Angst

…Boob Department.

So, late, late late yesterday afternoon St. Joe’s called with the verdict on the biopsy: it’s cancer.

However, as cancers go, it’s far from the worst of all possible worlds. Their pathologist declared it a papillary carcinoma, which is a rare cancer that, in older women, is usually slow-growing. And in my case, both tumors are “encapsulated,” which means they’re closed off from spreading around with gay abandon.

If she’s correct, then as this kind of news goes, it’s actually fairly positive: According to the American Journal of Clinical Pathology “EPCs [encapsulated papillary carcinomas) are in situ carcinomas with an excellent prognosis and can be managed with local therapy with or without sentinel lymph node biopsy.”

That’s from a 2009 paper, so of course it’s a bit old. However, from what the radiologist said, the thinking must still be along these lines. She said they no longer yank out your lymph nodes — which, other than the disfiguration of your boob (which is hardly fatal), is the big issue with breast cancer, because it leaves you vulnerable to infection of even the tiniest little nick or paper cut.

Rummaging through the Hypochondriac’s Treasure Chest, we find a literature review in an open-access journal. Open access is less questionable in the hard sciences than it is in the humanities. As of 2014, this review of published research indicates “this form of cancer is usually low grade and rarely recurs. . . . Understanding the low-grade nature of this form of breast cancer allows treatment options to be less radical and safely omitted.” However, this same group of authors calls papillary breast cancer “diagnostically challenging” and remarks that if the tumor appears in conjunction with invasive cancer, that might not be great, especially if it occurs in a younger woman. However, I fortunately am old as the hills, and I’m told these things were quite small.

And finally, the Brits say, in a website dumbed down for the public, “Doctors usually treat papillary breast cancer with surgery. These cancers usually grow slowly, and don’t usually spread to the lymph glands or other parts of the body.”

So if I’m understanding what the woman said to me, it looks like the outlook is about as positive as it can get for a cancer diagnosis. I feel a great deal less frantic than I did while waiting for news…right now what I most want is just to get the surgery under way, get the damn things out of my boob, and move on.

My son is going to take the dogs for as long as I’m incapacitated. Suspecting this was coming up the pike, I’ve already hired a cleaning lady and lined up a pool guy. Cleaning lady has begun deconstructing my house — in addition to breaking the vacuum cleaner ($140!), she also quietly knocked the shower door off its track. Neighbor is coming over this evening to try to fix it. I just hate hiring cleaning help…honest to god, they do more damage than good! And then when they break things, they don’t tell you — they leave it for you to find out. Had a helluva time getting out of the shower stall this morning.

Let’s hope that’s not true of pool guys.

Tomorrow I’m meeting with a surgeon at the Mayo. I have no intention of letting St. Joseph’s cut me up, having damn near died there a few years ago. Besides, St. Joe’s Healthgrades ratings for patient safety are much lower that the Mayo’s and even lower than John C. Lincoln’s. JCL is located in the heart of a desperate slum, for hevvinsake, a few blocks from the headquarters of a dangerous meth gang. So…one wonders. At any rate, if I have to get radiation treatment and the Mayo doesn’t do that at its (relatively nearby) hospital on the 101, then I’ll have to get that done at JCL or St. Joe’s, since I can’t afford the gas to drive halfway to Payson five days a week for five to eight weeks.

So things appear to be as under control as they’re going to get. Unless, of course, the Mayo’s surgeon upsets the apple cart tomorrow…

ooohhh-kayyy….. Tomorrow St. Joesph’s radiology department is supposed to puncture my boob to see if I have cancer. It’ll be the middle of next week, at best, before the result comes back; a miracle if it reaches the Mayo Clinic surgeon by the time I’m supposed to meet with him for a second opinion. I’m pretty well decided that if surgery is needed (as seems increasingly likely), I’ll have it done at the Mayo, simply because their safety level is much higher. However, if several weeks of daily radiation treatments are required, I will ask if that can be done at St. Joe’s, which at least is within driving distance. From my house, the Mayo is halfway to Payson; even if Medicare covers this entire flying circus, I still couldn’t afford the gasoline to drive out there every day for five to eight weeks.

Meanwhile, students are turning in papers today. My assistant is junketing in China, so the entire task of reading these golden words falls to me. I’ll have to read frantically, well into the night, to get through the stuff. Eight (of twenty-five) classmates have posted their papers so far. The things aren’t due until midnight, meaning the bulk of these things will have to be read when I’m in pain, scared, and definitively NOT of a disposition to spend my time on student drivel.

I’d resisted reading the radiologist’s report myself, preferring to just fork it over to Young Dr. Kildare and the beloved Old Guy at the Mayo. But yesterday I thought I’d better take a look at it.

Googled the terminology she used to describe the two lesions and discovered exactly why YDK disagreed with beloved OG@theMayo about the urgency of moving forward. Holeeeee shit! The radiologist’s alleged 50-50 chance of the things being benign (read “50% chance of malignancy”) appears to have been very optimistic. The probability that these things are cancer is higher than 50%. Possibly much higher.

