After many years of having abnormal mammograms because of fibrocystic breast diease the feared cancer diagnosis finally came. My journey began on February 14, 2005 (Valentine's Day) with a stereotactic breast biopsy after my usual abnormal mammogram. The biopsy revealed DCIS with a micro invasion. Receiving this diagnosis from Dr. Kerrigan, my surgeon was quite shocking and extremely alarming. I remember feeling both panicked and numb. Dr. Kerrigan outlined for me what my surgical and non-surgical options and probable treatment plan would be - lumpectomy with Sentinel Lymph Node (SLN) biopsy followed by 6 to 7 weeks of radiation and 5 years of Aromatase Inhibitors. So the surgery was scheduled.
Immediately I began the "crash course" on breast cancer. The information seems different when you're learning it for personal reasons instead of how I had learned it in nursing school. All that I read confirmed that Dr. Kerrigan had set out on an appropriate course of treatment for me. I proceeded with the scheduled lumpectomy and SLN surgery. At my post-surgical visit with Dr. Kerrigan he told me that the lumpectomy had removed all of the cancer, I had clear margins on all sides and my lymph nodes were negative (big sigh of relief). He also told me about a relatively new treatment that was being done on early breast cancers such as mine. The new procedure, Mammosite RTS (radiation therapy system) places a treatment catheter inside the breast to deliver the radiation internally as opposed to the traditional external whole breast radiation. According to the American Society of Breast surgeons, in order to be a candidate for Mammosite RTS the following criteria must be met:
• Age > 50 years old
• Invasive ductal carcinoma or ductal carcinoma in situ
• Total tumor size (invasive and DCIS) less than or equal to 2 cm in size
• Negative microscopic surgical margins of at least 2 mm in all directions
• Axillary lymph node/sentinel lymph node negative
I met each of the criteria, it seemed this treatment was tailor made for me. Dr. Kerrigan had conferred with Dr. Edwards the radiation oncologist I had chosen and they both agreed that I met the criteria and would be a good candidate.
I had never heard of Mammosite RTS, so again I began the "crash course" to learn more. The more I found out, the more excited I became about this as a treatment option. According to current data, Mammosite RTS compared to external whole breast radiation yields the same results as far as recurrence rates. However, Mammosite RTS is less irritating to the surrounding tissue, concentrates the radiation in the most probable site for a cancer recurrence and of course is more convenient. This is definitely a factor for people who live a distance from the treatment center and have families or careers to consider. For me, I liked the idea of fewer side effects and preservation of healthy tissue.
To have Mammosite RTS I would have to have a similar surgery to what I had just had in order to insert the Mammosite catheter into the lumpectomy cavity, so the surgery was done and the catheter placed. The catheter was inflated with fluid and remained in place for the treatment period. The catheter was positioned so that it exited my breast on the outer side almost under my arm, making it very easy to secure and keep out of the way by tucking it into the side of my bra.
The day after surgery I went for the planning session with Dr. Edwards and his team in Radiation Oncology. During this session I had a CT scan to measure the size and position of the catheter balloon in my breast. From this they determined how far to insert the radioactive seed and how long to leave it in.
Each treatment began by getting a new CT scan to confirm the balloon was unchanged. Then the catheter was hooked to a loading machine which inserted the wire containing the radioactive seed through the catheter and into the balloon. The wire with the seed stayed in place for about 9 minutes and then was removed by the machine. After the wire was removed, Dr. Edwards and his team would check everything and cap the catheter and I was sent on my way. The second treatment for the day was done 6 hours later. Between treatments I was fine to resume normal life. I walked for exercise, drove, cooked (not much) shopped (a lot) and did just about anything but heavy lifting and repetitive motion with my arms. I experienced no side effects during the five days (ten treatments) of therapy. There is the potential for some skin changes and irritation, but I have not experience any of these symptoms.
Now, the treatments are behind and life is returning to normal. As I reflect I realize how thankful I am to God for my wonderful doctors, David Kerrigan and Scott Edwards for being aware of this cutting edge treatment in breast cancer. I am also very thankful to the Cancer Center at Peninsuala Regional Medical Center for being able to do the treatment locally. It has meant a great deal to me to be able to stay close to home, to my family and my support system during this stressful time. What a great team we have right here on the shore!
Written by Dawn Denton for our September 2005 Newsletter
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