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Coarse Heterogeneous Calcifications and axillary lymph involvement
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Coarse Heterogeneous Calcifications and axillary lymph involvement

Wow.  Here I am: an RN on the other side of the system.  

Can someone please explain this to me?  Bloody discharge from the left breast with an area in question between three and six o'clock.  The rad report states the aforementioned area is comprised of "coarse heterogeneous calcifications" categorized as BiRad 4, and used "very worrisome" in his report; hence, the need for a couple of stereotactic biopsies early tomorrow morning followed by an ultrasound guided biopsy of a corresponding axillary lymph node. At the time the radiologist explained, with impressive artistic ability, what the "typical" lymph node anatomy looks like, and further mentioned, with more art skills, how abnormal the anatomy of the questionable lymph node appears regarding fat and the hilum; however, shortly thereafter everything that was said to me sounded a great deal like the teacher from the Peanuts cartoons:  "waa wa waa wa." This is very Greek to me.  (Why did i specialize in cardiology and open heart surgery patients?)

I'm not looking for a diagnosis, histology will provide that in the next three days.  I'm simply trying to understand why the MD is concerned if there is no discernible mass.  I need lay terms, if possible. I can barely process daily events or remember where my toothbrush is with this stress level.  So, simply is best. Nice and s l o w.

Thank you so much for your time regarding this line of questioning.  It is greatly appreciated.
Tags: coarse, heterogeneous, calcifications, Breast, bloody discharge, axillary lymph node, axillary lymph node pain, Breast biopsies
19 Comments
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25201_tn?1255584436
It wouldn't matter what your speciality .... we all get "that way" when it's "US" that they are talking about. The description of the calcifications seems to be that they appear to be made up of different elements. This may or may not mean much but there does not need to be a mass ... IF and that's a BIG IF, a cancer diagnosis is forthcoming it would seem to be an early stage of disease. I can only imagine the description you were given of the lymph node; the Radiologist must be more than an artist of speech. I can't imagine what one could make out of a bean shaped node other than it being enlarged and possibly misshapen ??? Let me remind you that it's always a good idea to take someone with you when you expect to receive any type of explanation ... our minds do tend to wander when we should be taking notes or listening to each and every word. Try to hang on to some "calm" now while you wait for your biopsy results ... Please come back when you get them ... you have peaked my curiousity ... Take care
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Avatar_f_tn
I can't really add much to japdip's good explanation, but I did want to offer my hope for an easy biopsy experience and benign results. Please try to stay positive and take one step at a time, easier said than done, I know.
I'm also an RN, retired, and MUCH older than you. When I was diagnosed with LCIS as a result of a biopsy on two areas of microcalcifications, I felt very much like you do now. I felt "I should know all this", but like japdip said, it's very different when it's us. I got a lot of information and support from the wonderful women here and I'm happy I found this site. Fortunately, LCIS is not that serious and only requires vigilant screening because of the high risk of developing an invasive cancer and I feel really grateful for that. But I worried and stressed as much as anyone until I knew exactly what I was dealing with just like everyone else. So even though what the radiologist reported and told you sounds ominous, please hang onto hope. And even if it does turn out to be cancer, there's still reason to hope that it's found early and highly treatable.
I do wish you all the best and please let us know how you're doing if you wish by adding a note to this thread. We do care.
Sending you a big hug from Michigan (          ),
nc
PS: I do hope you have a supportive family member or friend to be with you during the biopsy and after. As japdip said, it's very common to miss what's being said to you when you're under so much stress.
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Avatar_f_tn
Well, well, well. To start, I'd like to thank you for your kind words of support.   I did go for my biopsies today. The two areas they biopsied of my breast were each very different.  The lateral was relatively quick and only mildly uncomfortable. The second was taken via the 6 o'clock point of tbe areola and down. It was excruciating regardless of the lidocaine and epi. Due to the vascularity of that site the bleeding wouldn't stop easily and I developed a deep hematoma. The MD showed me all of the tissue taken from my breast and I was amazed. "Just need to be sure we have as much of the microcalcifications as possible."  I must say, though, the edema and firmness it has is pretty flattering! Too bad it is covered with bruises, steri strips, and bandaids.  The lymph node biopsies went smoothly.

