Facing The Verdict

"How long can I possibly delay the procedure?" I inquired. "Two weeks" came the reply. "You mean there's no putting this aside til next year? " I asked pensively. " No. Two weeks tops", she reiterated.

Finally, after months of living as a worrywart, I have reluctantly gathered enough courage to face my fears. I came to see a surgeon yesterday morning. Not the kind who would grant my fervent hopes of "upgrading" my physical attributes but a surgeon who would help me address my current health concerns, a cancer surgeon. So all you my friends could stop nagging me now about me being oblivious to an impending life threat, me foolishly not using my medical background to handle the situation and me being the coward who cannot confront her issues head on. It seems hitting rock bottom is the only way to wake me up from my sick sense of complacency.

Last week, my co-resident was restlessly musing about the lump she recently palpated on her breast. She couldn't wait to have it excised. Worrying consumed her too much that she wasn't able to sleep the whole night of our duty. I offered, "doc, actually I have lumps on my breast too. It has been here for months and it's getting larger and fixated by the day that it occupies almost the entire left breast." Initially, she thought I was pulling off a joke trying to make her feel better. The minute she realized I was serious, dead silence filled the room. "Why aren't you doing anything about it?" she asked worriedly. " Coz I don't see myself living that long, doc. I may do something about this now but predictably this will recur after 10 years or so. I don't want to prolong the agony. I'm tired. " I realized how my argument sounded kinda twisted, and all she could say was, "Goodness, what is wrong with you, Grace?"

About 7 years ago, I went under the knife already. That time I had no doubt it was just some benign growth my left breast harbored. Although I was still in med school with relative naivete to the disease processes than I am now as a full-pledged physician, I didn't see it as a serious threat. After all, the mass, though there were 2 of them, didn't exceed 2.5 cm and were movable, typical of a benign growth. Truly, as it turned out by pathologic studies, were fibroadenoma. Breast cancer patients at that time followed the age prevalence patterns with more than 80% of cases occurring in women over 50 years old. Times have changed. Now, it is not unusual to be hearing reported cases of breast cancer in women as young as 26 years old.

Four years ago, I felt a lump on my left breast again, same in consistency with the previous lumps excised. Since it was not causing pain, and I was certain that it was another case of fibroadenoma based on clinical findings, there was no indication for its removal. Six months ago, as I was watching breast cancer awareness programs on tv, I decided to examine my problematic breast. I was alarmed to find out that I grew another set of mass in the same breast, this time fixated and larger. I knew something was wrong. I was bothered but I brushed it aside. I was starting my radiology residency soon and nothing should get in the way of that. Contrary to what others think that I am apathetic of my condition, I was bursting into tears everytime I thought about it. I spent sleepless nights wondering if this was the end of me, if the life I have lived so far was meaningful enough, or if it was only wrapped up in inanities that I often subject myself .

I wasn't scared of death. I was scared of the process one has to go through before culminating in it. With the recent treatment modalities available for breast cancer, survival rates are higher.. for a given span of time at least. Death was out of the question. I knew I'd still live, even if this turns out malignant. It's one curable type of cancer, when given immediate attention. I was terrified of having to go through surgery, chemotherapy and all the treatments that's gonna hurt. I was scared of pain. I always was. So I delayed intervention to my problem hoping it would just go away. But then it didn't. In fact, it worsened. The thought of dealing with ulcerating mass that stinks and and its spread to other organs is tormenting enough. Benign or malignant, I was finally pushed to do something about it.

My doctor is a female surgeon who went through the hell of breast ca herself. Based on her clinical findings, my present mass has got to be cystosarcoma phyllodes, a rare type of breast tumor characterized by its rapid growth. Despite its ominous sounding name, it's classified under benign. The online management of breast diseases describes it as follows:

The malignant counterpart of fibroadenoma is cystosarcoma phyllodes or the newer term of phyllodes tumor, in which the epithelial elements are benign, but the stromal tissue is malignant. It results from malignant degeneration of fibroadenoma, estimated to occur in 1% of patients, who have fibroadenoma for many years. At presentation, most women are between 40 and 50 years with a typical presentation of a rapidly growing mass.

The clinical behavior of phyllodes tumor is unpredictable. The majority of phyllodes tumors are local problems and do not metastasize. Less than 20% of phyllodes tumors metastasize by vascular spread, most commonly to the lung, pleura, and bone. Thus, lymph node dissection is not indicated. Local recurrence is likely, if incompletely excised. Therefore, a wide local excision is required.

Some recent studies have attempted to separate cystosarcoma phyllodes into benign and malignant groups. The benign group is characterized by smooth, non-infiltrative borders and the fibrous elements have minimal nuclear atypia and low mitotic activity. This is in contrast to infiltrative borders , presence of nuclear atypia and increased mitotic activity usually greater than five mitotic figures per 10 high power fields in the malignant group. It should be mentioned that not all metastatic phyllodes tumors meet the above criteria. Thus, it is more appropriate to classify the phyllodes tumors into low and high grades and to treat these tumors with wide clear margins.

Given the size of my mass occupying almost my entire (albeit minute, yeah humor me) left breast, the procedure to be done (lumpectomy) will be something short of mastectomy, granted that this is truly benign. It differs from mastectomy in that the axillary tail of lymph nodes, nipple and skin will be spared. My surgeon pointed out that the erythematous portion of my skin will be excised though. Fate has a nasty sense of humor. It's taking away a part of me that is practically non-existent to start with. It shouldn't bother me to have my left breast taken. As Mama Fe and Snow taunted, "okay lang yan, wala namang difference kung mawala eh". Some kind of friends you are. I honestly don't know it's possible impact on me as a woman or as a person. I'm still currently awaiting the fine needle aspiration biopsy result. However the result turns out, benign or malignant, it's definite that my left breast has to go and that I will be intubated, a procedure I frequently did to critical patients but I wished would never be done on me. Malignancy on the other hand assures that I 'll have to go through not only that but chemotheraphy as well. Translation- bye bye long locks and more.

While Mama Fe is going through a depression these days out of the pressures of her work, I am enjoying my job but have to take a break to be cured. I know everything will be okay. Prayers have worked wonders for me time and again. Everything happens for a reason. Everytime I talk about this with friends, I drop the subject the moment my eyes start filling with tears. I just can't go on. ..I can't let them enjoy the view of me looking despicably ugly when I cry.