A Personal Journey Through Breast Cancer Quiz

Answer: Mammography

Mammography is a really important means of early detection of breast cancer. It may not be comfortable but a few minutes of discomfort versus life is a hands down choice in getting a mammogram done. The recommended ages to get this test are fifty to seventy-four, once per year or in some places like the USA, once every two years. Believe me, survival chances increase with your attention to getting a mammography done as recommended.

The low-energy X-ray used with mammography is truly a vital way to examine the breast. With the mammogram it is possible to screen for changes in the breast tissue from year to year and also in the detection and diagnosis of tumors.

With my mammography they detected something that could not be felt through self-examination but nonetheless there was something abnormal within the left breast. During the mammogram my left breast was placed on a plate, which is part of the machine, and another plate moved to compress my breast for the imaging. It is not a comfortable procedure but it doesn't take very long if you listen to the instructions from the technician and allow the technician to place you and your breast in the proper position. Once you are in position, do not move. Generally one image is taken through top to bottom and another is taken from side to side of the breast. The procedure is then repeated on the right breast.

Answer: Detection, measurement and imaging

A sonogram or ultrasound imaging is a useful and painless way to clearly view a suspicious lump within the breast as well as define a more clear location of the area than a mammogram does. Sound waves are used to create a computer-generated image for the specialists and technicians to view. A gel is placed onto the area to be viewed. The technician will then run a paddle-like part of the machine over the area and take images that are saved into the computer. This test is completely painless. Once the images are complete a radiologist will view the images and determine what to do next.

In my case it was decided that a biopsy would be done right away, using the sonography machine to guide the expert through that process. A local anesthetic was used to freeze my breast and with the guidance of the ultrasound, hollow needles were used to draw out tissue and cells from the suspicious lump. These tubes, called core needles, make noise like an elastic band snapping when each is activated to aspirate (draw out) some tissue and cells. The test results came in within a two-week period. My biopsy was done three days before Christmas in 2010. It was difficult to wear a happy face through the holiday season but I did manage fairly well. The more knowledge I researched the more confident and comfortable I felt and worry diminished somewhat. I felt certain that my results would be positive as cancer but I was in the mindset of being in full attack against this frightening disease.

Answer: A visit to the oncologist

You will be given an appointment to meet with your oncologist. An oncologist specializes in the treatment of cancer in patients. There is more than one type of oncologist. The main oncologists a patient will see are professionals in medical, surgical and radiation treatments. Together they will treat you and help to make your journey through cancer as efficient as possible. Your first oncologist will be a clinical oncologist who will be in charge of managing your care and treatment by setting you up with your necessary appointments with your "treatment" team of doctors. In some cases you may have to see your regular general practitioner in order to get your oncology appointment set up the first time, as well as to discuss which surgeon you would like for any possible upcoming surgery.

My general practitioner is the one who set me up with both my oncologist and my surgeon. He has played an important role in my recovery process along with my medical team of specialists. With every visit I was always asked how I felt emotionally. Of course I felt depressed at times, encouraged at times, confused at times, but my medical team always informed me and helped me to understand procedures and probable results which gave me the confidence to feel more positive.

Answer: Electrocardiogram

Meeting with your surgeon to discuss your options is one of the procedures for many, depending on the overall specifics and severity of the cancer. In my case I had a small intraductal carcinoma which measured 1.2 cm. Intraductal means that it is usually a noninvasive condition of the cells that line the ducts of the breast. A carcinoma is a medical term meaning a malignant cancer (a tumor with the ability to become worse). In some cases it is found to be quite invasive and has the ability to spread (metastasize) to other parts of the body.

About two weeks prior to surgery I had to have several tests done which may or may not be tests that you will also have done. These pre-operative tests I had included a CBC (complete blood count) to measure the type of blood cells in my blood sample. I had a urinalysis (to check for nitrites, sodium, potassium, urinary calcium, phosphate, diabetes, protein, enzymes and more). More of the tests that I had were an electrolytes/urea test (to check for abnormalities like kidney failure and also that of dehydration in the blood chemistry), E.C.G. (electrocardiogram to check that the electrical activity of the heart was healthy for surgery), a chest x-ray (to check that the lungs were in good form) and an ISL PTT test (to check how well my blood clots). Additional tests included an AST (aspartate aminotransferase), ALT (alanine aminotransferase), GGT (gamma-glutamyltranspeptidase ), and ALP bilirubin (alkaline phosphatase), which are all liver function tests.

