Rare Cancer Support Alliance

Whoohoooo, finally, I have discovered the Rare Cancer Support Alliance (www.rare-cancer.org) which not only lists details about a malignant phyllodes tumour but has forums where other ladies have posted and answered queries, given their stories about their journey, what worked, what didn’t work, what they were advised, shared their histopathology reports etc etc.

I posted an introduction to me and my predicament whilst also looking through the various postings and forums for other information.  I also researched previous postings where I note that there are some posts that refer to similar pain being due to surgery and the nerve endings settling down.

I can’t explain how relieved I am to have found somewhere that has honest information and balanced views about this type of tumour.

I also found reference to a Barth report that’s been recently published… Barth Report which although I don’t have access to the whole report has given me food for thought regarding mastectomy, metastasing and radiationtherapy.  Finally I feel that I’m getting a better picture.

2nd op confirmation and more searching

Greta called back early today to say that she had been able to speak with the other consultant (mine’s still on holiday) who has had a look at my notes and test results etc.  The other consultant has agreed to take one of the patients off my consultant’s already brimming surgical list from the 5th November, so that my appointment remains on the 5th November with my consultant.  I can’t express how relieved I am to have my operation as expected on the 5th November and with a consultant whom I trust.

Today I spent a long time searching through pages and pages on the internet.  I was able to find some information about a phyllodes tumour but very little information still (read none!) about a malignant variety.  Why can’t I find information?  I deserve answers.  I deserve to know what this is about?  I need to know more so that I can prepare for the road ahead.  I’m scared and frightened and don’t know where to turn to.  I’m lucky in that I have support from friends and family (although I’m somewhat angry at Mum for not being here to help) but I need answers, real answers and facts, numbers and statistics.  What is my prognosis?

Macmillan nurse call

Greta called me today following my queries on the answerphone.  She’s brilliant and what a fab service she (and their team) provides.  She gently assures me that have spoken with another consultant (mine’s on holiday) the believe that it would be best to do another excision first to then test this and then, if need be, perform a mastectomy.  The voice of reason was there – she asked if I could cope if they did perform a mastectomy and the testing of the removed tissue proved that they had got the tumour in the first operation.  How would I feel having unnecessarily authorised the removal of my breast?  She’s right – that would fill me with horror.

She apologised once more that the literature given to me about a Phyllodes Tumour has only one line about a malignant version and tells me that she’s been speaking with the publications and reference departments asking them to see if it would be possible to ensure that there is a publication about a malignant phyllodes tumour however she felt that they wouldn’t do this as it is so rare and resources were tight and needed to be spent on more prevalant cancers.

Greta also noticed that I had been booked in for the 2nd operation on 19th November but remembered that I had discussed my music request for the operating theatre as Handel’s Fireworks on the basis that it was Guy Fawkes ie 5th November.  I asked that if there was a reason that the operation should be later then that was OK but I would prefer it sooner and over with but it MUST be with the same consultant – I totally trust him to do the right thing, for me.  Could it be an administration error?

Oh, could I wait for yet another 14 days?

Macmillan nurse call

I have been experiencing a sharp stabbing pain in my right breast. It feels a little like a hot poker being stabbed into my breast and pulsing with pain. The pain only lasts for a few minutes however takes my breath away and all I can do is try to breathe through it whilst the tears run down my cheek and I wince with pain. I don’t know what’s causing it ie if the pain relates to the tumour or the reconstruction. I did have shooting pains before surgery but not to this intensity. Today I decided that I really needed to check in with my Macmillan nurse and ask if this is normal. I also wanted to ask about a mastectomy. Are we assuming that the best course of action is to simply do the operation again and then do a mastectomy, if need be – ie to do our utmost to preserve my boob? But if this method might give the tumour a chance to grow further and mean that the outcome may be worse, would it make more sense for me to elect to have a mastectomy at this piont and eliminate earlier the chance of it spreading?

Unfortunately I got the answerphone and left a message for Greta outlining the above. I felt dreadful just leaving a message – what would happen if she didn’t call back as promised within 24 hours? What then? Who can I ask?

