I'm Not Home Yet

I threw away my prosthesis Monday night and moved my wigs off of my dresser. I don't know why it's taken so long, nor do I know why there are still things I can't look at and can't get rid of.

I have several tote bags in my bedroom that I've used in the 3 years I've shuttled back and forth between here and M.D. Anderson. They're filled with insurance forms, bills, magazines, puzzle books...the stuff that accumulates while you wait. Waiting is an art in which I've become well versed.

I can't make myself go through it. I try now and then, but that chemo nausea returns like a ghost to remind me of how bad it's been.

I also carry a small notebook with me that includes, among other things, several pages detailing the physical reactions I had to chemotherapy. I agreed to participate in a study that required I keep track. I can't tear those pages out.

I remind myself that I've been through a lot. I got rid of the prosthesis, I moved my wigs. It's a journey of reconciliation. I'm not home yet.

25 Breast Cancer Myths

Get the facts; there are lots of myths and misunderstandings floating around out there in the American consciousness. Check out the article at Health.com.

Canola Oil May Prevent Your Daughter's Risk Of Breast Cancer

WebMD has an article today about the potential for canola oil to diminish your daughter's risk of breast cancer. The findings are based on a study done with mice, so there's more research to be conducted before we can known with certainty.

Nonetheless, it couldn't hurt to make the change from corn oil to canola. It's good for you.

See the article here http://www.webmd.com/breast-cancer/news/20081117/canola-oil-may-affect-breast-cancer-risk?ecd=wnl_brc_112508

Bride of Frankenstein, Part 2

My boss told me yesterday that one of his friends gave him a calendar with photos of women who've survived breast cancer. He called them "cheese cake" photos.

I love my new breast, but I don't think anyone would want to actually look at the poor scarred thing.

My Cancer Was A Gift

My Cancer Was A Gift

Indeed it was.

Hidden Comments

To protect the privacy of people who are kind enough to leave a comment, I have hidden them. Nonetheless, I'd love to hear from you and if you leave an email address, I'll respond as soon as possible.

Breast Cancer Information Resources

A (not complete) list of Internet resources on breast cancer. Inclusion in this list does not necessarily imply a recommendation.

Detailed Breast Cancer Risk
GE Health Care
Breastcancer.org
Cancer.com
Discovery Health
Revolution Health
National Coalition for Cancer Survivorship
Planet Cancer
ICON Magazine
National Cancer Iinstitute
Susan G. Komen Foundation
National Breast Cancer Foundation
Medline Plus: A Service of the U.S. National Library of Medicine and the National Institutes
of Health
Breastcancer.net
WebMD
MedicineNet.com
Mayo Clinic
M.D. Anderson
National Cancer Institute
American Cancer Society
Healthline
Oncolink: Abramson Cancer Center of the University Pennsylvania
Doctors' Guide to Breast Cancer Information and Resources
Centers for Disease Control and Prevention

I am sorely tempted to (compulsively) alphabetize these, but I've been interrupted by my computer challenged co-worker and now it's time to leave. More tomorrow, perhaps a brief intro to these.

Comcast Pink Ribbon

Watch a wide array of informative, entertaining and inspiration programs from Lifetime Television, Parents TV, Discovery Health, Showtime and Exercise TV with medical direction sand original content provided by Breastcancer.org.

To help raise awareness and provide important information about breast cancer, Comcast partnered with Breastcancer.org and several cable networks to launch The Pink Ribbon Campaign, an original video-on-demand and online initiative bringing together educational and inspirational content for all women and their loved ones.

The Pink Ribbon Campaign presents dozens of programs about prevention, detection, treatment and living with breast cancer as well as discussion forums, health and fitness advice and relevant news clips.

Throughout the entire month of October, Comcast customers with On Demand service will have free access to programs that will encourage and inspire women who are fighting or have survived breast cancer, including episodes of HBO's Sex and the City, Showtime's The L Word, celebrity bios from Bio Channel and Lifetime original movies, such as Living Proof, starring Harry Connick, Jr.

In addition, there are dozens of programs in categories including:

Pink Originals
Original, exclusive programming created specifically for the Pink Ribbon campaign by Lifetime and Parents TV. Topics including how to talk to children about cancer, and what to expect from diagnosis, treatment and recovery are also covered.

Meet the Doctors
New and original content produced by Comcast, in partnership with the University of Pennsylvania Abramson Cancer Center, provides an overview of risk factors, importance of knowing family history and tips on how to detect and defeat cancer.

Prevention-Healing
Programs from Discovery Health and Exercise TV provide in-depth information about prevention, including how to perform a breast self-exam.

TV and Movies
Special segments from TLC, Style Network and Lifetime provide advice for patients and survivors from demonstrations on how to wear a scarf to tips on boosting confidence and self-esteem.

