Not Quite Finished

It has been 2 weeks since my last radiation treatment and although my incision area is still quite red and recovering from blisters and peeling, I am doing well without having any regular appointments for treatments but I learned I am not completely done. My radiation oncologist, Dr. John Wilson had given be a script for a Lymphedema evaluation and treatment which will be 6 weeks from my last radiation and it is twice a week. So starting at the end of June, I will go twice a week at 4:30 pm to a specialist to treat and prevent symptoms of Lymphedema.  This will take me to almost the end of July. 

At first I was concerned that I would feel a little lost being on my own after so many weeks of being under close supervision, but I am actually relieved.  I have follow up appointments with both oncologist- I learned the one that gave me chemo is called a Medical Oncologist (Dr. Gor) and the other, of course, is called the Radiation Oncologist (Dr. Wilson). I see them both in June. 

I also feel relieved that I am not a failure because I could not make dietary changes while in treatment. I think I was overwhelmed and holding on tightly to what was familiar. So now, little by little, I will start to eliminate meat and add more grains to my diet. I reached out to Carol and Shari Hennes last evening and Carol will send me some recipes that Shari had given her over the years. This is a family where 3 people have had breast cancer- all 3 different types..... Mother, Father and Daughter. I am going to try. For awhile I was thinking I did not want to try to change because it felt too hard but now I feel ready to set a schedule for exercise and to cook on weekends and pick up on the easy recipes from Carol.  I am so afraid of disappointment from failure- it is the hardest courage I have to muster for changing my lifestyle habits. Wish me luck....... and I will take a few prayers on this task as well. 

Home Stretch

Well Monday is my last Radiation treatment. Underneath my left breast is slowly healing  and I have now peeled around the incision from the "Boost"  procedure.  I still have much to say as of today but I am not sure what I will be talking about in the future except that you can count on me for having something to say for sure. 

I do believe that I have fatigue although I am not certain I know what fatigue is. It seems that I can still push through exhaustion. I have been coming home from work or other activities and having to go right to bed- I can't think or function to do some routine things after a day at work. I become weary easily. I think they call it fatigue. I recognize that I am not sure  that I am suppose to stop. I believe that all those many months when I had my major depression and I experienced laden paralysis, I just pushed though the physical immobility. And now I am doing the same. Again - more disconnect from my body's signals that something is wrong and I need rest. 

There is a big brass bell in the waiting area at the radiation center that they ask people to ring 3 times when they are done. I will let you know now, I am not ringing it. I am still resistant to being part of the cancer community. You will likely not get invitations to join me on a fund raiser for breast cancer or any other kind. I kind of believe that cancer does not need me like some other causes that are closer to my heart. And I do not want to represent them.

I am grateful for the science that has helped me be treated and hopefully successfully. I am even more grateful for Shari, Maureen and Rona and all their wisdom and support. I am deeply appreciative of all the women who have gone before me and been saved from dying from this disease. I guess too, the fact that I work in the medical field has led me to distance myself  from the research community to solve problems of cause and treatment. I need to focus on the day to day challenges that face our patients and their families that come in for guidance. I need to keep my reservoir of energy and compassion full. My career demands that I have all that I need to give to those in need on their unfamiliar road.

Yesterday I went for a bone  dexascan as asked to do by Dr. Gor, my medical oncologist. The new hormone suppressing medication that I am now taking has possible side effects of weakening the bones.  So I got my baseline- I have also lost an inch of my height. I am now only 5' 4 1/2".  I used to be be 5' 5 1/2". While I was there I saw a friend who just learned that she needs a breast biopsy and she was scared.  So although I do not  want to step into the shoes of a crusader for cancer cure, I would provide comfort and information to anyone who is faces the challenges that I experienced. I did give her my number again and I hope she reaches out to me. It is important not to feel alone.  

I do have more to say but right now I need to go rest. I cannot type any more or sit up. Will write again as soon as I am up to it. 

