6/19/19: My NP Called Me

My NP called this morning, as promised.

Every time someone from the Breast Center calls, it's a different number. But now I know to pick up just in case.

I had prepared a list of questions in advance. The NP had me ask my questions first, but in this post, I think it makes more sense to describe important information first.

I have my appointment with the breast surgeon next Friday. I'll have my husband go with me to that appointment.

The NP said the surgeon would likely recommend a mastectomy.

She said she spoke with the surgeon about my case. The cancer being in 2 locations, in 2 quadrants of the breast, is complicating. Usually, when the cancer is in one location, they surgically remove the tumor, then treat the location with radiation to reduce the chances of recurrence. I guess the radiation is targeted to the specific location of the cancer, and it's not an option if there are 2 locations. I wasn't clear on why not, but I found this site that lists radiation as an option if the cancer is "located in one site."

Additionally, the second lump being so close to the nipple is also complicating. She said because of this location, breast-conserving surgery doesn't provide a good option cosmetically. 

She said she would also make an appointment for me with a plastic surgeon to discuss breast reconstruction surgery. We will have to drive to the main hospital in the city for that appointment. At this point, I'm not sure how I feel about breast reconstruction surgery, but I figure it makes sense to meet with the plastic surgeon to learn about the process and what my options are.

Other things we talked about during the phone call:

I asked for clarification regarding the first lump. She said the lump itself is a sebaceous cyst, and the cancer is behind it. The cancer showed up as a "shadow" on the ultrasound, so it looked like maybe the cyst had ruptured, but it turned out to be "not related." I'm still not fully clear on it, but it seems like it's just a coincidence that the cyst happened to appear in front of the cancer.

And the second lump? It's a cancerous tumor. She called my case "multifocal" because there is more than one lump, but when I Googled it, I think maybe she meant "multicentric" because she was clear that my 2 lumps are in different quadrants. I'm not sure if having multicentric cancer is automatically worse than having unifocal cancer, but it can't be better. (In Googling "multicentric breast cancer", it does appear that a mastectomy is the typical course of action.)

The NP said that when there are multiple tumors, they evaluate the cancer based on individual tumor size; they don't add up all the tumors for a total size. She referred to my tumors as "small," and she said having the 2 locations doesn't necessarily mean the cancer is more advanced. I guess that's reassuring. 

I asked if they could tell what type of cancer it is, and what stage? She said they are still waiting on the receptor testing. And they will have a much clearer picture after surgery. During surgery they will look at the lymph nodes (something about a dye, and a biopsy) because apparently if breast cancer spreads, it will spread to the lymph nodes first. She did say that my lymph nodes "looked okay" on the MRI, so that's a "good sign."

Finally, I told my NP that I had read online that it takes about 2-5 years for breast cancer to grow big enough to be palpable. So understanding that my body has already hosted this cancer for a while, is there anything I can or should be doing now that I've been diagnosed? She said the only lifestyle recommendations are regular exercise and a healthy diet.

6/4/19: NP Appointment

After the MRI, I headed over to the Breast Center.

Since "my" NP (the one who saw me initially) was not in the office that day, I was seen by a different NP. She gave me a lot of good information, so I'm glad I had this appointment after all.

Mostly, the NP reassured me that bruises and sebaceous cysts can appear anywhere on the body, and I just happened to get them on my breast. The bruise itself looked like a regular bruise. Why did it appear? Who knows. Maybe I put weight on it in just a certain position while sleeping. The bruise would just have to run its course, which means it might get worse and change lots of colors before getting better. 

She assured me that the area was not infected. Symptoms of an infection would include redness, pain, and a fever. 

She also explained that using a warm compress mostly helps to encourage the cyst to drain, but since neither of my lumps had any kind of opening in the skin from which to drain, there was probably no reason to do it, unless I felt it relieved some discomfort. 

She said if the cyst drained, that would be a good thing. Surgical removal was an option, but the entire "sac" would have to be removed, or else it would likely just return again. If the cyst isn't actually causing any problems, it's usually best to just leave it alone.

I mentioned that the bruise was becoming more painful as the day went on. The NP suggested I wear a supportive bra. (Back at home, I pulled out my most supportive bra and wore it for the next several days, even while sleeping. It really did help relieve the pain quite a bit.)

Finally, the NP took a photo of my bruised lump to show my regular NP. I wish I had thought to take a photo, too, for my own records. But I didn't.

5/16/19: NP Appointment

If you remember, I am actually writing these posts in retrospect. I am writing this post on June 15, and by now I have been to the Breast Center a number of times. I have to say, everyone I have interacted with at the Breast Center has been amazingly kind, professional, and helpful. You figure it probably takes a certain kind of person to work at a place where they mostly deal with patients who have or might have cancer. These are women who are all really good at their jobs, and I appreciate them so much.

