Friday, October 12, 2012

Testing, one, two..

There are few things scarier than hearing you have cancer - unless it is trying to figure out just how far  cancer has advanced. Why?  Because fear of the unknown trumps pretty much anything - just watch any well-shot horror film.

 As a now seasoned veteran of the cancer game, I can say with certainty the most harrowing part for me was the whirlwind month or so of diagnostics.  (And that is saying something considering I recently spent about a week in the bathroom and lost another 3 pounds after receiving my latest dose of chemotherapy.)

Really? Am I the only one who remembers this?
Since I've "gone public" with my journey with cancer, many people have shared with me their fears and questions as they've had their own diagnostic tests run. This is scary business and life is at stake.  Trust me - I understand.  With that in mind I've decided to explain some of the common tests that are run in the diagnostic phase of breast cancer.  Because as anyone who grew up in the 80's can tell you - knowing is half the battle.

Mammogram -

To the best of my knowledge the term mammogram comes from the greek root mammo - meaning "breast" and ogram - meaning "I didn't think it physically possible to flatten the girls out that far." In addition to regular breast exams this scan is on the front lines of detecting breast cancer. Guidelines vary - so check with your doctor - but the American Cancer Society recommends annual mammograms for women with average risk of breast cancer over the age of 40.

Note the woman's clenched fists and "angry eyes."
What to expect -  A technologist will position your breasts one at a time beneath what appears to be a giant c clamp and then - for lack of better terminology - proceed to squish them beyond recognition.  A low level x-ray image is taken in each position and then reviewed by a radiologist who will send the report to your doctor. Normal breast tissues change over time and with menstrual cycles so sometimes a repeat mammogram or ultrasound will be ordered to follow up on possible abnormal findings.  Mammograms can be a little cold, awkward and moderately uncomfortable - but nothing that a post-exam latte can't put right.

Risks include exposure to low levels of radiation as well as possible false positives resulting in unnecessary biopsies. Or, in my case, the mammogram was falsely negative due to the axillary location of the tumor (it was located in my armpit area).  As with any screening tool, it's not a perfect process, but mammograms are the current gold standard for early detection of breast cancer - and early detection means survival. (So get 'er done!)

 What they don't tell you - After changing into a gown and locking up my belongings, I was led into a waiting room where other gowned women awaited their turn to get to second base with a technologist who may have signed a "cold hand" affidavit.  Be prepared to make awkward small talk with overexposed geriatric women about their doctors/the decaying state of their body/their grandsons marital status - or at least find a current Better Homes and Gardens to help you avoid seeing things you wish you hadn't.

Ultrasound (with or without biopsy)

If you have dense breast tissue (which is doctor talk for small boobs), have breast implants or if there is an area of tissue that warrants a closer look, chances are your physician will order an ultrasound and possibly an ultrasound guided biopsy to check it out. 

What to Expect - You might remember this procedure if you ever had a baby - hopefully they will use a gel warmer this time!  During a breast ultrasound a technologist presses a gooey, hand held transducer back and forth against the breast tissue. The transducer produces sound waves which help visualize the tissue. Through the images that are produced, radiologists can determine if a nodule is fluid filled (normal) or dense (not so much).  They can also determine blood flow to the area (cancers have particular blood flow patterns).  It is completely painless unless biopsy is included and I know I always find them interesting to watch.

 As with any test, be sure to ask questions if you don't understand the images on the screen.  Technologists are usually happy to explain what they are looking at - but remember they can't give official results so resist the urge to badger them.

Risks for an ultrasound are essentially nil.  Biopsy risks include bruising, bleeding, allergic reaction to lidocaine and of course discomfort.

What They Don't Tell You - Be suspicious of anyone who says a breast biopsy might "pinch" a bit. They stick a big effing needle into sensitive tissue and then snip off bits of you to send to the lab.  The radiologist numbs the area with lidocaine but at least in my case this did not cover all the pain. And in my humble opinion, if you don't have to suffer through something - don't!  My doctor gave me a prescription for a sedative that I took an hour before each biopsy (I ended up going through this twice after some suspicious nodules were also found in my left breast post MRI - those ended up negative) and I am so glad she did.  However, it is not necessarily something that is volunteered so if you are concerned about discomfort be sure to request a prescription ahead of time.

Also, biopsy results take several days to come back from the lab due to the processing techniques.  Be prepared to wait a while to find out results - it's normal and unfortunately can't be sped up.  If I remember correctly they told me to expect results no sooner than 3-5 days but when it was positive I had calls from the lab, my doctor and a nurse after two days.  Sometimes no news can be good news.
Breast MRI

Breast MRI's aren't super common as a diagnostic tool from what I understand.  It was ordered in my case because I already had a positive biopsy and they wanted to be certain there was no other involvement or other suspicious nodules in either breast.  It was ordered by my surgeon to help him decide my surgical options.

What to Expect - MRI's remind me a little of squeezing into a giant tampon applicator and then attending a rave.  They are ridiculously loud and if you have a tendency towards claustrophobia, be sure to request a sedative in advance.  The technician will go through a checklist prior to the scan to be certain you have no metal anywhere in or on your body. This was a scan that required contrast dye to be injected at a certain point in the test but after the set-up this was not a big deal.  It is cold in the room and once they start scan you are stuck there for a while - so say yes to an extra warm blanket or two.

It is exactly as comfortable as it appears - except add cold and loud.
What They Don't Tell You -   My scan happened to be scheduled the morning after I worked a 12-hour night shift in the ICU.  I traipsed downstairs bleary-eyed, still wearing my scrubs and was a little dismayed that I not only had to disrobe but also place my breasts in what appeared to be two beer cozies for the duration of the scan.  I was also incredibly dehydrated after working all night and because I have puny veins to begin with, it took a total of six attempts by three people to finally start the IV before the scan could even begin.  Take home lesson:  schedule your scans for days you don't have stuff going on - and drink plenty of water before you go!