Dexa scans are the most commonly used test to measure bone density. Your results from this test can be a great help for diagnosing your initial bone loss and for monitoring the effectiveness of your Osteopenia treatment plan. 

What are some common uses of the procedure?

DXA is most often used to diagnose osteoporosis, a condition that often affects women after menopause but may also be found in men and rarely in children. Osteoporosis involves a gradual loss of calcium, as well as structural changes, causing the bones to become thinner, more fragile and more likely to break.

DXA is also effective in tracking the effects of treatment for osteoporosis and other conditions that cause bone loss.

The DXA test can also assess an individual's risk for developing fractures. The risk of fracture is affected by age, body weight, history of prior fracture, family history of osteoporotic fractures and life style issues such as cigarette smoking and excessive alcohol consumption. These factors are taken into consideration when deciding if a patient needs therapy.

Bone density testing is strongly recommended if you:

• are a post-menopausal woman and not taking estrogen.
• have a personal or maternal history of hip fracture or smoking.
• are a post-menopausal woman who is tall (over 5 feet 7 inches) or thin (less than 125 pounds).
• are a man with clinical conditions associated with bone loss.
• use medications that are known to cause bone loss, including corticosteroids such as Prednisone, various anti-seizure medications such as Dilantin and certain barbiturates, or high-dose thyroid replacement drugs.
• have type 1 (formerly called juvenile or insulin-dependent) diabetes, liver disease, kidney disease or a family history of osteoporosis.
• have high bone turnover, which shows up in the form of excessive collagen in urine samples.
• have a thyroid condition, such as hyperthyroidism.
• have a parathyroid condition, such as hyperparathyroidism.
• have experienced a fracture after only mild trauma.
• have had x-ray evidence of vertebral fracture or other signs of osteoporosis.

Cancer is everywhere and comes in over 200 forms-

There are 7 risk factors for my type of breast cancer and I have 6 of the 7.

1)  I am over 50.   2)  I am obese.   3)  My breasts are dense.   4) I started menstruating at age 10 1/2 and completely finished at 54.   5)  I delivered my only child at age 36.   6)   I took birth control pills for over 30 years.   7)  Started at age 18 and until I was 53.         

Risk Factors

Doctors have established a genetic link in about 5% of breast cancer cases, so a family history of cancer can put one at risk. Other common factors include:

• Age: About 80% of breast cancers affect women over 50.
• Obesity: Women who have a body mass index (BMI) over 30 are more likely to develop cancer. The risk is even greater if the excess weight was gained after menopause.
• Early menstruation/late menopause: Women who got their periods before age 12, or enter menopause after 55, are more at risk of developing breast cancer. This may be because the breasts are exposed to estrogen for a longer period.
• Late pregnancy: Breast cancer is more common in women who have their first full-term pregnancy after age 30. It isn’t clear why, but studies show that early pregnancies may prevent the genetic mutations caused by estrogen exposure.
• Radiation exposure: Women who have received radiation treatments to the chest, particularly when during breast development, are more likely to get breast cancer later on.
• Medications: Women who have been on hormone therapy or birth control pills for four or more years have a higher risk of breast cancer.
• Breast density: Breasts are considered “dense” when there is a high ratio of tissue to fat. Women with dense breasts are more likely to get breast cancer, although doctors aren’t sure why.
•  

Cancer Types

Cancer is a class of diseases in which cells divide without control or order. The over-division of cells results in a structure known as a tumor. Not all tumors are cancerous. In order to be classified as a Cancer, a tumor must destroy adjacent tissues.

Non-cancerous (benign) tumors do not invade into surrounding tissues, and they do not spread to other parts of the body (metastasis).

There are more than 200 different types of cancer, each with a unique variety of signs and symptoms, diagnostic and staging features, and treatment options.

Most cancer types are subcategorized into a variety of oncology classifications. Learn more about theOncology Classifications of Cancer.

