Just Get Me Through This! - Revised and Updated. Deborah A. Cohen

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      • Spreading the news, and determining how broadly and by what means to expose yourself to the “outside” world.

      COMPREHENDING AND COMMUNICATING THE NEWS: AN UNEXPECTED TIDAL WAVE

      Malignant Cells: Are Those the Good Ones or the Bad Ones?

      It’s 4 P.M. on a Thursday afternoon, and I’m waiting for a meeting to begin in my office. The phone rings and I decide to answer it while I await my guest. I had been to see a “breast specialist” forty-eight hours earlier for a biopsy on a lump I had found on the side of my breast, but to be honest, I hadn’t thought twice about it since. He had reassured me, “It’s probably nothing. With women your age, most likely—80 percent chance—it’s just a fibrous knot.” I had no family history, knew nobody who had breast or any other cancer in my age group, so I had just put it out of my mind.

      No more; actually, never again. When I answered the phone, he got straight to the point. “Hello, this is Gene Nowak. I’m sorry to tell you this, but the lab tests showed some malignant cells in your biopsy, which will require treatment.” Malignant? Are malignant cells the good ones or the bad ones? I could tell by the tone of his voice that malignancies didn’t exactly bring you the winnings of a lottery ticket, but what did he mean? Did he mean cancer? I had only known two people with cancer, and they were older relatives of mine, my grandfather and my uncle, more than ten years ago each. I knew that “lumps,” tumors, or cysts—whatever you call them—were classified as either malignant or benign, but I didn’t know which was okay and which meant cancer. It just wasn’t on my radar screen. It was irrelevant to my young, healthy, active life. Treatment? What does that mean? Is it surgery? Or does it mean lots of other medical “procedures” that are terrifying, so the doctors don’t tell you the potentially far-reaching implications of them now, because you have enough to swallow today? My head was spinning.

      So, I queried, “Dr. Nowak, does this mean I have c-c-c-c-cancer?” And he responded, “Yes, unfortunately it does. Why don’t you come see me tomorrow morning when I have some time to sit with you and thoroughly discuss your alternatives.” Tomorrow morning? Can I wait until then? Will I still be alive!? I was in shock. I managed to get out, “Okay. What time?” Then I put the phone down. Now the entire room was spinning. I was shaking and my heart dropped to my stomach. I called my mother. “Mom, the biopsy is back and it shows some malignant cells.” “What???” she responded. “Mother, I have breast cancer,” I replied, deliberately pronouncing each word. And as I hung up the phone on her because those were the only words I could muster, my meeting guest was standing at my office door. I looked up and said, “I have to cancel our meeting and go home. My doctor just told me I have cancer.” And I picked up my coat to leave. Yes, malignant cells are the bad ones. And there, I had even said the “c” word three times. As I left the office, I knew that somehow my life had changed forever, but I was not yet quite sure how. All I knew was that I felt as if I had been smacked in the face by a tidal wave. Somehow, I would have to pick myself up and put myself back together again.

      A NOTE FROM THE ONCOLOGIST

       What’s Malignant, What’s Benign, and What’s Metastatic? Cell Growth Formation 101

      Every cell in your body has a specific function. Brain cells transport neurological messages, stomach cells help digest and absorb food, and breast duct cells make milk. Occasionally, however, a change in the chromosome pattern in the DNA of a cell occurs—a “mutation.” This can be caused by an inherited defect, external factors such as radiation or environmental toxins, or a combination of the two. Usually, a mutation has no effect at all on the cell—it continues to do its job as “programmed.” Sometimes, the mutation is lethal to the cell, so the cell just dies and is washed out of your body (no big deal, we make billions of new cells every day).

      Less often, the mutation leads to the transformation of the cell in such a way that it no longer performs its function (e.g., producing milk, telling your hand to move, absorbing your lunch), but rather reprograms itself to simply replicate or “clone” itself. A group of these cells is a tumor. A “benign” tumor does not invade or damage other parts of the body, while a “malignant” tumor will be fueled by and destroy surrounding tissue. In sum, a malignant breast tumor is composed of breast cells that have replicated themselves out of control, overtaking and destroying healthy cells and tissue in their wake.

      If you are reading this book as someone with “early-stage” cancer, you are lucky that most likely, all the cancerous cells have remained grouped together in the original tumor site in the breast—that is, your cancer has remained “local.” Survival rates are very high for localized, early-stage cancer, and often you are “cured” by surgery alone. All the additional treatment you may undergo is “preventative” or “adjuvant,” just extra “insurance” in case microscopic cancerous cells have broken away from your tumor and moved to other parts of your body. When original “clonal” cells migrate from the breast organ to another place in your body and begin forming tumors, that is called a “metastasis.” When you hear of cancer “metastasizing,” it means that the cancer has spread to other organs—in the case of breast cancer, most commonly the lungs, bones, or liver—and is invading the healthy tissue of those organs.

      There Are Many Roads Leading to “Suspicious.”

      If you’re reading this book, unfortunately you may have realized that there are many roads which can lead your doctor to mutter something about “suspicious———” (fill in the blank). It could be several alternatives: a “lump” you found yourself, either intentionally or accidentally; a “thickening” that your doctor found upon examination; or a mammogram where something caught the doctor’s attention. Whatever the pathway there, the next step is typically a biopsy. You must understand the role of the biopsy, and what information you can glean from it before considering your surgical options, if that is the appropriate route. Remember, early-stage cancer is very treatable, with extremely high survival rates. In a strange sort of way, think of yourself as lucky that your doctor was suspicious. It may have saved your life.

      A NOTE FROM THE SURGEONS

       A Biopsy Is a Biopsy . . . or Is It?

      For those of you just beginning the breast cancer journey, you need to be clear about exactly what a biopsy can and can not tell you. While there are variations on each, there are essentially four types of biopsies, which are increasingly invasive, but also increasingly exacting in terms of diagnosis. However, other than a complete surgical biopsy which removes the entire mass, biopsy results are not 100% definitive. Biopsy types are:

      1. Fine needle aspiration (FNA). Conducted in the surgeon’s office, this involves inserting a needle into a mass that can be felt and removing representative cells. This is not felt to be a definitive diagnosis, but is still fairly accurate.

      2. Core biopsy. Conducted in the radiologist’s office, this uses a sonogram to identify the mass and then a wide bore needle to remove a core of tissue. Definitive surgical decisions can be made on the basis of a core biopsy diagnosis because it provides a bigger sample than FNA.

      3. Stereotactic core biopsy. Conducted in the radiologist’s office, this uses a mammogram to detect calcifications or architectural distortions that are not able to be felt. This also takes a core of tissue and uses a special table placing the patient facedown. Definitive surgical decisions can be made on the basis of a stereotactic core biopsy.

      4. Excisional (open) biopsy. Conducted СКАЧАТЬ