No Hill For a Climber, Understanding the Pathology Reports

With a cancer diagnosis it often seems as if for every question that gets answered, a half dozen more will pop up. At times, I’m not too sure if my over active and inquisitive mind is a blessing or a curse. By my very nature, I am compelled to fix problems, and to do so, it requires that no stone is ever left unturned. By obtaining answers to my multitude of questions, it helps me in thinking through further questions that must be asked, even if the answers to them are going to be difficult to hear. I am an optimist by nature, but I am also a realist. I would much rather know uncomfortable truths than to be comforted by gentle sugar coated platitudes designed to make me feel better. Sugar coating fixes nothing, ever.

Loraine and I have been caring for her brother Howard for the last year who also has cancer. He has liver cancer that is now at a pretty advanced stage. There is only one treatment protocol even being considered for him now, and it it damn scary to say the least. On top of this, I have a very demanding  trucking along with my continuous toils on my website. I must be careful in not conflating problems that arise with his illness over problems that have arisen with Loraine’s when I am fatigued. So far, this has not been too much of an issue, but I am often mentally and physically exhausted. I do not have a regular sleep pattern because of my job, plus my PTSD has made me a chronic insomniac for several years now. Actually, I have not had good sleep for a few decades now. It is what it is I guess. We are more prepared for personal battles than we sometimes give ourselves credit for.

Pathology Report

Sentinel lymph node, left, biopsy:

    • Metastatic carcinoma involving one of one lymph node.
    • Carcinoma is 4 mm in greatest dimension
    • Extranodal extension is present.

A few lymph nodes were removed from Loraine’s arm pit area on both sides during her bilateral mastectomy. This was done to confirm if the cancer has spread outside of the original tumor. One small breast cancer mass measuring 4 mm was found to exist in one of her left side lymph nodes. While this was not something we wanted to hear, we are thankful no other cancer was found in any of the other lymph nodes. We already knew from the first visit with Dr. Butler that if cancer was found in the lymph nodes, then radiation treatments were definitely going to happen, with a possibility of chemotherapy too. We will know further treatments once we have seen the oncologist and radiologist on the treatment team here soon.

Extranodal extension simply means the cancer has metastasized.

Left breast, mastectomy:

    • Invasive ductal carcinoma and ductal carcinoma in situ, completely excised
    • Lymph-vascular invasion is identified.
    • Fibroadenomas

My younger sister passed away from adenocarcinoma of the cervix, therefore seeing “adenoma” used in any term associated with breast cancer was terrifying to me. Thankfully,  fibroadenoma’s are  noncancerous tumors in the breast, that could still require some form of treatment for some women. These lumps are actually fairly common, yet they should still be taken seriously.

Invasive ductal carcinoma (IDC), also known as infiltrating ductal carcinoma, is cancer that began growing in a milk duct and has invaded the fibrous or fatty tissue of the breast outside of the duct. IDC is the most common form of breast cancer, representing 80 percent of all breast cancer diagnoses.

Ductal carcinoma in situ (DCIS) is the presence of abnormal cells inside a milk duct in the breast. DCIS is considered the earliest form of breast cancer. DCIS is noninvasive, meaning it hasn’t spread out of the milk duct and has a low risk of becoming invasive. DCIS is usually found during a mammogram done as part of breast cancer screening or to investigate a breast lump.

While there is no good cancer, it is a relief to know that what was found in Loraine’s pathology report is that hers is both an early form (DCIS) and the most common (IDC) and treatable forms. Ladies, never ever forget, early detection saves lives. If you find a lump during self examination, get yourself to a doctor and have it evaluated. Your life depends on it.

Axillary contents, dissection:

    • One lymph node negative for malignancy

Right breast, mastectomy:

    • Fibroadenoma, measuring up to 9 mm in greatest dimension.
    • One lymph node negative for malignancy.

The pathology findings was followed by four or five more pages of medical jumbo mumbo that only a doctor can make sense of. Kind of like legal documents where five hundred multi-syllable words are utilized when only 50 common words would suffice. By explaining in common layman’s language to you what the reports mean, it also helps to bring myself to a more clear understanding of what we are facing.

Loraine and I have humongous challenges in the future ahead of us. We know that by the very nature of cancer there will be a mixed bag of good days and bad. With cancer,  you might find humor in topics that others will not know not know how to respond to. We might laugh when others might cringe. We have even cracked jokes about her getting a variety of prosthetic bra sizes to keep people guessing Loraine’s cup size. I have seen the comeback of a fierce fighting spirit in my dear wife that reminds me of why I fell in love with her in the first place. This same ferocity is how she survived the difficult years of my military career. As tough as my assignments might have been, I can still appreciate the hardest job in the armed forces belongs to the spouse of a service member.

This coming Tuesday, the drains should be all removed and Loraine will be able to begin returning to some of her normal activities. Her faith in God above has kept her spirits high, and it has been a chore to keep her from over doing it during the last two weeks of recovery. Nothing will keep my sweet heart down, we will beat this.

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