Cancer Symptoms

Cancer patients experience a wide variety of symptoms. Each cancer’s symptoms depend on the type and stage of the malignancy (cancerous growth), and the patient’s overall health. Some cancers produce no specific symptoms, underlining the importance of regular cancer screenings, as well as risk factor minimization. Learn more about the Symptoms of Cancer.

Cancer Stages

Cancer staging is determined by the size, location, and behavior of a cancer. A cancer’s “stage” is a descriptor, or identity (usually a Roman Numeral between I and IV) that influences the treatment and outlook (prognosis) of the cancer. Learn more about the Stages of Cancer.

Cancer Treatment

The various stages of cancer require unique treatment strategies. Treating late-stage cancers, for example, may involve a variety of therapies and treatment modalities aimed at reducing the cancer’s symptoms. Treating early-stage cancers, on the other hand, may involve a simple curative procedure.

Cancer treatment differs depending on the unique characteristics of each cancer and patient. The appropriate treatment strategy relies on a number of factors, including the type, size, and location of the cancer, as well as the patient’s medical history and overall health.

There are several standard treatment modalities available for cancer, such as chemotherapy, surgery, and radiation therapy. These treatment modalities are designed to complement an array of cancers and physical scenarios. Many cancer patients also incorporate alternative therapies into their cancer treatment plan. Talk to your doctor about the best treatment strategy for you. Learn more about Cancer Treatment

Breast Cancer

Breast Cancer is the second-leading cause of cancer death affecting North American women. Around the globe, breast cancer is the fifth-leading cause of cancer death. This disease also affects men, but breast cancer is diagnosed 100 times less frequently in men than it is in women.

Breast cancer develops when cells displaying uncontrolled growth, invasion, and/or metastasis arise in the breast. In conversational usage, the word “breast” is used to identify the part of a woman’s body that contains the mammary glands (glands that produce milk to feed infants). In medical usage, the word “breast” identifies the upper portion of the human torso.

Learn more about the symptoms of breast cancer, breast cancer stages and breast cancer treatment. You can also check out the National Breast Cancer Foundation for more info.

Men and women have breasts that arise from the same embryological tissue. During puberty, estrogen and other sex hormones promote breast development in females. As a result, the adult female breast is a more prominent structure than the male breast.

(See also: Breast Cancer Drugs, Breast Cancer Awareness Month, Breast Cancer Research, Breast Cancer Organizations and Breast Cancer Statistics)

Breast Cancer Risk Factors

Most risk factors associated with the various types of breast cancer, such as age and gender, cannot be avoided. Other risk factors, such as tobacco use, lack of exercise, and a poor diet, are the effects of lifestyle choices.

Breast cancer’s single greatest risk factor is being female. Other than this unavoidable quality, most breast cancers are diagnosed in the absence of any recognizable risk factors.

Common risk factors of breast cancer include:

• Gender: Women are almost 100 times more likely to develop this disease than men.
• Age: Approximately 80% of breast cancers occur in women over the age of 50. Women over the age of 85 have a 1 in 8 chance of developing the disease.
• Family History: If you have a mother, sister, or daughter who developed breast cancer before age 50, your chances of developing the disease are doubled. Statistics also indicate that your breast cancer risk is elevated if you have any extended relatives, male or female, who have been diagnosed with the disease. In spite of familial risks, most breast cancer diagnoses are attributed to random, non-inherited cancer.
• Radiation Exposure: One of the side effects of radiation treatment, or radiotherapy, is elevated cancer risk. This risk is more serious if you received the treatment during breast development (adolescence).
• Obesity: Statistics indicate that obese women are more likely to develop breast cancer than women of a healthy weight.
• Pregnancy Late in Life: Women who have their first full-term pregnancy after age 30 are more likely to develop breast cancer.
• No Pregnancy: Women who have never become pregnant are more likely to develop breast cancer.
• Ethnicity: Caucasian women develop more breast cancers than women of any other race or ethnicity. Black women, however, are the most likely to die as a result of breast cancer.
• Tobacco Use: Studies have produced mixed results regarding the link between breast cancer and smoking, but limiting your exposure to tobacco smoke will undoubtedly improve the quality of your health.
• Early Menstruation: Women who began menstruating before age 12 are more likely to develop breast cancer.
• Late Menopause: Women who enter menopause after age 55 are more likely to develop breast cancer.
• Birth Control: Some evidence suggests that breast cancer development may be related to the long-term use of birth control pills.
• Alcohol Consumption: Studies suggest that women who drink more than one alcoholic beverage per day are 20% more likely to develop breast cancer.
• Breast Density: Breasts that are described as “dense” can make breast cancer diagnosis more difficult. Dense breast tissue looks solid and white (similar to a tumor) in most imaging tests, such as an x-ray. Furthermore, dense breast tissue can be difficult to distinguish from a tumor during a mammogram.
• Hormone Therapy: Menopausal symptoms are often treated with a hormone combination of estrogen and progesterone. This hormone treatment may elevate your breast cancer risk.