Answer: Active lymph nodes in the armpit

What the specialists in nuclear medicine must check for are active sentinel lymph nodes in the armpit of the affected side. What they do, to check the lymph nodes, is inject a dye into the nipple area of the affected breast, twice.

For me this was excruciating but had to be done so I was a good patient and remained very still. The pain didn't last long so I did get through it. I didn't want them to have to repeat the procedure. They didn't freeze me because that would be painful as well, so I was told that I should try to relax and be still. Right after the injection of dye was completed, to help lighten the mood, I said that they had big mosquitoes in that room. The two technicians laughed. I told them I understood how stressful it must be for them to have to inflict pain like that on their patients. They appreciated being thought of and considered.

The sentinel lymph nodes (first nodes in a chain of nodes) may contain cancer cells which have spread from the breast to the lymph nodes. The procedure is called a lymphoscintigrapy (also called scintimammography) which is done by nuclear medicine experts. A blue dye called Tc-99m sestamibi, a radioactive tracer, is injected because this is a very good test for early stage breast cancer. The dye then goes through the body. Since cancerous cells will absorb more of the dye than other tissue does, this test makes it easier to see what is going on inside the breast and the lymph nodes. It is done when breast tissue is quite dense and allows doctors to check the tissue even further. With this dye you may or may not get a metallic taste in your mouth. Once the dye has been injected, you must lie face down with the affected breast hanging down through a hole in the table. During this time you cannot move. This scan can take about an hour. The scan is like a mapping to find which lymph nodes are active and could be at risk for containing cancer cells. Images are taken of the breast as the dye progresses through the system. Estrogen receptor positive and progesterone receptor positive cancer are a good result to get with these tests. What this means is that to survive the cancer depends on the hormones of estrogen and progesterone. Having both readings with positive results increases your survival rate due to the further and particular treatments you become a candidate for.

Answer: To determine whether cancer has spread elsewhere in the body

Although the PET/CT scan does take about an hour and the patient must be still the entire time, it is useful in determining whether cancer has spread anywhere else in the body. The injected dye will show up in other areas that could be affected. For this scan the patient is prone on a table and a machine rotates around them taking images of the activity inside the body from all angles.

For me this was almost nauseating as the machine went around and around so I closed my eyes and tried to just block it out as I lay very still. I kept busy singing inside my head which was helpful but it was difficult to remain so still. The technicians did ask how I was doing. I just kept still anticipating the next procedure that I would have to face.

Answer: To show the surgeon the exact location of the tumor

The wire localization is an ultrasound guided insertion of a wire that is put into the tumor and is visible outside of the breast. This is done to guide the surgeon to the tumor that will be removed. This helps to minimize the amount of cutting during the surgery later. A local anesthetic is used to freeze the area so you won't feel the wire being inserted through the breast tissue. This procedure is done for biopsies and in the case of surgery being a lumpectomy. You may or may not feel pressure during the placement of the wire.

I did not feel discomfort, dizziness or pain. If you get this procedure done be sure to tell the radiologist how you feel. It is important to communicate clearly. People do have different pain thresholds and different reactions to what is going on.

Answer: Removal of the tumor and close surrounding tissue

A lumpectomy is the surgical removal of a cancerous tumor along with a little bit of healthy surrounding tissue. This procedure is considered to be non-invasive in comparison to the complete removal of a breast during a mastectomy. A lumpectomy leaves a patient with most of their breast intact, say for an indentation where the tumor was removed from. The incision is roughly two to three inches in length. During the surgery an incision is made in the armpit of the affected side and active lymph nodes detected in previous preoperative (before surgery) tests are removed, bisected and studied. This incision is two to three inches in length as well.

In my case one lymph node was removed and the results from that were that it was clear, so no cancer had spread anywhere else. I was then stitched up and brought to the recovery room.

