Thursday, July 19, 2012

It's A Diagnosis -- but Is It A Disease?

Cancer is a huge diagnosis. Huge in several ways. 

Of course there’s the overwhelming impact the diagnosis has on a person newly diagnosed, and on his or her family and close friends. 

But also huge in terms of the range of medical conditions cancer includes. To say someone has 'cancer' is a little like saying someone has an 'infectious disease' or a 'mental illness'. It can mean so many, many different things. Even to say a woman has breast cancer is still to speak very broadly. 

Generally the details of another's diagnosis becomes ... mmm, dare I say 'boring'? At least confusing and hard to follow. That is, unless you are comparing experiences or are very personally involved in understanding the other person's treatment plan. 

So, if I start to bore or confuse you, feel free to skim and skip. The last two or three paragraphs tell where I am today. 

My breast cancer diagnosis is 'ductile carcinoma in situ' or DCIS. DCIS is sort of 'the sniffles' of the cancer world. Cancer patients and survivors make up the proverbial 'big tent' and nevertheless post-treatment DCIS patients occasionally wonder if they legitimately belong to the world of cancer survivors. 

Like 'the sniffles,' it's possible to imagine DCIS could go untreated and the individual’s body would deal with it. And the medical professionals estimate between 50% and 66% of DCIS incidents would cause the patient no decline in health, let alone threaten life, if simply ignored. 

Unfortunately, the remaining cases go on to become full-blown, life-threatening invasive cancers. At this point, we know of no way to distinguish the sniffles that will go away (or stabilize and matter not) from the beginning of life-altering, even life-threatening pneumonia or tuberculosis, as it were. 

Most patients and most doctors dealing with breast cancers simply have no tolerance for waiting around to see which is which. The bad guys can sometimes move quickly, sometimes move sneakily and aren't anything you want to mess around with. 

So treatment is recommended for all diagnosed cases of DCIS. And the treatments are the same treatments generally used to treat invasive breast cancers -- lumpectomy or mastectomy with or without follow-up radiation. 

My DCIS was identified by a biopsy; the biopsy in turn was recommended based on results of a routine annual mammogram. Obviously I've been getting annual mammograms precisely so breast cancer wouldn't sneak up on me; if I got it, I wanted to catch it and treat it right away. 

But I guess I'd always assumed early detection would also mean less invasive treatment options. So I was in utter shock when the diagnosing radiologist included a double mastectomy in the range of treatments I might be facing. 

In one weekend, I'd gone from having a near-microscopic area of calcification in one breast to a conversation about removing both breasts entirely! 

And it doesn't stop with a conversation, of course. The conversation lead to consultations. Then more imaging: a MRI of both breasts first; then later enlarged images of the other breast. Now, recommendations for further biopsies. 

And the additional biopsies will be done. After which, I expect I will get a treatment recommendation. If I'm lucky, the treatment will be along the lines of a lumpectomy or two lumpectomies. That seems currently to be the most likely scenario. 

But I'm trying to prepare to handle worse news. Because the most likely scenario in early June was a biopsy reading of 'benign.' 

Likely scenarios are nice -- but they aren't definitive. 

And while I wait and prepare, I'm also trying to remember what my yoga instructor tells me so often:  "Breathe!"


Cameron VSJ said...

Hi Janet,

I have a quick question for you regarding your blog, but I couldn't find your contact information. Do you think you could send me an email whenever you get a chance?




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