or Moderately Differentiated): Grade 2 cancer cells do not look like normal cells. They are growing somewhat faster than normal cells. Grade 3 (High Grade or Poorly Differentiated): Grade 3 cancer cells do not look at all like normal cells. They are fast-growing." Ixia > > >> Mine was 3 tubules, 2 nuclear, 1 mitoses = 6 SBR, > > >> moderately differentiated. No doctor will elaborate, but I'm [quoted text clipped - 33 lines] > > - Show quoted text - Ixia and Tim, Yes, I was mixing up "highly" with "poorly" differentiated. Ixia, thanks for the detailed information, and the distinction between radiation exposure and radiation treatment. Hopefully I'll get some answers about how nuclear test victims should be treated, will advise. Les if your mother is really ill....gosh, I don't know. very tough decision. but oh the weather in the Pacific NW....divine.... ask your doc if you can splice it in. unless you don't like your mom (sorry, mordant humor, we cancer patients and old ladies are entitled, sometimes)....I love my mom but she drives me nuts! ;-) On Jun 25, 5:13 pm, Eva <EvaDSt...@aol.com> wrote: > "downwinder" <desertny...@cwo.com> wrote in message > [quoted text clipped - 33 lines] > > Thanx Eva Eva and Ixia, Thanks for the info about radiation. I asked my doctor to get that started soon. I've been planning to wait to visit my mom till afterwards if she makes it that long. I'd only interrupt radiation to attend her funeral. Smoke seems worse today. Every breath feels like a drag on a Camel, even in the house. I understand we'd have to travel at least a hundred miles to get out of it. Eva, I checked out the June Scientific American at the library, don't know how else to get it. At least I don't have the Her-2 problem. I qualified for the Oncotype DX test, but won't get the results till mid-July. Les |
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