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.