Information Overload - Pathology Reports

Okay, I thought I'd capture in one place my diagnosis and test results as I know them so far. Some of you are doing your own research, and perhaps this will help you to understand what kind of thing I've actually got. It's a beast, there's no denying that. If any of you are in the medical field (I know I've got Don, Libby, Mom S., Kathleen, and Ramona on my side!) or have experienced reading these kinds of results (Steve & Kerri, and Aunt Ann) then maybe they'll mean something to you. Otherwise, this is a boring entry for the rest of you to read!

Doctors:
Surgeon: Dr. Patricia Dawson
Radiologist: Dr. Hallum
Oncologist: Dr. Kristine Rinn
Psycho Oncologist: Dr. Judith Lipton
Naturopathic Physician: Dr. Michelle Robeson

Facility:
Swedish Cancer INstitute and Swedish Breast Care Centers
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Tumors (Biopsy Results):
A. Breast, left at 11 o'clock, needle core biopsy:
- infiltrating ductal carcinoma
- poor tuble formation
- high nuclear grade
- low mitotic rate
- Bloom Richardson score (Nottingham modification) 7 of 9.
- Ductal carcinoma in situ (DCIS) identified, cribriform and solid types of intermediate nuclear grade with necrosis.
- microcalcifications identified associated with DCIS
- no vascular/lymphatic space invasion identified
- ER: 95% of tumor cells positive, invasive carcinoma
- PR: 50% of tumor cells positive, invasive carcinoma
- c-erb B-2: POSITIVE (score of 3+) for overexpression of c-erb B-2 (Her2/Neu) protein

B. Breast, left at 1 o'clock, needle core biopsy:
-infiltrating ductal carcinoma
-intermediate tubule formation
-high nuclear grade
- low mitotic rate
- Bloom-Richardson score (Nottingham modification) 6 of 9
- Ductal carcinoma in situ identified, cribriform and solid types of intermediate nuclear grade with focal necrosis
- microcalcifications identified associated with DCIS
- no vascular/lymphatic space invasion identified
- ER: 90% of tumor cells positive, invasive carcinoma
- PR: 70% of tumor cells positive, invasive carcinoma
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Bloodwork:
All results within normal ranges, except Hgb is 15.8 (normal range is 12-15); Hct is 45.5 (normal range is 36-45), CA 27.29 is 44.4 (normal is 0-38.6).
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Total Body Bone Scan:
(directly quoting):
IMPRESSION:
1. No evidence of metastatic disease to bone on this bone scan.
2. Bilateral maxillary sinusitis is noted.
3. Degenerative changes in the hips bilaterally.
(My nurse said this amounts to "wear and tear on the hips." Should I send Tessa a thank you card?!)
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Radiology Report CT Thorax w/Cont 71260
(directly quoting):
IMPRESSION:
Two tiny pulmonary nodules, one within anterior right upper and the other withing the anterior aspect of the right middle lobe. Suggest 3 month follow up exam..

IV Contrast Enhanced CT of teh Abdomen and Pelvis:
(directly quoting):
IMPRESSION:
Tiny left hepatic lobe hpodensity which is too small to characterize. Exam is otherwise unremarkable.
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XR Chest, 2 View 71020
(directly quoting):
IMPRESSION:
No plain film evidence for parenchymal lung nodule. Please see CT report which demonstrated tiny right middle and upper lobe nodules.
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MRI-BREAST< Bilateral wo/w Contrast C8908
Left breast:
At 11:00 4.5cm from the nipple on image No. 27, is a heterogeneous mass with irregular and lobular borders. It measure 2.6 x 2.2 x 2.2 cm. There is an approximately 4 mm nodular component which is just slightly anterior and medial to the primary mass. This may represent an exophytic component of the primary mass or a small local satellite lesion. On ultrasound evaluation, the former was more likely. Kinetic evaluation demonstrated rapid uptake with persistant, plateau, and washout type curves. Approximately 12 percent of the mass demonstrated the most suspicious type of curve in that it was rapid uptake with washout. A similar appearing mass is seen at 1:00 5 cm from the nipple on image No. 25 measuring 2.3 x 1.3 x 1.6 cm. It also had lobular and irregular borders and demonstrated heterogeous enhancement. Kinetic evaluation was consistent with rapid uptake with persistent, plateau, and washout type curves. Approximately 15 % of this mass demonstrated teh most suspicious type of curve again which is with the rapid uptake and washout. Some non-specific foci of enhancement are seen scattered throughout the left breast which likely are related to physiologic changes.

Right breast:
Low probability for invasive neoplasm. No areas having morphological dynamic enhancement fesatures suspicious for carcinoma are seen. Again, the right breast demonstrates some non-specific foci of enhancement scattered throught the breast which likely are related to physiologic changes.

Conclusion:
1. RIGHT BREAST: Category II: Benign, routine screening mammography.
2. LEFT BREAST: Category VI: Known breast carcinoma.
3. Chest: Category II: Benign.

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Soooo, that's all I've got right now. There was a note on the MRI results saying that an MRI can not necessarily find ductal carcinoma in situ, and since I have DCIS in my left breast that leads me to conclude, again, that an elective mastectomy on that breast may be in order. Again, I repeat, though, that I will not make that decision yet....we'll cross that bridge when we come to it.

My outlook is good right now. Caley is caring for Tessa with such love, affection, and seeming ease that my heart feels light in that regard - it's such a blessing to have her here. Ryan and I really had a lovely time on our date last night, and I feel confident and loved having him at my side. My friends' and family's support has meant the world to me, as well. I am ready to get this cancer out of my body NOW.

I am looking forward to a wonderful weekend, filled with family and friends. I'm not focusing on Monday - there isn't any point. It will hurt, and undoubtedly it will suck, but I'm stronger than the scalpel, stronger than the cancer, and stronger than this process. I really believe that.

Tessa is doing beautifully, partially due to the fact that her mother isn't a total stresscase now that Caley is here to help. We now talk relatively openly in front of her about what's happening, although we avoid saying the "whole" truth. She knows that Mommy is going to the hospital for an operation to get the cancer out, and that Mommy's breast will have a really big cut and need a really big bandaid, and that it will be sore for a long time. I haven't told her that they're cutting off my breast - it just doesn't sound right. When it's time, I will show her my (healed) scar, and talk about how the doctors will build me a new breast when all the cancer is gone. She also knows that her mommy will take some "strong medicine" (e.g. chemo) and that I'll be sick, tired, and sleep a lot. With Caley here and her general routine relatively uninterrupted, she seems to be okay with that.

I'm struggling with fatigue trying to keep up with myself and this whole process, and fighting a sinus infection to boot, but I'm doing remarkably well. I am blessed, and I am so grateful to all of you for caring. I love you!

Love,
Kristina