So anyway. The Breast Center NP confirmed my two lumps are easily palpable. 

Regarding my first lump, she reassured me that sebaceous cysts can occur anywhere on the body, and I just happened to get one on my breast. 

She said the second lump felt similar to the first lump, but since we can't assume anything, we need to take the next step to figure out what the second lump is. After a mammogram and ultrasound, the next step is to get an MRI. 

The NP explained that MRIs require pre-authorization from my health insurance. The Breast Center would take care of obtaining that pre-authorization, which usually takes a few days. Then they would call me to set up the appointment.

She advised me to not bother with a dermatologist just yet. We would see what the MRI showed, and then go from there. 

5/13/19: Mammogram and Ultrasound - Inconclusive

At the Breast Imaging location, even though I had been told on the phone that a mammogram wouldn't be necessary (because one had already been performed on that breast within the last 3 months), while sitting in the waiting room, I was told that the radiologist wanted a diagnostic mammogram after all. This time, I definitely remember little stickers being placed on both the lumps.

Since my appointment had been scheduled as an ultrasound only, I guess having the mammogram first disrupted their schedule, because I had to wait a bit longer than usual for my ultrasound. 

The ultrasound technician (not the same person I saw at my first visit) looked at the first lump first, then looked around for the second lump. Curiously, she couldn't see the second lump on the ultrasound machine. She asked me to show her exactly where it was, and she spent quite a bit of timing looking for it, but she just couldn't see it on the machine. Eventually she gave up and left the room to confer with the radiologist. 

The technician and the radiologist (also not the same person I saw at my first visit) returned together. The radiologist, too, spent quite a bit of time looking for the second lump on the ultrasound, but couldn't see it. I really don't know how ultrasound technology works, but it seemed weird - and a little alarming - that the machine couldn't detect a mass that obviously existed and was easily palpable.

Anyway. The radiologist confirmed that the first lump was a sebaceous cyst, and she recommended I see a dermatologist, who might advise me on whether to leave it alone or get it removed. 

Regarding the second lump, the radiologist simply said that she was unable to see it. She said maybe the dermatologist could advise me on both lumps. I have to admit, this lack of information was troubling, and internally I was glad to know I had an NP appointment at the Breast Center coming up.

3/16/19: No Change, and I Got Billed

I used a warm compress for a few weeks, and though the cyst seemed to get smaller after each use, it would always return to its usual size between warm compresses, and it didn't seem to get any closer to draining. I gradually just stopped with the warm compresses.

Knowing that the lump was "only" a sebaceous cyst, I really wasn't worried about it anymore, even if it wasn't draining or getting smaller.

Meanwhile, I received my bills for the PCP appointment, the diagnostic mammogram, and the ultrasound. For the mammogram and ultrasound, I got one bill from the radiologist, and a separate bill from the Breast Imaging location's affiliated hospital. (My PCP and the Breast Imaging location belong to the same hospital network.)

2/19/19: PCP Appointment: $230
With insurance, I paid only the co-pay: $20

2/21/19: Mammogram & Ultrasound Radiologist: $246
With insurance, I paid: $83.15

2/21/19: Mammogram & Ultrasound Hospital: $857
With insurance, I paid: $216.85

Total cost: $1,333
With insurance, cost to me: $320

2/21/19: Mammogram and Ultrasound - It's a Sebaceous Cyst

At the Breast Imaging location, I needed to fill out all the same paperwork that is required for routine mammograms.

The diagnostic mammogram was pretty much the same as a routine mammogram - my breast was firmly squeezed while I stood in various awkward positions! - except they only looked at my right breast with the lump. I'm writing this months later, so my memory is a little foggy, but I think they also put a little sticker on the lump, like a marker to show where it is.

I returned to the waiting room until I was called for the ultrasound.

In the ultrasound room, I laid on my back with my right arm over my head. The technician squirted a warm gel on my right breast, and then went to work with the transducer. I could see the images on the screen, but of course I couldn't make any sense of them.

When the ultrasound was complete, the technician left the room to show the images to the radiologist. They both returned together, and the radiologist told me my lump was a sebaceous cyst. She explained that the cyst was in my skin layer, not actually in my breast, and it was not concerning. Phew! (I didn't know the word "sebaceous" at the time and had to Google it afterwards. Sebaceous cysts are basically non-cancerous cysts in the skin.)

The radiologist said sebaceous cysts sometimes will drain on their own - gross! - but that's a good thing. To promote the likelihood of draining, she suggested I use a warm compress on it a couple times a day, for a couple weeks. (Just wet a towel with hot water, squeeze out the excess water, and hold it on the lump until the towel cools. Repeat once or twice.)

She also said it's possible the cyst might get infected. In that case, it would be red and painful, and I should let my PCP know.

Finally, she recommended a 3-month follow-up ultrasound. I made that appointment at the front desk before leaving.