Catia Bitching Cancer

So, what does this mean and what are the possible treatment options?

For those of you who know me best, you will also know without me telling you that I immediately started researching about breast cancer. I looked up cancer sites to get the basic information about ductal carcinoma, grade, classification, etc… and when I thought I understood most technical terms I started skimming journal articles. I wanted to be prepared to ask questions, but also to be able to determine, by asking questions, whether my team of doctors and nurses was up-to-date with the current research and competent.

I also contacted a friend who had the same insurance and had had breast cancer six years ago. She and her husband directed me to a few websites that had been useful to them. Finally, I told my best friend in Italy, who is an oncologist. She gave me more information, as well as more websites to look at. I spent over a week doing research. I can honestly say that I am able to make informed decisions about my future treatment, though no decision is going to be easy or risk-free.

The low-down of it is this: I have a multifocal or multicentric carcinoma (there is more than one site, but we don’t know yet that the two sites are related to each other – multifocal – or independent from each other – multicentric). That means at the least having a quadrantectomy (removal of one quadrant of the breast). If the margins (the area around the cancer that will be removed together with it) are clear (no cancer), then with radiation and possibly chemo, the recurrence and survival rates are the same as if I had a mastectomy. The left breast, and indeed both breasts, will have to be constantly checked, to catch any recurrence real early. A quadrantectomy would save part of the breast, but depending on how big it is, the breast might be deformed. I could however, have a small implant put in and have the plastic surgeon match the two breasts. My age indicates treatment with chemo, but it is a little premature right now to think about that. Also, radiation treatment will have to be performed if I choose the quadrantectomy.

The second option for surgery is a mastectomy, but there are several types of this. The most common mastectomies nowadays remove the entire breast (simple or total mastectomy) and, sometimes, some of the lymphnodes in the underarm (modified radical mastectomy). Rarely now do they remove the chest muscle and all lymphnodes. With a mastectomy I likely won’t have to have radiation, but I still might have to have chemo.

Because there are several suspicious microcalcifications around the breast, it isn’t clear what kind of surgery would be more indicated. That is, while the quadrantectomy delivers the same outcomes, provided there are clear margins, I don’t know yet whether I can expect clear margins. One possibility would be to have the surgeon remove the two carcinomas first, biopsy all suspicious areas while I’m under, close up. If the suspicious areas turn out to be cancerous or precancerous, or if the margins were not quite clear, then the surgeon will open up again and perform a mastectomy or just remove more tissue to make sure the margins are clear.

Moreover, the surgeon will have to determine whether the cancer has spread to the lymphnodes in my armpit. To spare you the technical details, basically if a modified radical mastectomy is performed, lymphnodes are taken with the breast. If a simple mastectomy or a quadrantectomy are performed the surgeon could also take a few strategically located lymphnodes, avoiding extensive scarring. There is a procedure called sentinel node biopsy that helps determine which nodes to take out, but this is generally not indicated for women with multifocal or multicentric cancer, like mine.

The treatment to follow surgery will be based on whether the lymphnodes tested positive or not, plus a number of other questions. This is something that I will study and talk about later.

If I choose, or have to choose, a mastectomy, I am quite sure that I will also pursue reconstruction of the left breast, and matching of the two breasts for simmetry. I can have a reconstruction started concurrently with the mastectomy (simultaneous), or later (delayed). Depending on what treatment one envisages, it might be better to have delayed reconstruction. I will have to talk to the surgeon about this. Also, there are different types of reconstruction, and so far I lean toward having implants put in. It’s a longer procedure (it involves several sittings for stretching the skin), it does not last your entire life (I’ll have to have the implants changed sometime in the future), it might be more painful, but it doesn’t give me additional scarring or take away muscles that I want to keep using (like abdominal muscles or back muscles as in other procedures). But again, this is not something I will have to decide immediately.

I think this is it as for information. I spared you a lot more details than you can imagine. I also spared you pictures 🙂 But know that I have done my research, I have a good support network, both for medical information and for emotional support, and I don’t go into this uninformed or unprepared.

I will keep you updated.

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