A Change of Perspective

It’s Been a Week

A week ago, yesterday, I had a double mastectomy. I knew there was a lump in my left breast, but had no idea if there was any further involvement. Three days ago, we got the news we had been waiting for.

The histology report says that my left breast had invasive breast carcinoma, ductal carcinoma in-situ, cribriform and solid type, intermediate nuclear grade. Residual tumor was 1.4 cm. Resection margins free of malignancy. No involvement of nipple identified. The left axillary sentinel lymph nodeshowed a single benign lymph node with no evidence of metastatic carcinoma. The right breast presented with no cancer.

Everybody asks what type of cancer I had, so I’m going to have take this report around with me to answer that question because it’s complicated.  I had an invasive ductal tumor that was 1.4 cm. The Nottingham Histologic Grade was Grade II, Score 7. The Modified Black’s Nuclear Grade was 2. It was solid and cribriform type with intermediate nuclear grade. The margins were free of malignancy. The TMM Cancer State was T1c, No MX. Estrogen Receptor was positive (90%), Progesterone Receptor was positive (30%) and HER2/NEU was negative.

All this is good news, but what does it mean?

Quoting from the website http://ww5.komen.org/BreastCancer/DuctalCarcinomainSitu.html:

Ductal carcinoma in situ (DCIS) is a non-invasive breast cancer. In DCIS, abnormal cells are contained in the milk ducts. It is called “in situ” (which means "in place") because the cells have not left the milk ducts to invade nearby breast tissue. DCIS is also called intraductal (within the milk ducts) carcinoma. You may also hear the terms “pre-invasive” or “pre-cancerous” to describe DCIS.  
DCIS is non-invasive, but without treatment, the abnormal cells could turn into invasive cancer over time. Left untreated, about 20 to 30 percent of low grade DCIS will progress to invasive breast cancer [100]. Higher grade DCIS may be more likely to turn into invasive cancer if left untreated.  
At this time, health care providers cannot predict which cases of DCIS will progress to invasive breast cancer and which will not. Because DCIS might turn into invasive breast cancer, almost every case of DCIS is treated.  
Surgery (with or without radiation therapy) is recommended for the treatment of all DCIS. Prognosis is usually excellent.

 Apparently, I could have left it alone and waited, but surgery was inevitable and why not do it early instead of later.

So, what is cribriform? According to the website http://breastcancerinindia.com/Cribriform-Carcinoma-of-the-Breast.html:

As the name suggests, this carcinoma has typical “perforated” growth pattern. These cells in the cribriform carcinoma have what appears to be distinctive holes inbetween, consequently appearing like “swiss cheese”. This is a rare diagnosis which usually has an excellent prognosis, with a survival rate of 80%. This cancer is as rare as an incidence rate of only 6%. These tumor cells invade in nestlike structure the connective tissue or the stroma of the breast. it is not a very aggressive kind of cancer and is usually low grade. This cancer can simultaneously have some DCIS and some invasive elements. This breast cancer is found mixed with other types of carcinomas like tubular breast carcinoma and comedocarcinoma. Overall only 20% of these cancers are pure (cribriform invasive cancer forms 90%), 30% are largely cribriform with over 50% cribriform growth and 50% mixed cribriform cancers.

Still, awesome news, even if it is rare.

Now, what is all this Nottingham Grade stuff? According to the website http://www.oncolink.org/experts/article.cfm?c=35&id=2221:

The Nottingham histologic score is simply a scoring system to assess the "grade" of breast cancers.
It is a total score based on 3 different sub-scores. The 3 sub-scores are assigned based on 3 components of how the breast cancer cells look under a microscope. (The details of these 3 components are not critical for you to understand). Each of the 3 components is assigned a sub-score of 1, 2, or 3, with 1 being best and 3 being worst. Once the 3 sub-scores are added, a Nottingham score is obtained: the minimum score possible is 3 (1+1+1) and the maximum possible is 9 (3+3+3).
A histologic grade of III is assigned to any patient with a Nottingham score of 8 or 9. Grade I refers to Nottingham scores of 3, 4, and 5, while Grade II refers to Nottingham scores of 6 and 7.
In the end, the Nottingham score and histologic grades are not very useful in the big picture, as they do not alter final overall treatment recommendations. High-score cancers tend to relapse more often than low-score cancers. Ultimately, however, we don't use the score in making clinical decisions.

So, here’s my thoughts: we did the right thing by taking both breasts. The outcome was perfect, I’m doing well, and the risk of further breast cancer is low. Given all the options, I would do exactly the same thing. I want to emphasize, that it was the right choice for ME. Anyone else who is given the same information may make a different choice. It’s a very personal decision and I’m so honored that you have wanted to share this experience with us.

We went to the breast surgeon yesterday and he said I was healing well and he removed one of my drains. Yeah! He asked if I wanted the other one removed also, but it is still draining around 20 cc per day, so I chose to leave it in. The tubing came out easily and the hole has got a small scab on it already. The nurse warned that I shouldn’t feel like I can do everything just yet. Driving is okay, heavy lifting is not okay, don’t move the furniture, or enter a marathon. I’m guessing I’ll be 100% in about a month, maybe 3 weeks.

Anyone who knows me well, knows that I believe in angels and have followed their guidance on more than one occasion. I feel that I’ve been looking at this move to Tucson in the wrong light. Looking back with a different perspective, I can see that this is exactly where I was supposed to be.

I hate Tucson because I can’t find a job, it’s hotter than the face of the sun, and I’ve had cancer twice since I got here almost 4 years ago. But instead of looking at it as “I’ve had cancer twice” how about looking at it as “I’ve been in the right place to get the best medical attention”. If I were still in Rapid City, South Dakota (a place I love), I would not have had the incredible doctor who performed my hysterectomy in a way that contained all the cancer cells within the uterus and listened to me when I said to take everything, including the ovaries. If I were still in South Dakota, I would not have had one of the best breast cancer doctors in the United States working with me to have such a great outcome. Randy and I decided to move after he wrecked his truck and my mother died to be closer to family. My angels told me it was the right place to be. They were right, they’re always right. Now I know why they knew I should be here. I will try ever so much harder to like this place. I may forget that I made that promise when it’s 120 degrees in the shade and I can’t get cool, but I’ll try. I’m sure my angels will appreciate it, as will my husband.