What I Know So Far

So a couple of days ago I met with my new best friends (thanks to this unpleasant surprise) - the plastic surgeon said my incision is healing well and he'd be working with me on any new surgery or reconstruction if I liked, and the surgeon scheduled me for an MRI of the upper torso. That way they can look at the affected area, and my lymph nodes, and even my other breast.

No - wait - that was yesterday. Holy hell, that was just yesterday. See, this is what happens over the summer - I don't have a regular schedule, my sleep cycles get completely messed up, and I can't keep track of the days! But still... wow. It feels like ages.

Mostly, that's because one of my major coping strategies is to find out as much as I can. For me, feeling informed is comforting. So, even though I felt a little silly asking - I mean, I'm not ANY kind of medical professional! - I did get a copy of my pathology report.

So behind the cut is what it means, as far as I can tell.

Okay. Page one. Kind of funny - up at the top it says "This report may not be the final report" and five lines below that it says "--- Final Report ---" Ooookay.

• Excisional biopsy - this means they got the specimen by cutting it out of me.
• Moderately differentiated invasive ductal carcinoma [IDC], overall grade 2 of 3
  • Differentiation means how funky the cancer cells have gotten. Well-differentiated means they are still mostly like the normal cells they came from. Poorly-differentiated means they have turned into what I think of as "neutral" cells. I think this affects the cancer's ability to spread. The more "neutral" a cell is, the more it can try to attach on to a different part of the body and mess that up, whereas cancer cells that are still mostly like breast cells are more likely only going to affect other breast cells.
  • Invasive means it's growing past the border of where it originally showed up. Yes - apparently, you can have mutant cells show up in your body and it doesn't count as an invasion as long as they stay under house arrest. *grin*
  • Ductal is one of the two classifications of breast cancer - it originates in the milk ducts. The other kind is lobular, which starts in the tissue around the ducts.
  • Carcinoma = cancer in medicalese.
• Tumor size 1.4 cm - one of the ways they decide how bad you've got it is based on your tumor size. 1.4 isn't too bad. I'm really hoping there aren't any others floating around in there. Hopefully the MRI will catch anything even if it's really tiny.
• DCIS, cribriform subtype, nuclear grade 1 of 3, with focal necrosis
  • DCIS stands for ductal carcinoma in situ. *sigh* Hell. Hell hell hell. I am JUST now realizing that this is in addition to the primary tumor. But lemme 'splain first. In situ means "in its original place." It's a very low-grade cancer, and it's noninvasive - it grows, but it doesn't spread to other parts of the body. I guess it's even possible that the DCIS they found was actually there from before, because I had it very extensively.
    
    Slight tangent - I don't know whether or not it's known if DCIS develops into IDC or if it's just that having DCIS is a sign that you're also at risk for separately developing IDC. Kind of like weight and type 2 diabetes - you kind of hear it said that being overweight "puts you at risk" and there's an implication that it's causative, but it's quite possible that a separate factor causes both weight gain and diabetes, and the weight gain is simply the result that's easier to see, while diabetes is more subtle.
  
  
  • Just as 'ductal' is one of the subtypes of breast cancer, 'cribriform' is one of the types of DCIS. Here, the difference is based on how tightly the cancer cells are packed into the duct. Papillary is the lowest grade, with cancer cells sticking in from the edge of the duct like little wavy fingers. [Tangent - or like caterpillars; the French word for butterfly is papillon!] Cribrifom is more like a spiderweb or swiss-cheese form, where there's a network throughout the cell. And then the highest grade is either solid or comedo (I'm not sure on this) but it's where the duct is filled up with cancer cells.
  • Focal necrosis - okay, this I don't like. Necrosis means there's dead tissue floating around inside the duct. Focal means there's not a lot of it, but still. I couldn't find a lot of explanation on this, but I figure there's two possible reasons. One is that the cancer is killing off other cells. I don't think that's the case, though, because that sounds pretty "invasive" and DCIS isn't supposed to do that. I think it's more likely that it's cell poo that can't be flushed because the DCIS has things clogged up.

I'm going to stop there for now because (a) it's late, and (b) this is already pretty long. Also (c) I have cramps and I'm going to run a hot bath and go soak. Maybe do some reading.

I'll probably pick up where I'm leaving off, though, so if you read this and it bored you... well, now you know not to bother with the next one. ^.^

I'm also going to print out a copy of this post to give to the surgeon when I go for my next follow-up, so that he'll know what I'm thinking.