Breast Cancer Outlook

The outlook for breast cancer patients depends on the size, location, and behavior of the tumor, as well as the patient’s overall health. Because breast cancer diagnoses are so common, it is one of the most deadly cancers affecting women around the world.
Approximately 88% of women diagnosed with breast cancer will live for ten years after the diagnosis. Learn more about breast cancer survival rates.

Breast Cancer Prevention

It is very difficult to prevent a disease that typically occurs in the absence of risk factors. Here are a few measures that may be observed to help prevent breast cancer:

• Consume Alcohol in Moderation: A clear link between alcohol consumption and breast cancer has been established. To reduce your risk, limit your alcohol consumption to one beverage per day.
• Diet and Exercise: Eat a balanced diet of fresh, colorful fruits and vegetables, as well as meats that are low in fats and nitrates. Find an exercise routine that complements your body and schedule. Healthy diet and exercise will reduce breast cancer risk and improve your overall health.
• Cook with Olive Oil: Olive oils primary component, oleic acid, has been shown to suppress the development of breast cancer. Oleic acid also supports the effectiveness of many anti-cancer drugs.
• Preventive Surgery: This is an extreme measure designed to complement high-risk women:
• Prophylactic Mastectomy: This is the surgical removal of one or both breasts. This option is worthy of consideration if you have already had cancer in one breast or you have received results from genetic tests that indicate a high-level of breast cancer risk.
• Prophylactic Oophorectomy: This is the surgical removal of the ovaries. Typically, this procedure is used to prevent or treat ovarian cancer, but it also reduces breast cancer risk.
• Chemoprevention: A class of drugs known as selective estrogen receptor modulators (SERMs) has been shown to reduce breast cancer risk in high-risk women. Examples of these drugs include Tamoxifen (Nolvadex) and Raloxifene (Evista).

Ductal, Lobular & Medullary Neoplasms

Ductal, lobular, and medullary neoplasms are three of the main types of breast cancer.

Unlike most cancers, they are differentiated according to location rather than the cell or tissue type. Each one develops differently and has a different prognosis and treatment.

The most common type is ductal cancer, which occurs in the lining of the milk ducts. This cancer occurs in two forms: ductal carcinoma in situ (DCIS), which is confined to the milk ducts; and infiltrating ductal carcinoma (IDC), which invades the surrounding tissue. Ductal cancers account for 70% of all cancer cases.

Lobular cancers occur in the lobules, the small sacs containing milk-producing glands. Like IDC, it can spread to surrounding tissue and eventually to other organs. Because the lobules are located deeper in the breast, lobular cancers are harder to detect in traditional mammograms.

Medullary cancers account for about 5% of cases. They are technically a type of IDC, but are differentiated because they resemble a part of the brain called the medulla. These cancers can be hard to detect in the early stages, but since they are slow-growing, they usually have a better prognosis than other invasive types.

