The Diagnosis

REFLECTION

I have so many great ideas for the making of a blog full of wit, warmth, pith and pictures. My ideal-o-meter is spinning out of control. But my time is in demand and my energy is sapped and so you get the straight-text version.

Though I am still early in this journey, I can already see that knowledge comes to me Tetris style. At one appointment, blocks of knowledge are delivered and I build on them until the next appointment, when all previous blocks fall away and I start all over again. It's one reason I struggle with the motivation to update the blog. Each time I finally wrap my brain around something, I find out it was false or otherwise off in some aspect. But what I'm writing here is the most current understanding, so here's hoping it sticks, if only because I'm used to it.

DESCRIPTION

On Tuesday, I felt like I'd had sharp instruments the size of pencils stabbed repeatedly into my breast. As it turns out, that was because on Monday, sharp instruments the size of pencils had, in fact, been stabbed repeatedly into my breast. They call it a breast biopsy. Shouldn't that term make an appearance in a Fancy Nancy book? "My aunt had a breast biopsy (that's fancy for violence to boobies)."

The day of the biopsy provided fantastic blog-fodder, but there's so much else to tell now, that I'll share just a little. I was there for nearly four hours. At first I was very anxious, then I was given something to "take the edge off," resulting in two conditions: I was hilarious, and I have limited recall of the humorous exchanges between me and Jennifer the nurse, Carine the ultrasound tech and Dr. Decker the radiologist du jour, who happened to be nearly 7 feet tall. But I do remember this . . .

1. I was lying face down on a table with a hole in it through which my right breast protruded (let's be honest) hung, and I was worked on from underneath like at the Quickie Lube.
2. They had to raise the table high enough for the giant Dr. Decker to fit underneath. 
3. The paperwork I signed that morning said that after the procedure, "pressure" would be applied to stop my bleeding. It failed to disclose that this pressure would be applied by a device I'm pretty sure came from a work bench in one of their garages.
4. Jennifer checked on me during said application of pressure. She put her hand on my hand and asked, "How are you feeling?" Through clenched teeth I replied, "Like my boob is in a vise, and you?" But when I opened my eyes to share a chuckle with her, I could only see her from the eyebrows up. 

THE DIAGNOSIS

The first biopsy sample included a cluster of those calcifications I mentioned in my first post.

According to the pathology report, the diagnosis on them is DCIS, which stands for Ductal Carcinoma In Situ. Ductal means it is in my milk ducts. Carcinoma means it's cancer. In Situ means the cancer is confined to within the duct, and has not invaded surrounding tissue. That seemed like a good thing until we remembered this sample represents one tiny cluster (about 8 millimeters worth of tissue), and that dozens, if not hundreds of calcifications are present in the breast. The doctor called them "innumerable."

Although we can guess that all these calcifications are similar, it is not necessarily so.  Also present in the calcification sample was something called comedonecrosis, which means dead cancer cells were found in the sample. That seemed like a good thing until we were told it means the cells are multiplying so fast that the ones in the center of the duct are  overcrowded and are starving to death. The sample was graded a 3 out of 3 for aggressiveness and rate of growth. That seemed like a good thing until . . . wait, never mind. That never seemed like a good thing.

The other biopsy sample was from the mass itself. It was taken in a procedure guided by ultrasound, so I got to watch every detail of it, in all its gory glory. Let me think how to describe it. Oh yeah, it was a sharp instrument the size of a pencil being stabbed repeatedly into my breast.

The sample from the mass was diagnosed as IDC, Invasive Ductal Carcinoma. This time, ductal means originating in the duct, carcinoma still means cancer, and invasive means, well, invasive. It has left the confines of the duct and is attempting to take possession of the 'huge tracts of land' (Monte Python and the Holy Grail) that surround it. I like to picture Billy Crystal waving from the ductal doorway and calling, "Have fun storming the castle" (The Princess Bride).

It is unclear to me whether the IDC started as a DCIS calcification and grew, or the IDC spawned/is spawning the calcifications. I suppose it matters little. The mass was also given a 3 out of 3 grade for aggressiveness and rate of growth.

An internet source also classified my diagnosis as a cancer that is more likely than other cancers to recur within five years. Anecdotally, I am hearing that the more aggressive the cancer is, the more responsive it is to treatment. I hope it's true.


THINGS YET TO KNOW

The big concern, of course, is whether the cancer has reached my lymph nodes. The mammo images definitely show the calcifications approaching the node area (there goes the neighborhood). Dr. Brandon did say my nodes looked clean. Mammo, however, is not the preferred nor definitive imaging type for lymph nodes. MRI is.

My MRI is scheduled for Wednesday the 23rd, and my consult with the surgeon is scheduled for Friday the 25th. I will wait to make a final decision once I hear what the surgeon has to say, but I will be very surprised if I still own breasts by Valentine's Day. I may consider leasing, with an option to buy (Fletch).


GRATITUDE

Also on my ideal-o-meter, I picture dedicating a section of this blog to all those who serve and show love to my family during this process of overcoming cancer. It is not meant to give them glory, as I know they don't do it for glory. And although I do wish to thank these people, naming them here is not for that purpose either. It occurs to me to put the list here to stand as a witness that God works through others for my good. Somewhere down the line I may need reminding of that, and I hope also to be one through whom God can work for the good of others.

Right now that list includes:
Dave, who will always be first on this list, for his attentiveness, constructive concern, and strong arms;
Mom, who is "tender mercy" embodied;
Stacy, who is willing to drop everything on a moment's notice to be with me whenever I ask, and doesn't mind when I cuss;
Jamie, who can read, speak and write science, and who checks on me daily;
Jon, who cries with me;
James and Mark, who were willing and worthy to give me a blessing;
Jeni, who knows so much about Chico's medical community and is full of reasoned advice;
Julie, Deborah and Robin who, between them, bring food, keep kids, take up slack in YW, act as voice when my own fails, and most important, gab with me about so much more than just cancer;
Suzie and Ibs, who took my kids on an all day snow trip so we could have time to process, and who, like Stacy, stand ready;
Barbara, our Nurse Navigator, who is both gentle enough and forceful enough to guide us well;
Jill and Cody, who have sent great boob jokes my way (actually, they did that before cancer, too);
The cast and crew at Chico Theater Company, all but one of whom don't even know I have cancer, for taking my reds under their wing, for letting us all be part of something amazing, something of value, something pure and good and a heck of a lot of fun---all great antidotes to sorrow;
And many others, who have said prayers for me, given hugs, submitted to temple prayer rolls, and reached out in other ways.

I like to think of my support system as existing in overlapping layers. First layer Dave, overlapping with Family, then Friends, then Enloe's Cancer Center and finally, sort of acting as a safety net under it all, my wonderful Church.

I am overwhelmed with gratitude.