Visit to GP

Today I’m up very early to drive to London and get that appointment with my Doctor. I need to ask him if I should be signed off from work – I know I can’t concentrate or come to that sit up at a desk for any length of time. I also feel that if I am signed off from work then my employers will ensure that my role is properly resources as my team have been taking the load and doing ridiculous hours under extreme stress. My team were already pushed and doing additional hours due to redundancies and new projects so I’ve felt terribly guilty being out of the office with Mum’s death and now this. The way I’m feeling right now I’m worried about work, my team and stressing about what’s going on but feeling helpless to do anything or cope with the day to day of life.

I’m also wondering how I can possibly do my bit of sorting and sifting Mum’s possessions and organising the house if I’m working – not that I feel I could drive there or lift anything anyway. I’m feeling useless. My doctor however laughed at me and said he didn’t ‘do sicknotes’. I was a little shocked but didn’t even have the energy to question this. He then insisted that I had a flu injection to help with my immunity whilst I’m in and out of hospital. As I was leaving he handed me a note and laughed – I looked at it and he told me off for thinking that I would only need a couple of weeks away from work if I was facing the treatment he knew was already booked in. He then said he’d signed me off for two months and even that would be reviewed after the results were in from the next operation.

This made it all so very real that I wouldn’t be up and about quickly. I think I’d thought I would be so to be ‘signed off’ for such a long period of time was yet another shock or reality check. I’m devastated and once again call on Millie’s support and call in for a cuppa/lunch.

Millie had also been doing research on the internet and had seen a lot of the same articles but also some others, so it was good to compare notes. It was horribly obvious that we were both skirting the worst scenarios though and eventually we got there. talking round and round until eventually I asked Millie to help me ensure that my wishes were looked after ‘just in case’. It was, though, a relief to then talk candidly about the articles and information that we’d both seen but avoided talking about as it was too scary. BUT I do need to remember that I need a balanced view and that not every treatment, operation, eventuality is for every person and indeed if I’m armed with all the facts and figures, I can take some control of my own treatment and proactively control my future… because there is one!

Search for a solution begins

I was up very early and connected to the internet.  I’m determined to find something to help me work out what next.  What does this really mean?  I can’t believe it’s so rare that nothing is available I’ve just got to rummage.  I start, of course, with the cancer organisations in the UK and hope that I can find one as this will mean that I can call them or maybe call in to see them and find out more – nothing but a mere mention that it exists and is rare.

Breast Cancer Care UK’s site has only a short mention of what it is and some options to explore – but when I read this page I realise that really they don’t know for sure what to do… or not enough to quench my need for information.

I can’t even find a reference to it on the Macmillan site or Cancer Research or Breakthrough Cancer and believe me I think I searched through every page scouring for information.  I guess that as it’s not common their resources are spent better on more common illnesses.  But I’m not quite sure how this makes me feel except very very alone and yet more frightened at the unknown.

I then search through as many medical sites as I’m allowed to view (there’s a lot that appear to have the information but you have to be a doctor or have a secret handshake to see the information – why?).  WebMD usually comes up trumps but this time only tells me simply that “The following are tumor subtypes that occur in the breast but are not considered to be typical breast cancers”.  Wowza that’s helpful – NOT!   Doctors Doctor site has an outline in lay-persons language but then goes on to medical speak and I get lost in the detail.  I’m fuzzy enough as it is and taking things in and concentrating on things is out of my league at the moment.

I’m exhausted and tearful at the lack of information available.

Home

I left Millies and headed home today but not before Millie and I had talked at length about what happened yesterday. What does it really mean? We read and re-read the report but all those long words don’t mean anything and we look at the leaflet that I’ve been given by the hospital about phyllodes tumours but note that the only mention of a malignant version is one line and simply says refer to your specialist… oh great! Once again I’m asking myself what does it really mean, is this really happening? Would that explain why it still hurts sooo much? Reconstruction or the tumour still growing? Now another wait until my next operation which is booked in for 5th November but seems like forever away. How am I going to get my head around this if I don’t know what it is, or what is required to get clear of it? My mind is buzzing and Millie is loathed to let me go but I just need to get into my own space and cry… again!

Ed helped pack my bags into my car and I wished I had someone to take them out when I got home but was so tearful when I got back I daredn’t call a friend or colleague to ask.

The drive home was really painful – you forget that wearing a seatbelt is difficult not to mention every bump and lump in the road. Thanks heavens for surgical bras and waterproof mascara.