Some other types of breast cancer surgeries include: a partial or segmental mastectomy (also called a quadrantectomy) (the removal of part of the breast), simple or total mastectomy (complete removal of one breast) or modified radical mastectomy (total removal of the breast, lymph nodes in the armpit and leaving the chest muscles intact).

Answer: Exercise to keep the muscles and circulation working

Exercise is an essential part of recovery from surgery. Light exercise is explained and you are asked to begin right away. This is necessary so that the muscles stay strong and it helps to prevent the loss of circulation in the arm and shoulder after lymph nodes have been removed for example. Depending where you have surgery and how extensive the surgery has been, you might stay in the hospital for a few days, so before you go to the hospital pack things you will want if you are going to stay.

I was released the same day of my surgery and the anesthetic made me feel very sick. In fact I did vomit because of the anesthetic along with a full day of no food. Of course intravenous drips kept me hydrated and gave my body nutrition but my stomach didn't think so when I woke up in the recovery room. I wasn't embarrassed because this is common for a lot of people after surgery. If it happens to you, try to accept it as par for the course. I was happy that surgery was over, but there would be more to deal with after the healing would take place.

Answer: Bouncing, running, lifting

After my lumpectomy surgery it was important to take care of the incision areas. Lifting things over my head was discouraged other than just lifting my arms in the normal exercise routine. Running and bouncing had to be avoided so as to not put strain on the incision area and the interior of the breast during healing.

Wearing a supportive bra, in particular a sports bra, all the time, day and night, for the first couple of weeks will help to reduce movement of the breast. This also helps to support the incision area. Showering is a good way to help keep your incisions clean. Bathing is discouraged because soaking is not recommended. A shower helps rinse off soap residue without causing the area of your incisions to become softened to the point that it becomes weakened and more prone to infection like soaking in a tub might cause.

Patients should watch for extreme swelling, seepage from incision areas, heat and fever. If you experience any or all of these seek medical attention. Notify your surgeon and go to the hospital where the surgery took place because your records will be in the system. Your surgeon can meet you there or instruct the emergency doctors what should be done and which medications should be prescribed, if necessary.

Answer: Destroys cancer cells

Chemotherapy is a method of cytotoxic antineoplastic drug therapy used to destroy cancer cells within the body. It either stops the growth of cancer cells or at the very least slows down the growth of cancer cells. Chemotherapy can also affect healthy cells sometimes, like the cells within your intestines and/or the cells in the lining of your mouth. Some people can lose their hair with the treatment of chemotherapy. Chemotherapy may be a cure when cancer cells can no longer be detected in your body. It is a cancer control when it stops cancer from spreading to other parts of your body and in the case of terminal cancer it can help to ease the symptoms of pain associated with some cancers.

Since my lymph nodes were clear I did not have to go through the process of chemotherapy. However, prior to surgery I did not know whether chemo would be necessary or not, so I had my hair cut to prevent long locks of hair from plugging the drains if it fell out quickly. I donated a nineteen-inch braid to "Angel Hair for Kids", an organization that is a part of a program called "A Child's Voice Foundation" in Canada. They make and give free wigs for children, from financially underprivileged families, who have lost their hair due to chemotherapy or other issues such as alopecia. It made me feel good to be able to give my hair to a good cause. There are other organizations that accept donated hair as well.

Answer: No

With most treatments of breast cancer the number of treatments is between twenty and thirty. Before the procedure can begin some measurements are taken and four tattoos, the size of the tip of a pen, are inked into your skin with black ink. These are placed at the top, bottom and each side of the breast for the purpose of placing the cross-hairs for radiation in the proper position before each treatment. Once the tattooing is done your treatment schedule will be set up for you. In most cases you will have a radiation treatment once per day, five days a week, excluding weekends and holidays. Once you are set up and lined up for each treatment you cannot move.

