How to Monitor after Surgery

[Jeanne-Poo]

I am 41 yrs old & premenopausal. Diagnosed with Stage 2 High Grade in-situ ductal & invasive ca. Had 2.2cm Grade 3/3 removed in Jan. ER=99%, PR=0%, HER2/Neu=3.4 Have very dense breast tissue. Mass didn't show on mammos/ultra snds. Had MRIs done showed addl "densities" in LFT and one in RT. Had LFT brst conserv. surgery - margins & nodes both clear. Surgeon scooped out breast tissue where other lumps were Path. report on this moderately extensive multifocal duct adenocarcinoma in situ high grade IDed within & away from prior bopsy site. Margins free. Am doing 6 treatments of chemo now w/ hormone therapy. Due to other masses found and that they can't be biopsied as they don't show on mammos/ultra snds, am planning to have Dbl Mastesct via TRAM.  My concern is tracking after all this. Will "new" breasts be easier to read? When I ask how dwe know chemo working am told will know when U are here in 5 years. All we'll do is mammos/ultra 2X year, blood work & chest x-rays 2X a year. Shldn't there be more? Seems like not enough with all I will have gone through. What about MRIs? CAT Scans? I've asked about a PET scan but they say alot of $ and can produce false results. That its better to get baseline with CAT Scans, etc. Have done CAT scan shows rnd mass on adrenal gland they believe is nonfunct. adenoma otherwise clear. Bone scan & brain scan clear.  Isn't there more I will be able to do to monitor for reoccurance?! Don't want to get blind sided again. I found orig. 2.2CM tumor via SBE. Had gone for Mammos regularly, even diagnostic 2X yr for begnin lump for 2 yrs didn't show.

[eamona]

Jeanne-Poo,

If you are going to have a bilateral mast. with reconstruction using your own tissue, have you considered the DIEP procedure instead of the TRAM?  It does not use the abdominal muscle, so there is less pain, and more importantly, no compromise with abdominal strength.  Only a few doctors highly skilled in microsurgery do it, but is worth looking into.  Look on the site www.diepflap.com for extensive info.  The best of luck to you whatever you decide.   KBA

[CCF-RN,MSN-JS]

Dear Jeanne, Follow-up of breast cancer, after surgery and adjuvant treatment, is usually pretty much as outlined by your oncologist.   Here we do bilateral mammograms after TRAM flap reconstruction, but this depends on the surgeon or oncologist

[surgeon]

I think your decision to go for mastectomies, given your pathology report, is a good one. As to followup: all of the breast tissue will be removed. What will replace it, except for some skin already there, will be tissue and skin from your abdomen. In other words, it's no longer breast tissue and, really, mammography isn't much of use any more. In fact, when it's done, it often shows scar tissue and even calcifications resulting from the surgery which can raise alarm. But it makes no more sense than getting mammograms of your belly tissue. Recurrance, were it to happen, would almost certainly be within the surrounding skin, and would be viewable and/or easily feelable. There are those that go on with mammography of reconstructed breast tissue; but in my opinion it raises more questions than it answers.

[Jeanne-Poo]

Thanks for the quick response!  Since my cancer is so hormonally (estrogen) driven and believe I was told by surgeon 80% of reocurrance happens elsewhere in body, I am concerned about ovarian cancer or cancer in uteurus (sp?). Any additional exams/tests I can do for more aggressive screening?