After all was done, the physician took the time to show me, with great detail, the reason for their concerns and what they believe it is. DCIS. Apparently the microcalcifications are in text book display regarding morphology. The only question that she really has is whether or not it is invasive.  I should find out the final results tomorrow or Friday.  In the mean time, I'm sporting a lovely cold pack under my sports bra and taking oxycodone for the hematoma and nerve pain.

Thank you again for your support during this time of fear, sleeplessness, and uncertainty. It is so greatly appreciated.

Tara
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25201_tn?1255584436
Glad that's over ... enjoy that ice pack, it really helps. Sounds like you received a good explanation which I'm sure was of some comfort to you. You will get all your answers when you receive the Path. report on the specimens taken. Hoping for the BEST when you do hear.  Take care ....
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Avatar_f_tn
I must say, I had never expected to feel such appreciation from a stranger's post on a forum. I liken this to a group therapy of sorts... perhaps an alternative social media like Facebook.  I haven't told many people in my life what has been happening. Only parents, siblings, and spouse.  I don't want to worry anyone needlessly, regardless of my ongoing nervousness, - especially if all turns out benign.

I do know that I will be doing more in the future to help support those that find themselves in a situation like this by listening, sharing my experiences, donations for research, and a great deal more. I've actually been entertaining the idea of switching from cardiology to work in the breast clinic. I've also thought about some volunteer work to assist in making mammograms more accessible to those that wouldn't otherwise be able to have one.

So many ideas, but first things first: hear from pathology then move on to step two - whatever that may be.

Have a good night! I'm off to bed and think I may actually sleep for the first time in several days!

Tara
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25201_tn?1255584436
Your comments make it all worthwhile for us here and we appreciate that more than you can imagine. May I say that having folks like you come back later to share is what makes us THE COMMUNITY :) At least that's the way we feel about our little group. I wish you the very best with your results but no matter what I know you will be able to deal with it ... we women are a strong bunch when we're challenged. Glad we could help ... rest well :)
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Avatar_f_tn
Heard from my ARNP. I will be getting the Big Call at 16:00 pacific standard time. Five and a half hours. I have neglected my domestic duties the last couple of days due to the pain of the biopsied breast (still oozing) and I will likely take one more day off.  To pass the time I believe an afternoon of Beaches, Sixteen Candles, and Dances With Wolves will be in order with some delicious coffee and a blanket I'm crocheting for my six year old. The colors she selected are so bright and cheerful that it will be difficult to be distracted by any negative thoughts.

Will post more this evening when I know more.

xoxoxo from Tara in Seattle.
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Avatar_f_tn
Well, my biopsies came back. The breast tissue came back DCIS which is not supposed to be invasive. In my axillary lymph node they also found breast cancer - a different type, I don't remember what the relationship to estrogen was, but they are now saying there is invasive breast cancer somewhere that was missed and it requires further work up.

On Wednesday I will have blood work and a breast MRI with more biopsies to see what they can find. On Thursday I will meet with the dream team to find out what the plan will be.  On Friday (I don't remember if it is the same week or the week following) I will be meeting with genetic oncologists (?) because I am only 35.