Pink Ribbon Online
Fancast.com will feature most of the programs available On Demand, including episodes of The L Word, Whose Wedding Is It Anyway, One Tree Hill and profiles of celebrities who have battled breast cancer from Bio Channel. Additional content including videos in The Fan, links to relevant news articles and discussion forums is available at http://comcast.net/pinkribbon.

Can Breast Cancer Be Prevented?

From the American Cancer Society

There is no sure way to prevent breast cancer. But there are things all women can do that might reduce their risk and help increase the odds that if cancer does occur, it is found at an early, more treatable stage.

Lowering your risk: You can lower your risk of breast cancer by changing those risk factors that can be changed. If you limit alcohol use, exercise regularly, and keep a healthy weight, you are decreasing your risk of getting breast cancer. Women who choose to breast-feed for at least several months may also reduce their breast cancer risk.

Not using post-menopausal hormone therapy (PHT) if you don't need it can also help you avoid raising your risk.

Finding breast cancer early: It is also important for women to follow the American Cancer Society's guidelines for finding breast cancer early. (See the section, "How is breast cancer found?")

For women who are or may be at increased risk

If you have a higher risk for breast cancer there may be some things you can do to reduce your chances of getting breast cancer. Before deciding which, if any, of these may be right for you, talk with your doctor.

Genetic testing: There are tests that can tell if a woman has certain changed (mutated) genes linked to breast cancer. With this information, women can then take steps to reduce their risk. Recently the U.S. Preventive Services Task Force made recommendations for genetic testing. They suggest that only women with a strong family history be evaluated for genetic testing for BRCA mutations. This group is only about 2% of adult women in the United States.

If you are thinking about genetic testing, you should talk to a genetic counselor, nurse, or doctor qualified to explain the results of these tests. It is very important that you know what genetic testing can and can't tell you, and to carefully weigh the benefits and risks of testing before these tests are done. Testing is expensive and may not be covered by some health insurance plans. For more information, see our document, Genetic Testing: What You Need to Know.

Breast cancer chemoprevention: Chemoprevention is the use of drugs to reduce the risk of cancer. Many drugs have been studied for use in lowering breast cancer risk. The drug tamoxifen has already been used for many years as a treatment for some types of breast cancer. Studies have shown that women at high risk for breast cancer are less likely to get the disease if they take tamoxifen. Another drug, raloxifene, has been approved to help reduce breast cancer risk in women past menopause who are at high risk for breast cancer. Other drugs are also being studied.

Preventive surgery for women with very high breast cancer risk: For the few women who have a very high risk for breast cancer, preventive surgery such as bilateral (double) mastectomy may be an option.

Preventive (prophylactic) double (bilateral) mastectomy: For some who are at very high risk for breast cancer, this surgery (a double mastectomy) may be an option. In this operation both breasts are removed before there is any known breast cancer. While this operation removes nearly all of the breast tissue, a small amount remains. So although this operation greatly reduces the risk of breast cancer, the disease can still start in the breast tissue that remains after surgery. To date, this has been a rare problem.

The reasons for thinking about this type of surgery need to be very strong. There is no way to know ahead of time whether this surgery will benefit a particular woman. A second opinion is strongly recommended before making a decision to have this type of surgery.

Preventive ovary removal (prophylactic oophorectomy): Women with a certain gene change (BRCA mutation) who have their ovaries removed may reduce their risk of breast cancer by half or more. This is because taking out the ovaries removes the main sources of estrogen in the body.

Although this document is not about ovarian cancer, it is important that women with this gene change also know that they also have a high risk of getting ovarian cancer. Most doctors recommend that these women have their ovaries removed after they are done having children.

Stages of Breast Cancer

From breastcancer.org

Stages of Breast Cancer. Cancer stage is based on the size of the tumor, whether the cancer is invasive or non-invasive, whether lymph nodes are involved, and whether the cancer has spread beyond the breast.

The purpose of the staging system is to help organize the different factors and some of the personality features of the cancer into categories, in order to:

• best understand your prognosis (the most likely outcome of the disease)
• guide treatment decisions (together with other parts of your pathology report), since clinical studies of breast cancer treatments that you and your doctor will consider are partly organized by the staging system
• provide a common way to describe the extent of breast cancer for doctors and nurses all over the world, so that results of your treatment can be compared and understood

Stage 0

Stage 0 is used to describe non-invasive breast cancers, such as DCIS and LCIS. In stage 0, there is no evidence of cancer cells or non-cancerous abnormal cells breaking out of the part of the breast in which they started, or of getting through to or invading neighboring normal tissue.

Stage I

Stage I describes invasive breast cancer (cancer cells are breaking through to or invading neighboring normal tissue) in which:

• the tumor measures up to 2 centimeters, AND
• no lymph nodes are involved

Stage II

Stage II is divided into subcategories known as IIA and IIB.