Risk Factors

Doctors have established a genetic link in about 5% of breast cancer cases, so a family history of cancer can put one at risk. Other common factors include:

• Age: About 80% of breast cancers affect women over 50.
• Obesity: Women who have a body mass index (BMI) over 30 are more likely to develop cancer. The risk is even greater if the excess weight was gained after menopause.
• Early menstruation/late menopause: Women who got their periods before age 12, or enter menopause after 55, are more at risk of developing breast cancer. This may be because the breasts are exposed to estrogen for a longer period.
• Late pregnancy: Breast cancer is more common in women who have their first full-term pregnancy after age 30. It isn’t clear why, but studies show that early pregnancies may prevent the genetic mutations caused by estrogen exposure.
• Radiation exposure: Women who have received radiation treatments to the chest, particularly when during breast development, are more likely to get breast cancer later on.
• Medications: Women who have been on hormone therapy or birth control pills for four or more years have a higher risk of breast cancer.
• Breast density: Breasts are considered “dense” when there is a high ratio of tissue to fat. Women with dense breasts are more likely to get breast cancer, although doctors aren’t sure why.

Signs and Symptoms

The first sign of breast cancer is usually a painless lump or thickening in the breast. However, when the tumor cannot be physically felt, symptoms usually appear in the later stages. Advanced symptoms include:

• A clear or tainted discharge from the nipple
• Retraction of the nipple
• Reddening of the skin over the breast
• A change in the breast’s contour or texture

Diagnosis and Staging

Many breast lumps can be detected with a self-examination called the palpation technique, which involves feeling for lumps in and around the breasts. A similar method is used in clinical exams for initial screening. When a lump is felt, the doctor uses X-ray mammography, CT and MRI scans, or other imaging techniques to get a better look at the mass.

When possible, invasive biopsies are avoided using a new method called ultrasound computed tomography. This system uses sound waves to create 3D images of the breast, showing a better picture of the tumor. If the results are unclear, however, a needle biopsy may still be performed to confirm the cancer.

After the diagnosis, the next step is determining the extent or stage of the cancer. The stages are as follows:

Stage 0: The cancer is still confined to the tissues or ducts, as is the case with DCIS
Stage I: The tumor is larger, but has not spread to the surrounding tissues and axillary (underarm) lymph nodes
Stage IIA: The tumor has grown to 2cm to 5cm, but has not affected any lymph nodes
Stage IIB: The tumor has spread to one to four lymph nodes, but is still within the 5cm limit
Stage IIIA: The tumor is greater than 5cm and has affected four or more lymph nodes
Stage IIIB: The cancer has affected four to 10 lymph nodes and has penetrated the skin or chest wall
Stage IIIC: More than 10 lymph nodes have been affected
Stage IV: The cancer has spread beyond the breast to distant organs, such as the lungs and liver

Prognosis

The prognosis depends on several factors, but the most important are the location, tumor size, and stage. Invasive ductal and lobular cancers usually have poor prognosis, because they grow faster and are more likely to spread. DCIS and medullary cancers have the highest survival rates.

Treatment

Surgery is the treatment of choice for most types of breast cancer. New technologies have allowed surgical removal of the tumor while minimizing damage to the breast structure. Types of surgery include the following:

• Lumpectomy: only the lump and part of the surrounding normal tissue are removed. This is used for small early-stage tumors that have not spread.
• Partial mastectomy: the doctor removes the tumor, surrounding breast tissue, and some of the underlying chest muscles.
• Simple mastectomy: all of the breast tissue is removed, including the skin, fatty tissue, and milk ducts. This is used for invasive ductal and lobular cancers.
• Modified radical mastectomy: the entire breast is removed, along with some underarm lymph nodes. Unlike radical mastectomy, the chest muscles are left intact, making it possible to reconstruct the breast.

Most surgeries are followed by radiation therapy, a series of treatments involving high-energy X-rays. The rays kill remaining cancer cells and shrink the remaining tumor, if any. Chemotherapy is also used in late stage cancers, where the tumor has spread to distant organs.