I was prepared to hear DCIS... I was not prepared to hear "I don't know" so often today. What I want more than anything is to have my mom stroke my hair with her fingers the same way she used to when I was sick as a kid; or, lay on my dad watching kung fu theater with my dad while he wrapped me tightly in his arms. I can't stop hugging my three year old, and he doesn't push me away - but reciprocates with an equally strong hug  with a kiss to complete it
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Avatar_f_tn
Dear Tara,
I'm SO sorry to hear about your cancer diagnosis and all the uncertainty you still face. It sounds like you're getting excellent care and I'm sure things will all be sorted out for you soon. Your reaction is perfectly normal and I'm sure you know it will take awhile for everything to sink in. After that I think you're a strong woman who will do whatever it takes to beat this disease.
I'm also sorry to hear you're so young. I'm old enough to be your Mom and I wish I could be there to hug you and stroke your hair if it would make you feel better! It's good that you have kids to hug and kiss you and give you even more incentive to fight hard. Try to take one step at a time and try not to be overwhelmed by all the information being thrown at you. I hope your hubby can be with you to help keep track of what you're being told. I'm sure your parents and siblings will be as supportive as they can so please let them help you.
My thoughts and prayers will be with you as you start this journey. We'll all be here for you whenever you need information, support or just to vent. We hope you'll keep us updated if you wish to so we can rejoice with you at the end of this fight!
Hugs, ♥
nc
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Avatar_f_tn
Well, here is the final verdict: mastectomy of the left breast and pending genetic testing, possible mastectomy of my right. They want to start in two weeks, but I need more time. They're allowing me two months. I'm angry, sad, and really don't have much more to say.

Take care.

Tara
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Avatar_f_tn
Final verdict: mastectomy of left breast and possible right pending some sort of genetic test if it has a positive result.

Needless to say I am incredibly unhappy, angry, sad, and want to use excessive profanity.

Thank you for your support.

Tara
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25201_tn?1255584436
Of course you are feeling all those things right now; I think we have all been where you are now and somehow seemed to get "on top of things" after the initial shock and came out fighting the good fight. Time will help you come to terms with things as they are now and you will once again gain the strength to battle this dread disease. Isn't it odd that stats show that most mastectomies are on the Left ?? Some women prefer to sacrifice both breasts even without genetic testing but that is a personal decision on their part. The fact that cancer was found in a node I can certainly see that bilateral mastectomy might be considered rather seriously. Hang in there, kick, scream, curse or whatever helps ... it surely won't hurt and if it makes you feel better then DO IT !! As you know we'll be here to help in whatever way we can so please come back as often as you need to; we'll be waiting ....
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Avatar_f_tn
Tara, as japdip said, you go ahead and use all the words you want right now---you have every right. Try to get all the anger and frustration out now so you'll have the strength to fight like hell. Whatever choice you make will be the right one for you, but I can also understand the possibility of bilateral mastectomy. If that's the case, I'm sure you know that there are many options for reconstruction or you may decide not to do that. I think it's perfectly reasonable for you to want to have some time to explore all your options before you decide what's right for you. You just have to get all the information from your team (it sounds like you've got a good one) and trust your own judgement once you have the information you need. I know you're strong and you WILL find a way to fight this. Our thoughts are with you and we're here whenever or if ever you need us.
Hugs,♥
nc
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962875_tn?1314213636
Hi Tara,

Just wanted to say that I, too, am very sorry to hear that you have received this serious and disturbing report! It's certainly a lot to have to absorb...

However, since you  have lymph node involvement, as difficult as it may be, I do hope you'll be able to get to the point of feeling ready to begin treatment sooner than two months.

A retrospective analysis of breast cancer patients to determine the impact of delaying treatment 60 days after biopsy-confirmed diagnosis, found that for those with regional or distant spread, waiting longer than 60 days to initiate treatment was associated with poorer prognosis... (McLaughlin JM et al. J Clin Oncol 2012 Dec 20; 30:4493)

Wishing you all the best,
bluebutterfly

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Avatar_f_tn
I'm having a pitty party right now, so heads up.

My spouse thinks I am being selfish and b wordy now and that I need to think of the rest of my family. It was the worst thing I think I could have heard from anyone at this time.

To add, one of my biopsy sites near my areola isn't looking good. It was initially a small incision - maybe a quarter inch long, and now has a green scab on it the size of a quarter and slimy whitish on the outside not to mention my nipple hurts and the skin below the biopsy site looks so dry and starting to flake. The surgeon asked last week if I have a tape allergy to which I said no.