Stage IIA describes invasive breast cancer in which:

• no tumor can be found in the breast, but cancer cells are found in the axillary lymph nodes (the lymph nodes under the arm), OR
• the tumor measures 2 centimeters or less and has spread to the axillary lymph nodes, OR
• the tumor is larger than 2 centimeters but not larger than 5 centimeters and has not spread to the axillary lymph nodes

Stage IIB describes invasive breast cancer in which:

• the tumor is larger than 2 but no larger than 5 centimeters and has spread to the axillary lymph nodes, OR
• the tumor is larger than 5 centimeters but has not spread to the axillary lymph nodes

• Larger Version

Stage III

Stage III is divided into subcategories known as IIIA, IIIB, and IIIC.

Stage IIIA describes invasive breast cancer in which either:

• no tumor is found in the breast. Cancer is found in axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone, OR
• the tumor is 5 centimeters or smaller and has spread to axillary lymph nodes that are clumped together or sticking to other structures, OR
• the tumor is larger than 5 centimeters and has spread to axillary lymph nodes that are clumped together or sticking to other structures

Stage IIIB describes invasive breast cancer in which:

• the tumor may be any size and has spread to the chest wall and/or skin of the breast AND
• may have spread to axillary lymph nodes that are clumped together or sticking to other structures, or cancer may have spread to lymph nodes near the breastbone
• Inflammatory breast cancer is considered at least stage IIIB.

Stage IIIC describes invasive breast cancer in which:

• there may be no sign of cancer in the breast or, if there is a tumor, it may be any size and may have spread to the chest wall and/or the skin of the breast, AND
• the cancer has spread to lymph nodes above or below the collarbone, AND
• the cancer may have spread to axillary lymph nodes or to lymph nodes near the breastbone

Stage IV

Stage IV describes invasive breast cancer in which:

• the cancer has spread to other organs of the body -- usually the lungs, liver, bone, or brain

"Metastatic at presentation" means that the breast cancer has spread beyond the breast and nearby lymph nodes, even though this is the first diagnosis of breast cancer. The reason for this is that the primary breast cancer was not found when it was only inside the breast. Metastatic cancer is considered stage IV.

Additional staging information

You may also hear terms such as "early" or "earlier" stage, "later," or "advanced" stage breast cancer. Although these terms are not medically precise (they may be used differently by different doctors), here is a general idea of how they apply to the official staging system:

Early stage

• Stage 0
• Stage I
• Stage II
• Some stage III

Later or advanced stage

• Other stage III
• Stage IV

Doctors use a staging system to determine how far a cancer has spread. The most common system is the TNM staging system. You may hear the cancer described by three characteristics:

• size (T stands for tumor)
• lymph node involvement (N stands for node)
• whether it has metastasized (M stands for metastasis)

The T (size) category describes the original (primary) tumor:

• TX means the tumor can't be measured or found.
• T0 means there isn't any evidence of the primary tumor.
• Tis means the cancer is "in situ" (the tumor has not started growing into the breast tissue).
• The numbers T1-T4 describe the size and/or how much the cancer has grown into the breast tissue. The higher the T number, the larger the tumor and/or the more it may have grown into the breast tissue.

The N (node involvement) category describes whether or not the cancer has reached nearby lymph nodes:

• NX means the nearby lymph nodes can't be measured or found.
• N0 means nearby lymph nodes do not contain cancer.
• The numbers N1-N3 describe the size, location, and/or the number of lymph nodes involved. The higher the N number, the more the lymph nodes are involved.

The M (metastasis) category tells whether there are distant metastases (whether the cancer has spread to other parts of body):

• MX means metastasis can't be measured or found.
• M0 means there are no distant metastases.
• M1 means that distant metastases were found.

Once the pathologist knows your T, N, and M characteristics, they are combined in a process called stage grouping, and an overall stage is assigned.

For example, a T1, N0, M0 breast cancer would mean that the primary breast tumor:

• is less than 2 centimeters across (T1)
• does not have lymph node involvement (N0)
• has not spread to distant parts of the body (M0)

This cancer would be grouped as a stage I cancer.