Picked up paperwork to make my son a signer on my credit union accounts. This will make it possible for him to pay the bills if I’m incapacitated, whether for awhile or permanently, and it also will make it a great deal easier to access what will be his funds should I croak over. He’s already listed as a beneficiary for those and for the Fidelity IRA and brokerage accounts. Fortunately, I’ve dawdled endlessly on withdrawing the cash value from my semi-defunct whole life policy, so the insurance payout is still in force; he’ll get 40 grand from that, in the croaking-over event. So he’ll have enough to dispose of my remains and then some. Quite a bit some.

Unless he’s been reading this blog (which I doubt), he doesn’t know about the current flap. I’d prefer not to enlighten him until I know what the real story is. His dad, a notary public in addition to his corporate lawyerness, has refused to notarize the credit union documents. How the hell I’m going to persuade the kid to drive out to the credit union on Saturday to get his signature enrolled with that outfit without having to tell him what’s up escapes me.

At any rate, when (and if) that’s accomplished, all that will remain will be to figure out what to do with the dogs. I think my son will take them temporarily — for a week or two — if I  have to have part or all of my boob lopped off and endless radiation or chemotherapy administered. But after that: ????  I can’t imagine he’ll want to take on two corgis, now and forever, in addition to his marginally manageable adolescent retriever.

Why the fuck do these things ALWAYS happen when things are finally going smoothly and you just start to think you’ve got a grip on your life and you’re going to be preternaturally happy for awhile?

So it’s back from the extra trip to the mammography unit, where the radiologist says she and her ultrasound lady found two “nodules” which she believes to be dangerously suspicious. She explained all the reasons she thinks these things could be boob cancer, and she made good sense. So now they want to schedule a needle biopsy and, if that turns out positive, surgery.

Ducky. As if I didn’t have enough on my mind.

She said the chance that they’re benign fibroadenomas is about 50 percent. That, of course, means there’s a 50 percent chance that they’re cancer. Doesn’t sound like great odds to me. Because these are new growths, because of my age, and because I have never taken hormones, the likelihood that they’re malignant is elevated.

Look into this and you discover that benign fibroadenomas in old bats like me may (or may not) be precursors of actual breast cancer:

Women diagnosed with benign disease do appear to have an overall modest increase in risk for subsequent development of breast cancer, particularly for more hyperplastic or epithelial (the covering or lining) proliferative forms. However, the evidence regarding the risk of breast cancer for non-proliferative conditions is conflicting. Some research found that the risk of breast cancer for women with non-proliferative disease is about double that of women without benign disease (Bodian 1993b), while others find that lesions with no proliferative changes were not associated with an increased risk (Oza 1993; Henderson 1996; NBCC 1999). According to Hurley (1997), atypical hyperplasia is a risk factor, but is not with certainty followed by breast cancer; risk applies to both breasts, with greater risk on the affected side. There is no means to predict which women will go on to develop breast cancer and the effectiveness of current screening and management methods is unknown. Further complicating a physician’s ability to predict a woman’s risk for breast cancer is that most women do not have a history of biopsy for a benign lesion (Bodian 1993c; NBCC 1999).

Isn’t that informative!

Hm. Interestingly,  neurofibromas (a hereditary condition which I happen to enjoy) can also appear in one’s boobs, and they can be mistaken for fibroadenomas. And lo! These things are on the same side as the neurofibromas that infest my shoulder. Wish I’d known that…I would have pointed out the shoulder lumps to the radiologist. Oh well.

What a damn nuisance. You know, the truth is, I don’t really much care whether I live or die. My life is essentially over now, and I’m not at all afraid of dying. Nor do I imagine I have much of anything left to do on this earth: I fill my hours with frantic busywork mostly to pass the time. What does scare me is the prospect of suffering the way my mother did with her cancer…and with her incompetent quack doctors. Truly, I would cheerfully die right now, today, rather than suffer the way she did.

Because I’m all by myself and there is no one here to help me, the hassle factor is almost more than I can bear to contemplate. The biopsy is nothing, but if, as seems fairly likely, they decide these things are cancers, the upshot will be lumpectomy and radiation therapy, according to the radiologist.

That means an overnight stay in the hospital plus God only knows how long to recuperate enough to get back to a normal life. None of the sites I’ve looked at say how long it takes to recover, but I would assume it will be at least a couple of weeks… Evidently long-term pain and numbness of the arm, plus some other uncomfortable and weird manifestations, are possible. The radiologist seemed to be saying they would perform radiation therapy at the time of the surgery, but all of these sites talk about five or six weeks of radiation therapy.

So. At the outset, someone will have to take care of these dogs, since I will be unable to do so for at least several days and possibly longer than that. Someone will have to take care of the pool, which is merrily going green — I have to do battle every day to keep the algae blooms under control, because I was too damn lazy and cheap to drain the thing and refill with fresh water last winter. Probably someone will have to run to the grocery store at least a few times to get me some food. And of course all these little projects I’ve been doing, trying to get books published and the incoming giant index and the various other editorial projects are going to have to go away, to the loss of at least a couple thousand bucks. If I’m unable to function well enough to teach my classes next semester, that’ll be another $4800 out the door.

Ugh. Just what I need to make my day!