Because the cancer first spreads to the axillary lymph nodes, most women also undergo a sentinel lymph node biopsy to check for metastasis after surgery. If cancer is detected in the lymph nodes, the doctor performs an axillary lymph node dissection (removal of the affected lymph nodes) to prevent further spread.

Prevention

The best way to prevent breast cancer is regular mammography, especially for women over age 50. Most risk factors, such as drinking, smoking, and obesity, are easily avoided, so a lifestyle change can greatly lower one’s risk.

If a patient has one or more non-controllable factors (such as age and genetic predisposition), the doctor may suggest clinical procedures to lower the risk. The most common is “chemoprevention,” which involves a class of drugs known as selective estrogen receptor modulators (SERMs). These drugs control the body’s production of estrogen, which is believed to be a major factor in cancer development.

Where Is My Body? Which Body Is Mine? What A Good Body! And I Love You !

Just took an evening shower and was wondering where my body went- this one is as confused and lost as the May weather is- I am in relation with a strange body- Hair filling in slowly on top of my head, hair growing under one arm and not the other, raw and red is my left breast especially underneath. New cream added for all the areas pealing and inflamed. Prickly stubbles across my belly......I am trans in a whole new way. New medication added to swallow every day for 5 years. 6 more radiation treatments to the sight of the incision. Then I wait another 6 weeks to met with a lymphedema specialist and get fitted for a sleeve for air travel.
I always struggled to stay connected to my body ..... now it is even harder. Me living inside a body that has--- had Cancer......    And I have had so many different bodies over the years. I have weighed anywhere from 137 (only when I was so sick with major clinical depression mind you) to my high which is now at 250.  For most of my adult life though I hung out between 154 and 162. My prize for loosing 80 lbs. Thank you Dr. Al Stunkard and Trevose Behavior Modification.
I want so much to take better care of myself and it is so deeply complex. Next week I meet with my own counselor again. Maybe it is not too late to find my way to a new and better body even with all the scars and reminders of breast cancer.....  we can transition ourselves in becoming a healthier and stronger me.   I say WE because I know it will take the cooperation, discipline and dedication of all of me to get this deviation on the right road.   It will be the better parts of me that will need to dominate the lower parts. Summoning those better parts takes energy and mindfulness that is focused and determined. I know what it takes as I have done it twice before. This time - so much more is at stake and I feel under-motivated. Maybe as my body heals, and I feel well rested again, like I did on the cruise, I can become interested. I walked on the cruise, even hiked and swam. It was all so lovely. No stress. No demands and responsibilities. Nothing like real life- I guess that is why they call it a vacation. 

Up to 25 percent of breast cancer patients whose surgery includes removal of lymph nodes in the area of the armpit eventually develop lymphedema. The condition can also occur in the legs or other parts of the body if lymph nodes are removed in the course of other types of surgery - for melanoma, colon, prostate or bladder cancer, for example - or are damaged by radiation treatment, infection or trauma. Symptoms include swelling and pain near the site of the removed or damaged lymph nodes. Lymphedema can occur immediately after radiation therapy or surgery, or weeks, months, and even years later.

http://www.med.upenn.edu/weightloss/stunkard.html

All gene tests are Negative

It is late and tomorrow I leave for a 3 day New Jersey Annual Social Work conference in Atlantic City. I will leave the conference a little early on Tuesday afternoon to rush back for a treatment of radiation at 4 pm. The great news is that my course of treatment can remain unchanged because I have no genes currently linked to cancer--- breast, ovarian, lung, colon or stomach-all came back NEGATIVE.  And I will start my estrogen lowering medication on Cinco de Mayo- Dr. Gor said that I should start the medication on a memorable easy date to remember as I will stop it 5 years from the exact date I start.  And since I was traveling- May 1st did not seem reasonable so I went the next best thing. 