Chemo Brain

From breastcancer.org

“Chemo brain” or “chemo fog” are terms used for thinking and memory difficulty that some associate with chemotherapy treatment. While some research suggests a link between chemotherapy and problems with thinking and memory, findings are not yet consistent and more studies need to be done. What we do know is that for many breast cancer patients, “chemo brain” is a very real issue. You may not remember where you put your keys or why you went to the store, or you may simply not be able to think of the right word. Join us to find out how other aspects of treatment can affect your cognitive abilities, learn ways to improve your mental skills, get the latest research on chemo brain, and more.
Join us tomorrow night between 7:00 p.m. and 8:30 p.m (EDT)* for this month's Ask-the-Expert Online Conference: Managing Chemo Brain. Christina Meyers, Ph.D., A.B.P.P. and George Sledge, M.D. will answer your questions about how long memory issues can last, what you can do to keep your brain active including tips to sharpen your memory, and more.
Christina Meyers, Ph.D., A.B.P.P. is a board certified neuropsychologist. She created the Neuropsychology Service in the newly formed Department of Neuro-Oncology at M.D. Anderson Cancer Center in 1984.
George Sledge, M.D. is the Ballvé-Lantero Professor of Oncology at Indiana University at Indianapolis, where he co-directs Indiana University Simon Cancer Center's Breast Cancer Program.
If you'd like to ask a question for our MANAGING CHEMO BRAIN conference, but will not be able to join the conference tomorrow night, you can submit your question now.
We'll answer as many questions as we can during the conference. A conference transcript will be posted at Breastcancer.org by October 22, 2008.
To join the conference, visit Breastcancer.org any time between 7:00 p.m. and 8:30 p.m. EDT* tomorrow night and click on the "Join Conference" button. It’s easy to participate; no special software is required. The live conference will appear in text on your screen.
Visit the Ask-the-Expert Online Conference page for more details.

Screening

From the National Cancer Institute
Screening

Screening for breast cancer before there are symptoms can be important. Screening can help doctors find and treat cancer early. Treatment is more likely to work well when cancer is found early.

Your doctor may suggest the following screening tests for breast cancer:

• Screening mammogram
• Clinical breast exam
• Breast self-exam

You should ask your doctor about when to start and how often to check for breast cancer.

Screening Mammogram

To find breast cancer early, NCI recommends that:

• Women in their 40s and older should have mammograms every 1 to 2 years. A mammogram is a picture of the breast made with x-rays.
• Women who are younger than 40 and have risk factors for breast cancer should ask their health care provider whether to have mammograms and how often to have them.

Mammograms can often show a breast lump before it can be felt. They also can show a cluster of tiny specks of calcium. These specks are called microcalcifications. Lumps or specks can be from cancer, precancerous cells, or other conditions. Further tests are needed to find out if abnormal cells are present.

If an abnormal area shows up on your mammogram, you may need to have more x-rays. You also may need a biopsy. A biopsy is the only way to tell for sure if cancer is present. (The "Diagnosis" section has more information on biopsy.)

Mammograms are the best tool doctors have to find breast cancer early. However, mammograms are not perfect:

• A mammogram may miss some cancers. (The result is called a "false negative.")
• A mammogram may show things that turn out not to be cancer. (The result is called a "false positive.")
• Some fast-growing tumors may grow large or spread to other parts of the body before a mammogram detects them.

Mammograms (as well as dental x-rays, and other routine x-rays) use very small doses of radiation. The risk of any harm is very slight, but repeated x-rays could cause problems. The benefits nearly always outweigh the risk. You should talk with your health care provider about the need for each x-ray. You should also ask for shields to protect parts of your body that are not in the picture.

Clinical Breast Exam

During a clinical breast exam, your health care provider checks your breasts. You may be asked to raise your arms over your head, let them hang by your sides, or press your hands against your hips.

Your health care provider looks for differences in size or shape between your breasts. The skin of your breasts is checked for a rash, dimpling, or other abnormal signs. Your nipples may be squeezed to check for fluid.

Using the pads of the fingers to feel for lumps, your health care provider checks your entire breast, underarm, and collarbone area. A lump is generally the size of a pea before anyone can feel it. The exam is done on one side, then the other. Your health care provider checks the lymph nodes near the breast to see if they are enlarged.

A thorough clinical breast exam may take about 10 minutes.

Breast Self-Exam

You may perform monthly breast self-exams to check for any changes in your breasts. It is important to remember that changes can occur because of aging, your menstrual cycle, pregnancy, menopause, or taking birth control pills or other hormones. It is normal for breasts to feel a little lumpy and uneven. Also, it is common for your breasts to be swollen and tender right before or during your menstrual period.

You should contact your health care provider if you notice any unusual changes in your breasts.

Breast self-exams cannot replace regular screening mammograms and clinical breast exams. Studies have not shown that breast self-exams alone reduce the number of deaths from breast cancer.

You may want to ask the doctor the following questions about screening: Which tests do you recommend for me? Why? Do the tests hurt? Are there any risks? How much do mammograms cost? Will my health insurance pay for them? How soon after the mammogram will I learn the results? If the results show a problem, how will you learn if I have cancer?

Risk Factors

From the National Cancer Institute.

Risk Factors

No one knows the exact causes of breast cancer. Doctors often cannot explain why one woman develops breast cancer and another does not. They do know that bumping, bruising, or touching the breast does not cause cancer. And breast cancer is not contagious. You cannot "catch" it from another person.