After my surgery I had massive interior bleeding and haematoma (bruising) so much so that my entire breast was black. I had originally thought that it was dark blue due to the dye injected prior to surgery. I called it my "Smurfette" breast until I learned that it was actually very badly bruised. The interior swelling was the size of a grapefruit so radiation was delayed. Every week for over three months I returned to the hospital to be examined by the radiation oncologist and ended up being rejected each time due to too much swelling. Gradually the swelling reduced to the size of a golf ball and radiation could not be prolonged any further. Generally it should be started within a three-month time frame, but radiation can harden the hematoma and cause a lot of pain so the decision was made to wait. Finally I did get my four itty bitty tattoos and began my treatments. Each treatment took less than a half hour getting set up into position. The actual treatment with the beams of radiation took less than a couple of minutes.

Answer: Reduces recurrence by as much as seventy percent

Radiotherapy is a very highly targeted means to destroy breast cancer cells that might still be lurking within after surgery has taken place. With the treatment there is a reduction in the recurrence rate of breast cancer by an amazing seventy percent. After lumpectomy surgery the radiation treatment is called external radiation which is a beam of radiation aimed at the area where surgery was done, where the tumor had existed. There are two angles of radiation beams done, each individually but during the same treatment period. One beam goes through the side of the breast and faces the middle of the chest. The other starts from the middle of the chest and faces the side. It is painless and many people can drive themselves to and from treatment. It is still recommended that you bring someone with you in the event that you do feel tired and will require someone to drive you home. For the radiation treatments and during the entire course of treatment patients are not allowed to use antiperspirants or deodorants or perfumes. Purchasing a baby powder with talcum powder mixed in is helpful to use as a deodorant, and it is recommended that you sprinkle and smooth the powder onto the breast in an effort to give a cooling effect.

I had twenty five rounds of radiation and by the time it was done my breast was like leather, tanned and quite cooked I thought. I had to use special creams to help the skin return to normal suppleness, which took a few weeks. The cream helped reduce the itching as the skin healed also. It was recommended that I avoid the sun during and after radiation for several weeks.

Answer: In some cases, no

A patient will have regular follow up exams with their surgeon and also with their oncologist once treatments are completed for lumpectomy surgery. A patient will often be given the choice of drug therapy or no drug therapy depending on the severity of the cancer they had and depending whether they had estrogen receptor positive and progesterone receptor positive cancer or not.

The benefit of drug therapy is its prevention of the recurrence of breast cancer. I opted to do a five-year regime of Tamoxifen Citrate (also known as Nolvadex, Istubal and Valodex), once per day, every day. This drug is a hormone blocker which helps prevent cancer from recurring in the affected breast and the unaffected breast. The drug is a selective estrogen receptor modulator (SERM for short) and blocks estrogen from becoming attached to any estrogen receptors on cancer cells. The drug slows growth and kills tumor cells. There are side effects of fatigue, hot flashes, upset stomach and even uterine cancer. I had a hysterectomy (removal of uterus) a few years ago so I do not have the worry of developing uterine cancer. For me, the side effects that come with the prevention of recurrence of breast cancer outweigh the risks of not taking any kind of drug therapy.

Answer: Yes

It is extremely rare for children to get breast cancer with a 0.1 percent chance of such a thing happening. In most cases, when this happens, it is known as juvenile secreting neoplasm. Take any suspicious lump seriously and have it checked properly, not just women and children but also men. Men getting breast cancer is most common over the age of sixty, although it can be found at any age. There are about one percent of men who develop the disease.

For myself, I did go through some depression but chose to listen and ask questions. I chose to read, to research and to keep notes that I could ask my medical team about. Through the process I did my utmost to be strong, positive and pleasant which I believe played a huge factor in beating this disease. I see my oncologist every year as well as my surgeon. I have a mammogram done every year and will for as long as I have to. February 18, 2013 was two years since I had lumpectomy surgery. August 4, 2013 will be two years since my last radiation treatment. So far everything is clear and the recurrence of breast cancer is less than fifteen percent over the next ten years. I have a positive outlook and continue to be hopeful that I will not have breast cancer again. I have both good days and bad days and I do expect that to continue for some time. Some days my mind is not as alert as it is on good days. I make mistakes that I'm often not even aware of especially when reading or writing. It is difficult because when people don't know what I'm dealing with they are often devoid of compassion. The trials one must go through with the process of diagnosis through recovery depend on what you let bother you. My advice to all is to get your mammograms every year and if you must deal with breast cancer, be positive and never give up or give in.