I just returned from 2 full days with several of my college buddies. Lunch, Spa treatments, cocktails and conversation, dinner, train into Manhattan, great Mexican lunch and Margaritas at Toloache and then "CHICAGO" on Broadway- and a very slow train ride home to Caren's. 2 hours later, I pulled into my driveway to unpack and repack to leave in the morning for AC at 830 am.   I am so looking forward to time with myself and strangers I have no yet met. 

Good Night and Sweet Dreams You All.

Friday Is A Big Day AND I Am Getting A "Boost"

Friday is a big day.  At 7:15 am I start my day by seeing my chemotherapy oncologist, Dr. Gor- Then I leave to go to radiation around 8 am- Then I will see my radiation oncologist, Dr. Wilson. By 8:45 I will be going upstairs to Genetics and getting my testing results.  One would think that there was something wrong with me with all these medical visits and treatments. I keep going in and out of belief. Almost like I was a kid, pulling petals off a flower- "He loves me, he loves me not, he loves me, he loves me not". "I am sick, I am not sick, I am sick, I am not sick" Not sure what to think anymore. I want to get as much information as I can from Dr. Gor on Friday and make sure she tells me everything she knows about me and my breast cancer. From what I understand now, she and I are going to be connected for a very long time. Thank goodness, the genetic results ought to be rather straight forward.

Then I am going to get my nails done and head up north to my friend Caren's house. Maryann and Vickie and I are spending the day together with Caren....Lunch at Caren's- Spa afternoon--Dinner out. (I think I might have my first drink before Noon). The 4 of us have known each other since 1974---- 42 years. There are 2 other great friends from that time period. Jan- she has to work - she is a teacher of Art down in Asbury Park.....and the other Nancy. I will miss them both on Friday.  Nancy was not invited because she has drifted away from us "girls" so to speak. If I had my way, she would be included. I still want everyone to be together regardless of how relationships shift as I am not one to let go easily in relationships.  Thank goodness for my friends- they really help keep me together. I feel loved and valued. And I count on them for plain FUN- The next day, 3 of us are going into Manhattan to see a matinee show and have an early dinner. Then I will be coming home to get ready to go to Atlantic City for the  New Jersey Social Work Annual Conference- I really am looking forward to some alone time.

It is hard for me to have all of my feelings when I need to be concerned about other people's reaction. While I am alone, I can sort through my thoughts and emotions without judgment or fear. At the suggestion of another long - time friend and colleague, Rona, I made an appointment to talk to someone whom I used to see a year ago.  At the very least, it will provide me with safety and maybe help me get a better perspective on living well with a cancer diagnosis.

Today at Radiation, I learned I am getting a "BOOST"- An in depth explanation is written below but basically, it targets the area of the lumpectomy to "boost" my survival rate and kill off cancer cells surrounding the surgical site.  So I now have an extra tattoo and a big black mark around my surgical incision- I will wash it off tomorrow morning. Good night everyone, and sweet dreams.

A Radiation Boost - "A Little Extra" At The End of Radiation

Early-stage breast cancer is often treated with a lumpectomy or mastectomy and radiation therapy. Even though the tumor may have been small and no metastases were found, women and their doctors still look for ways to prevent a recurrence. The technique of giving a radiation boost at the end of treatment has been very effective in keeping breast cancer from coming back.

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A radiation boost is one or more extra treatments targeted at the tumor bed.  This extra dose covers a small area and affects the tissue where cancer is most likely to return. Radiation boost treatments are given after the regular sessions of radiation are complete. Women who are 40 years old or younger at time of treatment get the most benefit from a radiation boost, but patients of all ages will have a lower risk of recurrence if they receive a booster treatment.

How is a Radiation Boost Given?

Breast cancer patients may have whole breast radiation (WBI) or partial breast radiation (given with external beams or brachytherapy), after which boost doses are given. If you're having a lumpectomy and are planning on radiation, surgical clips may be placed at the time of surgery, to help your radiation oncology team target your tumor bed during treatment. Your boost dose may be given with external radiation, via interstitial catheters, or from within a brachytherapy applicator.