Research has shown that women with certain risk factors are more likely than others to develop breast cancer. A risk factor is something that may increase the chance of developing a disease.

Studies have found the following risk factors for breast cancer:

• Age: The chance of getting breast cancer goes up as a woman gets older. Most cases of breast cancer occur in women over 60. This disease is not common before menopause.
• Personal history of breast cancer: A woman who had breast cancer in one breast has an increased risk of getting cancer in her other breast.
• Family history: A woman's risk of breast cancer is higher if her mother, sister, or daughter had breast cancer. The risk is higher if her family member got breast cancer before age 40. Having other relatives with breast cancer (in either her mother's or father's family) may also increase a woman's risk.
• Certain breast changes: Some women have cells in the breast that look abnormal under a microscope. Having certain types of abnormal cells (atypical hyperplasia and lobular carcinoma in situ [LCIS]) increases the risk of breast cancer.
• Gene changes: Changes in certain genes increase the risk of breast cancer. These genes include BRCA1, BRCA2, and others. Tests can sometimes show the presence of specific gene changes in families with many women who have had breast cancer. Health care providers may suggest ways to try to reduce the risk of breast cancer, or to improve the detection of this disease in women who have these changes in their genes. NCI offers publications on gene testing.
• Reproductive and menstrual history:
  • The older a woman is when she has her first child, the greater her chance of breast cancer.
  • Women who had their first menstrual period before age 12 are at an increased risk of breast cancer.
  • Women who went through menopause after age 55 are at an increased risk of breast cancer.
  • Women who never had children are at an increased risk of breast cancer.
  • Women who take menopausal hormone therapy with estrogen plus progestin after menopause also appear to have an increased risk of breast cancer.
  • Large, well-designed studies have shown no link between abortion or miscarriage and breast cancer.
• Race: Breast cancer is diagnosed more often in white women than Latina, Asian, or African American women.
• Radiation therapy to the chest: Women who had radiation therapy to the chest (including breasts) before age 30 are at an increased risk of breast cancer. This includes women treated with radiation for Hodgkin's lymphoma. Studies show that the younger a woman was when she received radiation treatment, the higher her risk of breast cancer later in life.
• Breast density: Breast tissue may be dense or fatty. Older women whose mammograms (breast x-rays) show more dense tissue are at increased risk of breast cancer.
• Taking DES (diethylstilbestrol): DES was given to some pregnant women in the United States between about 1940 and 1971. (It is no longer given to pregnant women.) Women who took DES during pregnancy may have a slightly increased risk of breast cancer. The possible effects on their daughters are under study.
• Being overweight or obese after menopause: The chance of getting breast cancer after menopause is higher in women who are overweight or obese.
• Lack of physical activity: Women who are physically inactive throughout life may have an increased risk of breast cancer. Being active may help reduce risk by preventing weight gain and obesity.
• Drinking alcohol: Studies suggest that the more alcohol a woman drinks, the greater her risk of breast cancer.

Other possible risk factors are under study. Researchers are studying the effect of diet, physical activity, and genetics on breast cancer risk. They are also studying whether certain substances in the environment can increase the risk of breast cancer.

Many risk factors can be avoided. Others, such as family history, cannot be avoided. Women can help protect themselves by staying away from known risk factors whenever possible.

But it is also important to keep in mind that most women who have known risk factors do not get breast cancer. Also, most women with breast cancer do not have a family history of the disease. In fact, except for growing older, most women with breast cancer have no clear risk factors.

If you think you may be at risk, you should discuss this concern with your doctor. Your doctor may be able to suggest ways to reduce your risk and can plan a schedule for checkups.

Understanding Cancer

From the National Cancer Institute:

Understanding Cancer

Cancer begins in cells, the building blocks that make up tissues. Tissues make up the organs of the body.

Normally, cells grow and divide to form new cells as the body needs them. When cells grow old, they die, and new cells take their place.

Sometimes, this orderly process goes wrong. New cells form when the body does not need them, and old cells do not die when they should. These extra cells can form a mass of tissue called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer:

• Benign tumors are rarely life-threatening.
• Generally, benign tumors can be removed. They usually do not grow back.
• Cells from benign tumors do not invade the tissues around them.
• Cells from benign tumors do not spread to other parts of the body.

Malignant tumors are cancer:

• Malignant tumors are generally more serious than benign tumors. They may be life-threatening.
• Malignant tumors often can be removed. But sometimes they grow back.
• Cells from malignant tumors can invade and damage nearby tissues and organs.
• Cells from malignant tumors can spread (metastasize) to other parts of the body. Cancer cells spread by breaking away from the original (primary) tumor and entering the bloodstream or lymphatic system. The cells invade other organs and form new tumors that damage these organs. The spread of cancer is called metastasis.

