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!!!
I am 33 years old, and I am a carrier of the BRCA2 genetic mutation. My Previvor journey started when my sister’s routine hysterectomy revealed that she had ovarian cancer. At her doctor’s suggestion, my sister was tested to see if she had a BRCA1 or BRCA2 mutation. Unfortunately, she did. So, while she began her journey of fighting the ovarian cancer and getting a PBM, I began my journey to see if I had the same genetic mutation that caused her cancer. There was a 50/50 chance that I carried it too. The next time I visited my OBGYN for my yearly exam, I talked to him about it. After he reviewed my family history and asked me some questions, he finally asked if I wanted to have the test done, right there in his office. I was in panic mode as I realized how much testing positive would mean for my family and me. I wanted to know, I needed to know, so that I could plan for my future. I have two daughters, and ultimately it was my love for them that made me go forward with the test that day.
It took two weeks for the test results to come back. After waiting for what seemed like forever, nothing could have prepared me for the news that confirmed that I was BRCA2+, just like my sister. NOT the news I wanted to hear. I cried for what seemed like days… I prayed to God to seek guidance as to what to do. And I asked Him to just give me peace with my decision. When I felt like I was ready for the next step, I found an oncologist to work with. After reviewing my test results and family history, she recommended that I take steps to prevent cancer because my risk was so high. It wasn’t a matter of if I would get cancer, but WHEN I would. I had already had a hysterectomy but chose to have my remaining ovary removed as well as my cervix in December 2011. I also made plans to have a PBM with expanders on June 1st of 2012.
In May 2012, I had my first pre-op appointments. I was completely at ease and relaxed, but by my June 1st surgery date, I was a NERVOUS WRECK—who wouldn’t be, right? The surgery lasted six hours and I was told that it went well and there was no cancer present. When I woke up, I was sore, screaming, and extremely scared. A big dose of IV meds helped me calm down and sleep until it was time to go home. When I was more alert, I felt my chest and examined the new me. My new breasts were hard and covered in bandages and had drains coming out of them. They weren’t pretty yet, and I had months of drains and fills before I’d be ready for my exchange surgery to get silicone implants. But the first big step was done. Waking up out of the anesthesia and post-op pain meds it hit me; it was done. I had done it. Tears poured down my cheeks. My daughters would not have to worry about their mom getting breast or ovarian cancer and dying because I had taken the first BIG step.
In August, I had a surgical washout due to a Seroma that had formed on my left side. The surgeons drained it and found no reason to take out the expanders. I felt great, but a few days later the Seroma came back on both sides. Fortunately, my PS decided that it was finally time to do the exchange. Not all doctors would agree to do this, but he said that it would probably help the thin skin that was being damaged by the rough expanders. Some women adjust well to the expansion process, but my skin was like paper and it was extremely painful.
On September 26th 2012 I had my third and final surgery—the exchange that replaced my expanders with silicone implants. I woke up after that surgery with soft squishy “foobs,” my surgical journey complete.
Since that last surgery, I’ve had no problems and have recovered wonderfully. I feel at peace with my decision. I feel good about why I did this. I feel empowered. I feel joy. I feel alive. My name is Leanna Kay. I am a Previvor, and I’m staying one.
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