I now think I'm losing my mind and need to seek psychiatric help although I've promised my husband i would be stronger for the family. I came to my brother's house for a friendly attitude adjustment (you know, the inappropriate jokes that only families can do to open your eyes) and I thought it was working. But now it's 2:30 and I have to get up in three hours and I'm in mental, emotional, and physical (or is it just in my head?) Pain.

I just want my mother. Please tell me if I need to toughen up.

Thanks,

T
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962875_tn?1314213636
Hi again,

I agree, that was a terrible thing to hear from your spouse!

This is not the time that you are supposed to be "strong for your family;" this is the time your spouse and other family members should be trying  to be  strong for YOU--to provide  whatever physical and emotional help YOU need. And it's NOT considered  "a pitty party" when someone feels overwhelmed in reaction to being diagnosed with  a serious, possibly life-threatening, disease and having to make difficult treatment decisions.

You have suddenly been plunged into "crisis mode" by what is quite likely the greatest crisis you have had to face in your life. It may take  6 weeks or so for the shock to wear off enough for people to regain use of their normal coping mechanisms. Meanwhile, every emotion you've mentioned above, plus a host of  accompanying physical symptoms, and even fleeting thoughts of suicide are not uncommon. (If anyone has such thoughts on more than a fleeting basis, and esp. if there is considerations of plans, professional help definitely needs to be obtained.)  

Since you are apparently are not getting a lot of support and understanding from your family, you may need to find another source: possibly a friend whom you can trust to listen to your feelings in a nonjudgmental manner, a nurse navigator, a BC support group, or, if you feel you need mental health services right now, definitely go for it!

Meanwhile, we are here to help in whatever way we can...
bluebutterfly
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Avatar_f_tn
I really am sorry that you're having a tough time, especially with your hubby's comments. You have no need to apologize to anyone or feel like you need to be "tougher".  Your feelings are just your feelings and there is no good or bad. Everyone needs to find their own way to cope, so you do whatever you need to do to find YOUR way. The note from bb gives you some excellent advice, so I hope you'll take it to heart and follow her suggestions. I've learned over time here that she's a very knowledgable, informed and kind woman whose advice is always worth hearing and following. I really don't have much to add to it except my support for you and hopes that things will get better soon. We're here for you and we do care, so please let us know how you're doing if you wish.
Hugs,
nc
PS: I'm sure you'll be getting that biopsy site checked out if it doesn't improve shortly. I got a nasty rash from steri-strips with one of my biopsies and then nothing on the next one, so it can happen.
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Avatar_f_tn
Update: Bone scan and PET scan tomorrow and Friday. Reviewing PMH put up flags. Today's diet: one super sweet coffee this morning then a manly diet of steak, eggs, and any other form of dead animal. YUM!!!

surgery is tentatively scheduled for the 22. Boobie rebuild mid June. I want those suckers so perky that I can dress like an 18 year old without a bra!

Decided to turn the journal into an autobiography. ought to be juicy.

P.S.
Green gross thing stopped oozing and is just hard as a rock. I figure they're cutting the thing off so if it isn't infected I'm not too worried.

T
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Avatar_f_tn
Thanks for the update, Tara. I'm  sure hoping the bone scan and PET scan are negative. It's sounds like you're ready to move on and get the surgery over with. I hope all goes well for you and it's as easy as possible considering. I also hope your reconstruction gets you those perky boobs you're looking forward to! Some plastic surgeons can do really amazing work, so I hope your results are all that you hope for. It sounds like you're in a good place mentally and ready to fight your disease. Please let your family and friends help out and I hope they'll all be as supportive as they can for you. It's not an easy journey, but I hope you come through it to a better place in the end. We'll all be thinking of you and waiting for an update whenever you're ready to give one.
Hugs,
nc
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