When breast cancer cells spread, the cancer cells are often found in lymph nodes near the breast. Also, breast cancer can spread to almost any other part of the body. The most common are the bones, liver, lungs, and brain. The new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer. For that reason, it is treated as breast cancer, not bone cancer. Doctors call the new tumor "distant" or metastatic disease.

The Structure of Breasts

(from The National Cancer Institute)

The Breasts

The breasts sit on the chest muscles that cover the ribs. Each breast is made of 15 to 20 lobes. Lobes contain many smaller lobules. Lobules contain groups of tiny glands that can produce milk. Milk flows from the lobules through thin tubes called ducts to the nipple. The nipple is in the center of a dark area of skin called the areola. Fat fills the spaces between the lobules and ducts.

The breasts also contain lymph vessels. These vessels lead to small, round organs called lymph nodes. Groups of lymph nodes are near the breast in the axilla (underarm), above the collarbone, in the chest behind the breastbone, and in many other parts of the body. The lymph nodes trap bacteria, cancer cells, or other harmful substances.

These pictures show the parts of the breast and the lymph nodes and lymph vessels near the breast.

Breast Cancer Awareness Month Begins

From Breastcancer.org

Your Pathology Report

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Page last modified on: June 26, 2008

At a Glance

Manage Your Anxiety

Getting tests done and waiting for their results can create a lot of anxiety. Here are some suggestions to help you manage your anxiety:

• Get to know the people on your medical team and make every effort to meet them in person. You'll find out who is the best communicator, who can answer which questions, who is available to help you when you need it most.
• Find a doctor who communicates with you who invites your questions and takes your concerns seriously, who gives you as much or as little information as you feel comfortable with.
• Make plans with your doctor about how to receive test results in a prompt way. Try to schedule important tests early in the beginning of the week, so you don't have to wait over a long weekend, when lab work may slow down or doctors aren't communicating with each other.

In this section you'll find the web version of the breastcancer.org booklet: Your Guide to the Breast Cancer Pathology Report.

Wait for the Whole Picture

Waiting is so hard! But just one test can lead to several different reports. Some tests take longer than others. Not all tests are done by the same lab. Most information comes within one to two weeks after surgery, and you will usually have all the results within a few weeks. Your doctor can let you know when the results come in. If you don't hear from your doctor, give her or him a call.

Get All the Information You Need

Be sure that you have all the test information you need before you make a final decision about your treatment. Also, don't focus too much on any one piece of information by itself. Try to look at the whole picture as you think about your options.

Different labs and hospitals may use different words to describe the same thing. If there are words in your pathology report that are not explained in this booklet, don't be afraid to ask your doctor what they mean.

Breast anatomy showing close up of ductal cells

• Larger Version

Breast Cancer Stage

The pathology report will help your doctor decide the stage of your breast cancer. It could be:

• stage 0
• stage I (1)
• stage II (2)
• stage IIIA (3A)
• stage IIIB (3B)
• stage IV (4)

Staging is based on the size of the tumor, whether lymph nodes are involved, and whether the cancer has spread beyond the breast. Your doctors use all parts of the pathology report as well as the breast cancer stage to shape your treatment plan.

How to Start

First, check the top of the report for your name, the date you had your operation, and the type of operation you had. Make sure they are right for you.

Parts of Your Report

• Specimen: This section describes where the tissue samples came from. Tissue samples could be taken from the breast, from the lymph nodes under your arm (axilla), or both.
• Clinical history: This is a short description of you and how the breast abnormality was found. It also describes the kind of surgery that was done.
• Clinical diagnosis: This is the diagnosis the doctors were expecting before your breast tissue sample was tested.
• Gross description: This section describes the tissue sample or samples. It talks about the size, weight, and color of each sample.
• Microscopic description: This section describes the way the cancer cells look under the microscope.
• Special tests or markers: This section reports the results of tests for proteins, genes, and how fast the cells are growing.
• Summary or final diagnosis: This section is the short description of all the important findings in each tissue sample.

How Would You Like To Be Remembered?

Before he died of cancer, one of my heroes (Leroy Sievers) asked his readers to tell him how they'd like to be remembered. I watched a bit of his memorial service yesterday and thought some more about it.

I'd like people to remember all the times when I could have judged, but didn't. I'd like them to remember my warmth. I'd like them to remember the times I made them laugh or shared with them one of those random facts no one else would know.

I wish there were someone who could share, when the time comes, how hard my life has been and how I rose above it, time and time again. That's really the greatest accomplishment of my life. I have thrived in an environment that could have destroyed me. My cousins survived, but I triumphed over bad genes and dismal nurturing.

I hope they remember how brave I've been. Not because I've lived through breast cancer. Not because I lived through my dad's suicide. I've been courageous by refusing let go of compassion, no matter what. It's a work in progress, letting go of anger and resentment, but I continue to put one foot in front of the other.