Hospital

Today I went back to see my consultant to get my stitches checked. Millie drove me up to the hospital and after a couple of hours in the waiting area, We anxiously hoped this routine check would be over and down with quickly – we had shopping and lunching in Kingston planned!! I was called in to see the consultant.

I should have realised that there was something odd when he came into the consulting room with a Macmillan nurse – but I’ve never been through this before so again, why would I notice anything odd! Mr Davies shuffled a little in his chair after sitting round and talked briefly about the operation he’d performed. He looked a little crestfallen when he said “Anna I’m really sorry but he’d received the path results and they indicated somethine else” – I had an urge to nip round the table and give him a hug! I felt terrible for him as he had done such a fantastic job to reconstruct my breast and had they managed to get clear margins, I’d require nothing further.

He then went on to talk about the ‘lump’ that had been removed and the histopathology report which said that the lump (or should I say lumps) tested not as benign fibroadenomas but as malignant phylloides tumour. A very different result and so very different in next steps.

The consultant and nurse were a little taken aback when I said that I knew about phylloides tumours and had thought that this may be what I had (albeit in a benign form) as I had done a little internet research and diagnosed myself with this – the main aspect being the burning feeling on the skin over the tumour and hot sharp stabbing pains in the breast.

They told me that as this is very rare (particularly in a malignant form) neither of them had actually seen or treated one and also told me that I had to remember that it wasn’t Cancer as we all understood it in that it doesn’t spread to other cells and is contained purely in the breast tissue. He then gave me the histopathology report with a wry smile saying that knowing that I was in IT I would need the report so that I could spell the long medical words!

The next steps advised is to perform another excision to remove the tumour and ensure that we get clear margins. Radiationtherapy may also be considered.

I was then taken to another room with the nurse to talk things through further… that’s when it really hit and the waterworks started! I just kept thinking “why me?”, “why now?”, “what next?” and a million other questions…

As I went back into the waiting area I was in pieces and poor Millie looked up from her book to see me standing there like a lemon with tears running down my face. (I since felt awful about not being in control as all the new patients with questions running through are now probably wondering if that’s going to be their result too).

The report told us the following:
Specimen
Fibroadenoma right breast
Macroscopy
Two pieces of irregular fibrofatty tissue 85mm and 25mm, weighing 33g. 7(7) krp.jc
Microscopy
Sections show pieces of a phylloides tumour which is associated with marked stromal overgrowth and slit-like compressed epithelial lumina. Frequent mitoses are observed – up to 10/mm2 including abnormal forms (tripolar). In addition there are scattered enlarged moderately pleomorphic cells present. There also appears to be infiltration of fat by the atypical stroma.

These appearances are consistent with a malignant phylloides tumour. No vascular invasion is seen. The lesion appears to reach the margins in several areas.
I don’t think I stopped crying or saying “Bollox” over and over for the rest of the day.

Ouch

I decide that I’ve got to grow up and take off the dressing. I know that if I left it until tomorrow my consultant would laugh at my pathetic-ness and whip the dressing off in one sweep, probably leaving me ouchy. Millie was out for the day and so had I had a bath and soaked the dressing under a flannel. I then picked at the corners. About and hour and a half later I managed to get the dressing off without passing out! I’m great with other people’s injuries but my own – forget it!! Although I have to confess not only did I feel nauseous having taken it off but the compression plaster was obviously helping me keep it all in place so removing it meant that any movement hurt ten times more! And very very stupid considering we’ve got a drive back to the hospital tomorrow over white lines and speed bumps!

I also got a message from my Doctor’s office asking me to call in for a flu jab and medicine review. It made me giggle as I don’t qualify for a flu jab and am not on any regular medicine so suspect it’s just a way for my Doctor to get me back in and see how it all went! Bless him, now that’s service!

Next few days or so

The next days passed with me sleeping for hours and lounging for the other hours and a few visitors but I think I was so fuzzy I was probably such a rubbish patient to visit. I am quite shocked at how tired and pathetic I was feeling after the anaesthetic. My boob was sore but I still couldn’t bear to look at it – although eventually had to. I was scared when I realised that I couldn’t feel anything, had I lost all feeling? would it come back? The compression dressing meant that I couldn’t see that much and was too scared to take the dressing off – it made bathing difficult but I wasn’t removing it!