Wednesday, October 22, 2014

Another six month oncology follow-up is in the books! It began with the usual assessment of vital signs, review of medications, and a brief discussion about "minnie paws". Warning signs of  recurrent cancer and a thorough inspection of both breasts and surrounding lymph nodes was completed.  My nurse practitioner explained that because my cancer was DCIS stage zero there is only a rare chance that it would ever recur.  We did revisit my family history of breast, colon, and skin cancers and I made note of when my screening colonoscopy and MRI are due.

I remember one of my doctors briefly touching on the debate about DCIS when I was diagnosed. My own research at the time uncovered the controversy. Some argue that DCIS is merely an abnormal pathology result that indicates cell mutations or changes which are not yet malignant therefore not cancerous. Others label it a malignancy stage zero. My doctors had made it very clear they considered it a malignancy as did my pathology reports. My care team was worried it had spread due to the size indicated on my MRI and the fact that there were no abnormalities on the prior mammogram.  My cells had not only changed rapidly but had spread throughout the duct. They all  three, oncology, general surgeon, and plastic surgeon, suggested I opt for aggressive treatment by having both breasts removed. Chemotherapy was not suggested because there was no cancer detected in the biopsied lymph nodes. Surgery was considered my cure.

Because DCIS stage zero had just been addressed I decided now was a great time to inquire about the debate.  My NP explained that this institution follows the federal guidelines and standards for the treatment of DCIS which considers it a cancer.  Although many times DCIS does not spread outside the duct system it certainly can. She went on to explain that cancer is all about mutating cells and that DCIS, when biopsied, shows changing cells, therefore it is considered a cancer but stage zero. My biopsy was listed as a carcinoma with atypical hyperplasia /changing cells in nearly all parts of the surrounding tissues. I told her that my surgeon was quite concerned about the size of the area viewed on my mammogram as well as the measurements from my MRI.  He had let me know before surgery that metastases were very possible. Therefore I had absolutely no qualms with aggressive measures involving bilateral mastectomy. Besides, in my own mind I had always said if I was ever diagnosed I would not settle for a lumpectomy or single mastectomy. Aggressive treatment was the only treatment for me!

Upon leaving the exam room I was flooded with emotions. I felt immensely blessed to have a clean bill of health and hopefully a long life ahead. However the survivor guilt hit hard and I fought back  tears as I set up my next appointment. I scanned the waiting room and noted wigs and turbans, those with support systems present and those without. I headed to the restroom to compose myself and once out the door I sat in my car and prayed for those still on their journeys. I thanked God for getting me to the place I am today. Next I whispered one more prayer for a friend who was newly diagnosed and was in surgery at that very moment. It's amazing how a very positive appointment can end up making one feel completely drained!

As October winds down and the pink starts to fade please take a moment to review your health history.  Look up when your last physical occurred and take measures to schedule scans and testing that is appropriate for your age and gender.  We can never be too careful.  Early detection of all kinds saves lives!!!