When all is said and done, there aren't many choices to make in life. You're born into certain circumstances and, as terrible as things eventually may get, all you can do is keep going. As I've said before, no one gets to call in sick to life. We wake up every day and try to get through it, no matter what. That's all we can do.

Getting up and going on doesn't require courage. Maintaining humor, gentleness, compassion and integrity--for those qualities I've had to reach deep inside. I have had to bring my attention back day after day. They've tested my mettle.

I wish people would remember that about me. How would you like to be remembered?

Ike Threatens People I Love

The migraine raged on all afternoon, all night and was there to greet me first thing this morning. I didn't cook dinner last night. I stuck it out at work until it was time to go home. When I got there, I actually went to bed and put a cloth over my eyes. Even in the midst of chemo, I rarely hung around in bed.

Hubby made dinner: turkey burgers. He did a great job, but I may never be able to stand the smell of turkey burgers again. I wonder if, because of chemo, I developed an overly acute sense of smell. There are so many things I can't stand to smell anymore. Raw beef. Turkey. Chicken (unless it's heavily disguised by spices). I'm still good with fish. I hate the smell of coffee cake and barbecue (these are definitely related to chemo). Enough of that.

I lived 19 years on the Gulf Coast of Texas. I'm accustomed to hurricanes, the anxiety of whether the path is true and it will eventually find its way to your home. I've lived through the endless rain, the high winds, tornadoes, the endless endless rain in an area not too far above sea level.

Today, I'm worried about all of the people who took (and continue to take) such great care of me at M.D. Anderson. I hope they're safe and that their homes are spared. I know Dr. Ross will be at the hospital, sleeping on a cot, taking care of the people who are so sick they can't go home. It's probably one of the safest places to be in Houston.

I remember every last one of them, from the people who park my car to the nurses who helped me get out of bed or stop bleeding, the medical techs who x-rayed me or ct scanned me to the doctors who saved my life. I can't know how they'll fare.

I'm holding my breath a little bit and saying prayers for all beings living on the Coast. But especially all of those people to whom I'll always be grateful.

Learning to Love the Scars

I've started doing yoga again. It's the slow, meditative type that allows me to "yawn my body open." I hope it helps with the osteoarthritis in my hips, but even if it doesn't, it's the first step to regaining my physical fitness regimen. Slowly but surely, I start again.

This week, Carson Kressley's show, "How to Look Good Naked" featured a woman who had been unable to feel attractive because of extensive medically-created scars on her body. I thought about watching it, even watched the first five minutes of it, but ultimately I decided to move on. Makeup, a new haircut, a new wardrobe--none of that is going to fix my own scar issues. Everyone tells me that no one would ever know, by looking at me, that I had breast cancer. People even tell me that I'm pretty.

My only thought is, "That's because you haven't seen me naked." I'm working hard to accept my scars, if not love them. Some days are better than others. I accept that they're there. I know that having them is preferable to being dead. I even know with absolute certainty that my husband still finds me attractive.

Someday maybe I will. All the time, not just intermittently.

Losing Weight

Lisa, the only M.D. Anderson employee I dislike, pointed out that I've lost weight since my last visit. She attributed that to the Ritalin, but since I haven't taken it in a month, I don't think that's the cause.

The question is, after having been alerted to diminishing weight, why do I think that's a reason to restrict food intake?

Feeling a little nutritionally crazy, teetering on the razor's edge of my long-time eating disorder potential.

On the up side, I'm not weighing myself yet. And yes, I do still own scales.

Not Myself

The second night of insomnia. I'm not sure if it's fatigue or maybe the after-effects of surgery or maybe the coming to terms with new diagnoses, but my intuition fails me. Back in Crazy Land, I have conversations but I can't determine the mindset of participants. I hate not being able to read people. I'm frustrated and baffled by my insularity. I need to see inside their heads.

I'm fairly certain that no one else here is attuned to the subtleties of human interaction. Otherwise, they might have noticed the distance in my eyes. They might have heard my voice coming from far away, as if I were standing in an empty room. On the one hand, it's a very good thing: I'm never vulnerable. On the other hand, it's a very lonely experience.

Clearly, I'm not myself. Whomever that may be at this point.

Test Results

The mammogram was fine, except tissue density makes it hard for them to say with certainty that all is well.

I've developed osteoporosis in my hips and spine, thanks to the chemo. That aching pain in my hips is arthritis.

"You've been through a lot," Dr. Ross told me. If he says it, it must be so.

I feel like I'm tired, anxious and depressed. I got to see Dr. Ross, though.

Up At 2:00

Another night of sleeplessness. I've been waking up at 4:00 every morning for about the last three weeks. Too much stress at work, at home and the nagging anxiety about Thursday's tests jolt me awake every night.

