Sunday, February 26, 2006

How did this happen?

In early December 2005, Venita found a ping pong ball sized mass in her right breast. Just showed up one day. Off to the GYN, saw a physician's assistant, who declared it likely fatty deposits from the onset of menopause, and sent her off for a bilateral mammogram and a right breast ultrasound (US).

Mammograms were unremarkable, US showed a small cyst. The radiologist cleared Venita to annual mammograms and instructed her to return in 4 months for a repeat US.

The following month, Venita saw her GYN for her annual exam, and he didn't like the mass, which had not changed in the intervening month. He sent her to a breast surgeon. Of course getting the appointment took a few weeks. A couple weeks after that first appointment, Venita was to have an excisional biopsy of the right breast mass, and sadly it turned into an incisional biopsy. The portion of the mass removed was about 4.5 x 2 x 1 cm. The pathology report indicated the portion removed had no clear margins, and the surgeon said most of the breast was cancerous.

The mass was very near the surface of the breast, and the cancer is in the nipple. As a result of the biopsy, the blood supply to the nipple was compromised (ischemia), and Venita is now experiencing pain there. The nipple is, in effect, dying.

The pathology report identified Venita's cancer as infiltrating (invasive) lobular carcinoma. An academic research study here describes the nature and outcomes of this type of cancer. (Don't try to read it all; it's highly technical.)

The surgeon wants to treat this cancer aggressively. She recommended a mastectomy (mast) with reconstruction, a sentinel node biopsy (which if OR-based frozen sections show node involvement, will turn into an axillary node dissection), and chemo, radiation, and hormone therapy. The pathology report showed the mass was estrogen and progesterone receptor positive and HER-2 negative, which is good news because it makes Venita a candidate for hormone therapy.

Before proceeding to the mast, the surgeon wanted more diagnostics on the left breast and sent Venita for an MRI. The MRI showed similar structures in the two breasts and a 8mm mass deep inside the breast. The surgeon is recommending a wire guided biopsy on the left breast and pathology of the excised tissue to determine involvement. Venita and Jim will be meeting in two days with the surgeon to clarify why she recommends a left breast biopsy instead of proceeding directly to a bilateral mastectomy.

Venita and Jim's entire week was a whirlwind of procedures and appointments that included the MRI, a blood test for hormone levels, a chest X-Ray, consults with the medical oncologist and reconstructive surgeon, and the consult with the breast surgeon about the ischemia.

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