Details, details, details

The pathology report we reviewed with Dr. Kim yesterday contains the following diagnosis: Multifocal ductal carcinoma in situ...largest focus of DCIS measures 0.35 cm; DCIS is estimated to span an area of approximately 2 cm...DCIS is located 0.5 cm from the nearest inked margin...no invasive tumor identified.

• "Multifocal" means there was more than one distinct mass, but the masses were close together. It would be better to have only one mass, but multifocal is better than "multicentric" which means the masses are widespread.

• 0.35 cm is very small - about half the size of an eraser at the top of a pencil. The site of the lumpectomy was rather messy with several large cysts. Dr. Kim described how he removed one mass initially but knew from the ultrasound that there was another and examined the area until he located it. We are very thankful for his diligence and skill.

• "located 0.5 cm from the nearest margin" means the mass was removed along with a surrounding margin of cancer free cells measuring 0.5 cm. Dr. Kim said he would have preferred a margin of 1.0 cm, but felt that 0.5 cm was sufficient and no re-excision would be necessary.

Based on this report and his experience and his estimation that I would not neglect the recommended schedule of mammograms, he concluded that the lumpectomy was sufficient treatment and that radiation would not be required. But he didn't advise against it and encouraged us to consult with an oncologist, which is just what we're going to do at 11 am on Friday.

Which brings me to two more details:
1. What is an oncologist?
Oncologists are physicians who study, diagnose, and treat cancerous tumors.

2. What are radiation treatments?
(from mayoclinic.com)

Radiation therapy — also called radiotherapy or X-ray therapy — involves treating cancer with beams of high-energy particles, or waves (radiation), such as gamma rays or X-rays. You may be familiar with the use of radiation in the form of diagnostic chest X-rays, computerized tomography (CT) scans or dental X-rays. But radiation therapy relies on much higher X-ray energy delivered at many more times that dose in order to treat cancer.

Radiation therapy damages cells by destroying the genetic material that controls how cells grow and divide. And while both healthy and cancerous cells are damaged by radiation, the goal of treatment is to hurt as few normal, healthy cells as possible.

You may be worried about radiation destroying healthy cells as well as the cancerous cells. But radiation is much more harmful to cancer cells than it is to normal cells. This is because cancer cells divide more rapidly than do healthy cells. Cells are more vulnerable to damage when they're dividing, making cancer cells more susceptible to radiation than normal cells are. In addition, normal cells can recover from the effects of radiation more easily than cancer cells can.

The silver lining keeps getting brighter

Dan & I heard great news from the surgeon (Dr. Kim) today; I'm too exhausted tonight to give all the details, but the long and the short of it is that I will not need any more surgery and may not need any further treatment (i.e., radiation). Tomorrow, I'll make an appointment with an oncologist to review the results and get another opinion.
Dr. Kim spent about an hour with us explaining what he did and what was found, answering all our questions and explaining his treatment recommendation. He also removed the drain which is a blessing in and of itself.
Praise God for this wonderful news and for His continuing love and faithfulness.

Info about DCIS

From cancer.org
Ductal carcinoma in situ (DCIS): This is the most common type of noninvasive breast cancer. DCIS means that the cancer is confined to the ducts. It has not spread through the walls of the ducts into the tissue of the breast. Nearly all women with cancer at this stage can be cured. The best way to find DCIS early is with a mammogram.

From breastcancer.org
What does DCIS mean?
The name "ductal carcinoma in situ" has three parts:

• "Ductal" means that the cancer started in the milk ducts.
• "Carcinoma" refers to any cancer that begins in the skin or other tissues (including breast tissue) that cover or line the internal organs.
  
• "In situ" is Latin for "in its original place." This means that the cancer is non-invasive: it hasn't spread into any normal surrounding breast tissue.

Ok well it didn't quite go according to plan

I DID have the pathology report faxed to Dr. Nash and she DID call me. So that was good. And what was even better is that she told me that my cancer is Ductal Carcinoma In Situ - which on a scale of 1 to 10 with 1 being the best kind of cancer to have and 10 being the worst - is a 2. Praise God.
I wasn't able to see Dr. Kim today or even talk to him, but I will see him tomorrow at 1:45, armed with questions.
If I have time later tonight, I will post some informative links about the treatment of DCIS.

Plan for today

• call Dr. Kim's office and request that:
• they fax the pathology report to Dr. Nash at the Baldwin Clinic
• to have my appointment rescheduled for today so I can get the painful drain removed and ask him all my questions face to face
  
• he call me if I can't get in to see him today so I can get the information I need over the phone