I saw Dr. Nuesch, my radiation oncologist this morning, believing we were finally through with each other. After his examination, he said he thought we should keep an eye on the hardness that refuses to go away. It's on the side of my breast and a ridge under my left breast. Generally speaking, I try not to notice. I'll be seeing him again, but I get a break for a year.

While I was waiting, I noticed a photograph of me in my (extensive) patient files. No wonder people cried when they saw me. I looked really sick. I was really sick. Seeing it made me a little sad. I'm not sure why.

Tomorrow, off to Houston.

Annual Check Up

I'm hiding in my office today, feeling profoundly unproductive. My annual breast cancer check is coming up on Thursday. It's always nerve-wracking, even though I have every reason to believe all is well.

Not much will get done today or tomorrow. Wednesday, I'm off to Houston. Thursday is the marathon day at M.D. Anderson, beginning with blood work at 7:00 a.m. I'll see Dr. Ross at the end of that day. It's something to look forward to.

I won't be able to drive back until Friday, but then I get a non-medical day off on Monday. I just want to get the week over with.

Thank you, Leroy

Before I had breast cancer, I never had heroes. The very concept eluded me. Now I have several--Dr. Ross, Dr. Christafanilli, Dr. Kronowitz, Lance Armstrong and Leroy Sievers. Leroy Sievers died on August 15. He was 53 years old.

Leroy waged a mighty battle against the cancer that eventually took his life. Like Lance Armstrong, he was fearless in his commitment to staying alive. He endured through countless procedures and treatments. One of the last treatments involved injecting glue into his spine. He developed a post-operative infection and almost died from it.

Leroy had many friends on the Internet. He wrote about his illness every day in his blog, "My Cancer," and gave voice to so many of us who've shared the same journey.

I always think that, if cancer reoccurs as it did with Leroy, I won't be willing to go through chemo again. If that means I die, then so be it. Leroy was a stronger, braver person than I. He grabbed onto life and held on, no matter how scary the ride got.

I hope Leroy can hear all of us left behind, saying thank you for the tremendous gift of his spirit.

Thank you, Leroy. I'm going to miss you so much.

Keeping Secrets From Myself

I finally figured it out. It's anxiety. In the past three weeks, I've

burned my right arm twice on the oven
burned two fingers of my left hand, testing the heat of a grill
sprained one of my ankles
cut both of my feet
hit my lower back against a sharp-edged table

I'm a disaster. All of these were accidents, but they form a pattern, obviously. Whenever I'm anxious, I'm so distracted that I go through periods of accidentally hurting myself. For as long as I'm fearful, I'm a danger to myself.

I haven't been aware of thinking about my surgery, but clearly my mind has been focused on the pain ahead. I'm so good at keeping secrets from myself. It's how I got through my childhood. I compartmentalize to keep anxiety at bay. The Inner Fascist asserts herself and, as always, finds an abundance of qualities that need correction.

Why, why, why. I shut down the Inner Fascist and wonder why she's back. I wonder why I'm falling, cutting, stumbling, injuring myself repeatedly. They defend me from what seems like unbearable anxiousness.

I'm a slow learner. Shhhh. Don't tell anyone, especially not me.

Surgery, Round Four

I've been complaining for weeks about not hearing from Dr. Kronowitz to set a surgery date. Yesterday, Brenda left a message on the machine requesting that I call her to discuss Dr. K's schedule. I was immediately plunged into depression.

I don't have to do this. I could allow the necrotic tissue to remain. Dr. Kronowitz suggested doing some scar revision on the tummy tuck. He said the scars might come back, though, and it will definitely be painful. I tried to think clearly about it last night, to determine whether I'd be sorry if I didn't do either one.

The brain was already hunkered down, trying to steel the body for the coming onslaught. I'm familiar with the mental strength that must be marshaled to get through the pain, though it most certainly will be pain of a variety I've already experienced.

At this moment, I don't think I can stand another abdominal surgery. Certainly a few more steroid injections might help with the pain I still experience over both of my hips. I plan to ask Brenda about whether surgery ultimately will be more efficacious in resolving this chronic pain. My guess is that it won't.

I can't speculate on how much of a toll surgery will take on my energy level, which is being managed relatively well with Ritalin. I need to carry on with my life and that requires that I'm not burdened with insurmountable fatigue.

I've worked so hard the past several months to regain strength, stamina and mobility. I wonder how much will remain after the surgery. Of course, I will start rebuilding again as soon as I'm able. Right now, I need to come to terms with the loss.

I can elect to move on and leave things as they are. I regularly remind myself of that fact. Just as regularly, my thought process shuts down. I know I will have the necrotic tissue removed. I like to think that in the dissociative silence settling over me that my brain is sending messages to this body beaten down by three years of medical assault. It's reminding the body that I can get through this.