Sunday, November 10, 2013

Say what now? Your guide to breast terminology

                Cancer care involves all kinds of crazy terminology. Between my writing background and what I've learned thus far on this journey, I feel pretty well-versed, so excuse me if I get lax at explaining things. Sometimes when I'm rambling, I leave people looking at me like deer caught in headlights. Or people caught in headlights... as in, like, boobie headlights. Get it? Get—whatever. Anyway, here are eight terms you'll see a lot in my blog, with my usual twisted spin:
They are everywhere, if you just look...
1. Bilateral breast cancer. If you read this fast, maybe you thought my boobs were fluent in two languages. But the word is bilateral. More specifically, bilateral synchronous breast cancer. That’s when freaks like me develop not one cancer, but two breast cancers in separate boobs. I’m the first Connors woman to have this. Such a trailblazer. Bilateral breast cancer doesn’t indicate the cancer has spread from one side to the other. Breast cancer doesn’t usually do that. More likely, these are two independent cancers. Guess who hit up a two-for-one sale at the Malignancy Mall!
2. Boob in the hole! (also known as stereotactic biopsy): The first of my three biopsies, this one tested the microcalfications (see an explanation of that term below). You get to lie down on your belly and let your suspect boob hang down through a hole, which is backlit with this ominious-as-all-hell lighting; maybe it’s to help the radiologist see, maybe it’s for dramatic effect. I dunno. Anyway, since it’s mammogram-guided, you get to have your boob squished a little bit for imaging sake. And you have to stay still, because the radiologist has just precisely mapped out the location of the suspicious area with some insanely hard-to-explain crap like X and Y coordinates and a whole bunch of other stuff that doesn’t make sense to me because I barely passed high school math. Using the tip of a large needle, samples from the area are removed amid what sounds like a cross between a staple gun and a retail pricing gun being discharged. A local anesthetic is used, and in my case, sometimes needs to be turned up a notch to keep screaming to a minimum. (Are you a sadist who wants to see this procedure being performed? Click here.)
3. BRCA: “It sucks to have a mutated B-R-C-A! It sucks to have a mutated B-R-C-A!” Go ahead, try to spell THAT one out with your arms, Village People fans. Everyone’s got BRCA genes. They’re tumor suppressors, or what stop most people from developing cancer. But mutations happen (bumper sticker alert!) and when these genes don’t work like they’re supposed to, you end up with a higher likelihood of developing cancer. As I’ve pointed out in my other blogs, this mutated
gene can be passed down from mothers AND fathers to their offspring, who have a 50/50 shot of inheriting it. Unlike other genes, you don’t need to inherit the BRCA mutation from both parents. One copy is enough to do its damage. Currently there are two exciting BRCA possibilities: BRCA1 and BRCA2, and each carries its own risk percentages. Both are way higher than the average population. How much so? According to the National Cancer Institute:
  • ·         The general population faces about a 12 percent risk of developing cancer during their lifetime; women with a mutated BRC1 gene face up to a 65 percent risk, while BRCA2 mutation carriers live with a 45 percent risk. That's me!
  • ·         Lifetime ovarian cancer risk is 1.4 percent for the average woman; for BRC1 and BRCA2 ladies it’s 39 percent and up to 17 percent, respectively.
Other very reliable sources quote even higher risk percentages. Can I get a “Holy shit!!!?”
4. Breast reconstruction: Not unlike reconstruction of the South after the Civil War, the reconstruction of breasts that "left the Union," so to speak, is also a monumental undertaking, and it’s usually done immediately after removing the breasts. Some women opt out of reconstruction altogether, others choose to have implants put in. I picked DIEP flap, where abdominal tissue and fat is removed to recreate the breasts. I get a tummy tuck out of this whole otherwise shitty deal. Yeah, they have to rebuild the boobs, but I. Get. A. Tummy. Tuck. Savvy patients might be able to convince their insurance company that the cancer has spread to the chin, cheekbones, under-eye area, brows, nose, eyelids, butt or thighs, making these areas also critical to, ahem, “treat.”
5. Oh for fuck's sake! How many samples do you need? (also known as ultrasound-guided biopsy):  I was lucky enough to have two areas that needed biopsy—one in each breast (although they take about four samples from each biopsy site; that's eight total passes in my case, for those keeping count). At least for this one I was lying face up or on my side. From these vantage points, I could see on the ultrasound screen the needle being inserted into the breast and guided to what turned out to be the cancerous areas. My ductal carcinoma in situ (DCIS) looked so perfect, like an adorable little football, that the radiologist thought it was nothing. He was silent about what turned out to be invasive cancer in my right breast, which looked like a Rorschach inkblot. All those irregular borders? That’s never good. Too bad it wasn’t in the shape of Elvis or some religious figure. I probably could have made some sweet money selling my boob on eBay.
6. Mammogram: Most people know what a mammogram is, but I felt the need to include it here just so I could virtually yell: IT’S NOT AS BAD YOU THINK, SO JUST GET THE GOD DAMN THING!
7. Microcalifications: A lot of women have calcifications, but they’re usually macrocalifications—vestiges of old injuries, infections, cysts, etc.—and they’re bigger and spread out over the breast in no particular pattern (or maybe they spell something out if you’ve got quirky breasts). Microcalcifications on a mammogram are more worrisome because cancer likes to mark its territory with these calcium deposits (and they're usually clustered). In my case, it looked like a little snow squall in my left boob. Yep. Got yerself some cancer a-blowin' in, Heather.
8. Oophorectomy: Is this even a real medical term? YES! Is it fun to say? YES! Does it have anything to do with Oprah? NO! It means to surgically remove the ovaries. Doing so preventatively can significantly reduce the risk of ovarian cancer and breast cancer.
Make sure you study this list long and hard. There WILL be a test...

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