The knock of the knot –  A Breast Cancer Blog with Lacanian Angles Curves

Needlework and Syringes

Keeping my routines as normal as possible helped me prepare mentally and physically for the lumpectomy, which some sources call a partial mastectomy, excisional biopsy or breast-conserving surgery BCS. Clinicians regard BCS as the gold standard for early stage breast cancer treatment. Surgeons skilfully accomplish “acceptable” cosmetic outcomes by removing just enough breast tissue to achieve adequate surgical margins. My life was as busy as normal. This fake normality was fuelled by a creeping inner denial. At work I kept schtum maintaining a professional secrecy – apart from my over arching boss, work colleagues were in the dark. The only giveaway sign was my attitude, more positive, stiffly smiley, unusually chipper. I was the smile without the cat.

Three days before surgery an NHS letter arrived advising me as a woman of a certain age to come for a routine mammogram for early cancer detection. Eye roll. Despite our state of the art technology this monumental failure of “joined up working” perpetually creates these painfully ironic events. Action-reaction: I gave them a call to cancel and mentioned that for their records my breast was already being treated for cancer. The following day I received a phone call asking if I was still up for the op. That took me by surprise, I was astounded to discover that clearly there must be women who do a runner, change their minds or simply say no thanks to surgery.

At 8:30am the day before my surgery I was summoned to the hospital’s Nuclear Medicine Department to have the necessary radioactive injection. Preparing myself for the same intravenous syringes (in the arm or hand) problematic hidden veins were not permissible. I drank a ton of water and tried to keep my veins visible by arriving briskly on foot, wearing gloves and keeping warm with lots of hand/finger agility moves. The big surprise was discovering that the needle enters around the areola. Ouch!

With my arms bent obediently behind my head, the needle injecting the radioisotope was expertly entered several times. The nurse warned me that it would hurt. Its path was numbed by doses of lidocaine, a local anaesthetic. The eye on the needle steady as if measuring across the face of a clock. The expression “sharp scratch” was replaced by a trill anecdotal comment about how patients acquaint this pain to a “bee sting” – a formulaic “sound-bite” indeed, but painwise none of this needlework caused undue discomfort.

Imagining the pain and playing through worst case scenarios were par for the course but in-the-act going with the flow wasn’t too horrendous. It felt barbaric yes, the nurses injecting around such an intimate part in full light of day and then massaging down to ensure the radioactive liquid was absorbed. It felt bizarre and a tad torturous. But the huge bruises (on the back of my hand) from the cannulas, (needed for the breast MRi and bone scan) were more sore and a greater nuisance to every day life. Nerve healing zings of pain, a week after the three core needle biopsies from the breast, took the biscuit. These sudden unannounced debilitating zings of excruciating but momentary agony went on 24-7 for several weeks. But perhaps this is individual. Instead of pain, the greater trauma was from not knowing the details of procedures. This made me feel cumbersome and  “done to” a vulnerability shrouded by my own ignorance and heightened feelings of useless ineptitude.

As part of the lumpectomy procedure the surgical oncologist had explained that the radioisotope and blue dye injections were essential to locating the exact nodes for SNB (sentinel node biopsy). The injected nuclear fluid tracks around the lymph nodes which light up once the blue dye is absorbed. For a lumpectomy to be successful the clinical team must ensure that no tumour cells have infiltrated the lymphatic system. This is now the clinical standard of care replacing the more complex full axillary node dissection which more frequently exacerbated fluid build up and swelling in the arm called lymphodema. This condition is still a classed as a possible side effect. A set of simple thrice daily exercises are recommended to reduce the chances of accumulated fluids. http://www.lymphedivas.com/  is a phenomenal outlet for fashion compression sleeves. Their blog is informative too.

The detection and treatment of breast cancer is like a biological game of hide-and-seek. Deciding if cancer is present, how widely it has spread and how to remove it are all part of the algorithm. I could not feel my cancer, it was non-palpable. What I did feel was a normal cyst. The cancer did not show up on the mammogram. I have learned that mammograms have limitations. At present they provide two-dimensional images of the three-dimensional breast. Glandular tissue and tumours are similar in density and remain occult especially in women with dense breast tissue.

My cancer barely showed on the ultrasound as an area suspicious for malignancy tucked alongside the cyst. DCIS means the cancer is still contained within the ducts. The biopsy gave confirmation that my cancer has a name, it’s called IDC and tomorrow we’ll find out if it has spread to the lymph. Above is a diagram of the types of cells, assisting to verify the stage of cancer. I would love to see what these cells are really like. Daring to ask the surgeon to keep it for me, he asked if I’d like it in a jar. In earnest I nodded. He thought I was joking.