The targeted boost dose may be given in one session, or during five to seven daily sessions.

Effect of Risk of Recurrence with Early Stage Breast Cancer

After being diagnosed with breast cancer, the first decision you may face is whether to have a lumpectomy or a mastectomy. You have to weigh that decision with the fact that breast cancer is most likely to recur in the same breast, right at the tumor site.

Many women opt to remove the whole breast, in hopes of never having breast cancer come back. A radiation boost is designed to prevent recurrence at the tumor site, even after a lumpectomy. Research has shown that women who had a radiation boost had fewer local recurrences - up to 50% less - when compared to those patients who didn't have the boost. Doctors hope that, because of better radiation techniques, more women will be able to choose lumpectomy over a mastectomy, and have a better quality of life after treatment.

For patients diagnosed with early stage breast cancer, either ductal carcinoma in situ(DCIS) or invasive breast cancer, a radiation boost protects against recurrence. Most patients who have a lumpectomy will qualify for radiation with a boost, and in some rare cases, mastectomy patients may also have radiation and the boost. There is some disagreement among radiation oncologists as to whether or not a radiation boost really benefits a patient diagnosed with DCIS, but it has become the standard of care.

  It's thought that a radiation boost may decrease the need to have a mastectomy due to recurrence after a lumpectomy by 35%.

Effect on Survival

Even though a radiation boost significantly reduced the risk of breast cancer recurrence, it did not appear to have any effect on overall survival up to 20 years out.  This does not mean that a radiation boost was ineffective, as concerns in addition to survival are important for people to consider during treatment.

Side Effects of Radiation Boost

A radiation boost is generally tolerated quite well, with fatigue being the most common symptom as with conventional radiation treatments.

A radiation boost does not appear to raise the risk of complications of radiation therapy, such as infection, and did not increase the risk of secondary cancers related to the extra radiation.  Secondary cancers are cancers that arise due to the cancer causing effects of cancer treatments such as radiation.

Fibrosis is the most significant side effect of a radiation boost and radiation fibrosis can be quite annoying.  Studies have found that at 5 years, as well as at 10, 15, and 20 years post radiation boost, the risk of breast fibrosis is substantial.  Thankfully this risk is often less of a concern for younger patients.

Okay Okay I Get It- I Am Not Dying.

Okay Okay I get it- I am not dying.

I was just expressing my emotions and where I am in my process. I have been in other places than this during this experience and I am a very emotional human being - things effect me deeply. My life seems short as much of what I wanted to experience I have not done yet.... some of those things seem important. Especially since I gave up so many others things that I once wanted- I finally found a way to not suffer about what I do not have in life by not wanting what I do not have.  I used to hope for a husband who loves me and whom I love, a life time partner or a larger immediate family of my own, or enough money in the bank to repair my home and cars, I have no new furniture- it is all hand-me-downs. My appliances are as old as my home. - almost 35 years old. I have to do it all by myself- it is hard to keep pushing through it all including Cancer. The process has been long and I am tired of it. For the last 20 plus years, my daughter came first- she needed my energy and my resources to give her a head start in every way I could. And when I look at her, I know I did right by her and hopefully she won't be sitting one day in a therapist's office telling them how she felt abandoned or smothered by her mother....that I was someone she could go to for comfort no matter what. That I let her live her own life and I always believed in her.   It just took so much time, effort, commitment, to accomplish that. I want time for me now.

I also think some of this reflection is the aging process. I am looking back over my life, even just the last 25 years and it has always been hard.  My breaks have only lasted a year or 2 but usually much less. I was almost out of debt and then I went and purchased a new used car for $10,000 which I am making payments on to 2 different sources over the next 2 years. My others cars are over 14 years old and I needed a newer car.  I feel so squeezed to just live my life and now Cancer. I am the happiest person I know who lives a life with struggles. I promise I will be okay again soon.  Just let me have my sadness and my thoughts for now.