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Posts with tag margins

Today, I am grateful

The following post is one of a series of posts appearing Monday through Friday on The Cancer Blog. This feature -- Today, I am grateful -- allows me to share with readers my appreciation for all the treasures in my life, both big and small. In my post-cancer world, I find It healing for my soul to be mindful of the good in my life. It is my pleasure to share my gratitude with you.

The night before my lumpectomy, way back in December 2005, I was consumed with fear, worry, and panic. Since I'd found it, the lump in my left breast had been sitting untouched for nearly two weeks. I imagined the mass spreading with each day and believed I could detect its growth each time I felt for it. A doctor told me if it was growing like I thought it was, my tiny pea-sized tumor would be the size of an apple within days.

My fears were unfounded and irrational. I know that now. But during the moments of uncertainty that filled my days between diagnosis and prognosis, I had no direction. I had only my wandering mind for company. The waiting really is the hardest part. Once faced with the specifics of our diseases, we can take action.

Continue reading Today, I am grateful

Lumpectomy technique saves patients from repeat surgery

On Sunday, for the very first time, I read a magazine article about the hospital where I received treatment for breast cancer. I had never before seen mention of my hospital, my doctors, my city in anything other than local and regional newspapers and on area television stations. I figured news about Shands Hospital at The University of Florida was out there -- in more areas than my own -- because it's a well-known facility. People travel from all over to receive treatment here. So I know it's a good place. But to see in the October 2006 issue of Good Housekeeping an actual blurb about a new kind of lumpectomy -- pioneered right here in Gainesville, Florida -- is exciting.

I am the happy recipient of this new kind of lumpectomy -- which really is not new at all. It was developed 20 years ago by the surgeon who performed my own lumpectomy, and it allows women who undergo lumpectomy the chance to avoid return trips to the operating room.

The method is called frozen section analysis, and it was first used by Dr. Edward Copland III, first director of the UF Shands Cancer Center, who was tired of waiting for pathology reports and tired of operating on patients two and three times to ensure clear tumor margins.

It all happens like this -- a surgeon removes the breast cancer tumor, takes tissue samples, freezes them in an embedding compound, and sends them to a pathologist for immediate analysis. In a typical case, this frozen section process adds just 15 minutes to the operating time. If pathology reveals more tissue must be removed, the surgeon returns to the patient, still under anesthesia, and continues surgery. The patient does not need to return for more surgery.

Surgeons at most institutions rely on a method called permanent section analysis to determine whether or not cancerous cells remain along the margins of a tumor. The technique is labor-intensive, takes days to complete, and requires patients to return for additional surgery if margins are not clear. Surgeons using the frozen section method still consult permanent sections to confirm margins are clear -- but they are mostly certain of their findings during frozen section.

Studies show frozen section analysis to be safe and effective -- and it adds just $851 to the cost of surgery, a savings considering the cost of returning for surgery as a result of permanent analysis.

There are many advantages -- but the procedure is tricky and on occasion can fail to detect some cancerous margins, indicating frozen section should continue to be used in conjunction with permanent section. Opponents of the practice say false positives could result in unnecessary mastectomy. But Copeland says this has never happened at UF -- and he would never remove a woman's breasts until permanent section confirmed it was necessary.

Despite the promise of this method, only a handful of institutions make practice of this surgery-sparing technique. Shands at UF is the only hospital in North Florida where breast surgeons perform frozen section analysis on a regular basis.

The procedure -- which is not risky, is not harmful, and clearly saves patients from returning for surgery -- is the exact procedure I received almost two years ago. Dr. Copeland removed my tumor, froze tissue samples, sent them to pathology, and 15 minutes later knew my tumor had clear margins and had not spread to my lymph nodes. He visited my family in the hospital waiting room just after surgery and told them the good news -- clear margins, no spread, a 1.1 cm. tumor, stage I. And while other tumor criteria, such as ER/PR status and HER2 status, did not come my way immediately, I at least knew the basics when I woke from surgery. No waiting. No worrying. No complaints.

Sunday Seven: Seven completely candid cancer confessions

I have a new friend who is a new breast cancer survivor. She is surviving a new diagnosis, a recent lumpectomy, and the moments leading up to another surgery to further investigate the margins surrounding the tumor removed from her breast. She is surviving the first phase of her breast cancer journey. A phase full of uncertainty and fear and panic. A phase so new and so fresh and so raw, her mind is whirling. A phase that has her grasping for any bit of direction she can find as she navigates a terrifying, unfamiliar road.

My friend is a young wife and mother whose worries are consuming her. She e-mailed me today and asked if I ever have moments when I look at my young children and worry that cancer will take me from them while they are young. She asked if I have always been so sure I will be okay. And so I replied with this candid cancer confession.

Continue reading Sunday Seven: Seven completely candid cancer confessions

Sunday Seven: Seven subjects of breast cancer pathology

When I first looked at my pathology report more than 18 months ago, it made little sense. Terms like Bloom Richardson Score and margins and Her2Neu were as foreign to me as the breast cancer that somehow invaded my body. So I read it over and over again and was eventually able to identify the basic meaning hidden within the four pages that detailed my disease. As it turned out, this report was my map. It led me in various directions for various treatments. It contained some roadblocks. It was sometimes confusing. And sometimes I got lost. There were some good and not-so-good stops along the way. And in the end, I reached my final destination -- in the land survival. And this is where I hope to stay. For a long time.

My map is not necessary anymore -- although I still look back at it. I've found that it makes more sense now that time has passed. I can interpret it more objectively, with more perspective and less emotion and fear. I am still learning about the disease that was removed from my breast. And I am realizing there was a lot I never really knew -- like these seven subjects -- when breast cancer was new and fresh and debilitating.

Continue reading Sunday Seven: Seven subjects of breast cancer pathology

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