My Breast Cancer and its History: Summary

 
 

 

 

 

 

 

 

 

 

last update July 9, 2017

Copyright © Nov. 2004

Erika Rusterholz

Medical Support:

PD Dr. Mathias Fehr

PD Dr. Christoph Rageth

 

optimized for screen

1024 x 768 pixels

-

"blocked contents"

should be allowed

Click on the pictures = enlargement

Click on the red words =

further pictures or text (in German)

AFTERCARE

 

 

 

The breast cancer has been removed, the therapies are provided.

 

Now it is very important that in regular intervals the breast is examined in order to recognize immediately the appearance of possible new cancer cells.

For the aftercare I have chosen the breast center in Zürich, as I already knew the physician (PD Dr. med. Christoph Rageth, see "Clarifications). He wanted to see me for detailed examination three months after the end of the radiotherapy. I did not fear that something bad could have developed, as I knew that the cancer had been thoroughly removed, going far into healthy tissue. And the well planned radiotherapy has surely destroyed any remaining cancer cells...

 

How my aftercare is scheduled:

 

1./2./3. year

4./5. year

from 6. year

3 x yearly ultrasound of both breasts incl. axillas, 1 x yearly mammography on both sides

2 x yearly ultrasound of both breasts incl. axillas, 1 x yearly mammography on both sides

The follow-up could now be reduced to 1 x/year but the above cycle will be maintained to make sure that because of the AHT set-off after one year, a possible relapse can quickly be discovered

(also because of the student courses taking place in spring and autumn).

 

from 12. year

No more student courses, therefore back to the yearly mammography on both sides.

Suggestion: ultrasound examination including axillas only once a year.

Investigations following surgery were: skeleton scintigraphy, ultrasound of liver and kidney, tumor marker (see also end report in "Surgery") -

since then no further blood tests have been made, no tumor marker classification; however, in the second year, again a skeleton scintigraphy because of suddenly occuring (increasing) pains in the spinal column (see Jan. 16, 2006) and a repeat of bone scintigraphy and MRI of the lumbar spine (see aftercare November 20, 2013).

Regularly investigation of the womb with pap test elsewhere.

 

The mammography pictures and CD's I have all at my house. For this documentation, however, only individual images are inserted in small format, usually when they show something special.

 

The results:

 

Aftercare appointment of August 16th, 2004: three months after the radiotherapy (6½ months after the surgery):

 

 

 

 

 
 

Ultrasound pictures:

scar tissue structure

 

Mammograms

 

 
 

three PICTURES

 

 

Mammography findings:

 

 

two PICTURES

 

 

Benign findings,that means, that the mammography did not show a suspicion for malignant changes.

(BI-RADS®-Classification: )

 

I am considered since several years as a risk patient for osteoporosis. A bone density measurement in August of 2004 was supposed to show if taking "Arimidex" since May 16th, 2004, could be justified, because an aromatase inhibitor contributes to a faster bone loss. The DXA measurement revealed a bone density inside the norm. However, in more recent X-ray pictures, a progressive degenerative modification was visible.

 

 

Aftercare appointment of December 6th, 2004:

The examination of breast and axilla did not show anything uncommon in the ultrasonic investigation.

 

 

Aftercare appointment of April 11th, 2005:

According to the ultrasonic investigation of the breast, everything is okay.

The ribs hurt a little under pressure. Could it be an after-effect of the radiotherapy?

 

I would like to discontinue the aromatase inhibitor "Arimidex" after exactly one year because of the following side effects:

 

- As I have been classified in 1987 as osteoporosis-prone, I have taken for more than 16 years "Kliogest" (hormone substitution) which I had to drop after the appearance of the breast cancer. Therefore, the osseous decrease is presently no longer restrained. Furthermore, an aromatase inhibitor even increases the risk. My big worry is that the bones could become friable and thereby both hip prostheses would become loose.

 

- Since many years I suffer at times from a very fast pulse. A beta blocker helps when it suddenly appears. - However, during the past months the beta blocker has no longer been very efficient. I had some attacks lasting many hours with very high pulse (about 180) and extremely low blood pressure (mostly under 85/50). I came more and more to the conclusion that the medicine "Arimidex" could be responsible for the indispositions, which are linked with states of anxiety. (Remark: please notice the entry under April 12, 2006.)

 

- Instead of increasing my weight again with big food servings and extremely many sweets, I have further lost weight. With 43 kg remaining, I seem to exist only as a surplus of skin and bones with some muscles inbetween.

However, I do not know whether "Arimidex" can be held responsible for this. I just mention it, since taking that medicine, I have constantly lost weight. Nevertheless, I have generally felt very well!

 

Since May 16th, 2005, I take no longer the aromatase inhibitor

with the agreement of my aftercare physician. In spite of this, eventually still remaining cancer cells will probably have no chance to grow again as they surely will be discovered at an early stage. I know myself in good care.

 

Now, four weeks later, I am already gaining weight again! The fast pulse attacks that were often appearing during the past months, have not shown up anymore since.

 

Aftercare appointment of August 22nd, 2005 - one year after the last mammograms:

Ultrasound: scar tissue structure

Ultrasound picture: lymph nodes

Mammograms

two PICTURES

one PICTURE

two PICTURES

The mammography did not show a suspicion for malignant changes. Detailed mammography findings:

 

Aftercare appointment of December 21st, 2005:

The ultrasonic investigation of breast and shoulder lymph nodes did not show anything unusual.

 

The international guidelines say that twice a year a thorough investigation of the breast and once a year a mammography should be sufficient as an aftercare. Only in case of additional discomfort (pain) would further investigations have to be done.

Because of the discontinued aromatase inhibitor, yet another third investigation became important for me in this second year.

 

 

Since last summer I felt increased pain in the spinal column. I gradually became uncertain, if maybe metastases were spreading. An additional examination would bring here a clarification.

 

January 16th, 2006: skeleton scintigraphy

The new photographs agreed quite well with those of February 2nd, 2004 (see picture in "Surgery"). In the spinal column, lumbar vertebrae 2/3, a black spot is to be seen in comparison with 2004. This was however already faintly visible at the earlier time. In conclusion, no definite reference to skeletal metastases.

 

One week later:

the skeleton scintigraphy has been compared with a DXA bone density scan of August 2004 and two conventional x-rays of the spinal column of Sept. 2004. These x-rays already at that time clearly showed degenerative changes in the vertebral column at the same place where today's intensifications appear.

Thus, as overall conclusion:

no reference to metastases in the bones.

(it is always good to have former pictures ready for comparisons)

Sector of skeleton scintigraphy

Lumbar spine with the vertebral bodies:

DXA bone density scan of August 2004

Sector of skeleton scintigraphy

of January 16, 2006

 

April 12th, 2006: During the last three months I suffered again very often from a fast pulse, also after stopping "Arimidex" in May 2005. One of theses attacks was so bad that I decided to free myself from these indispositions by a catheter ablation.

For those interested: I briefly described here my catheter ablation (in German language, with explanatory video)

 

Aftercare appointment of April 28th, 2006:

Breast and axilla lymph nodes were examined carefully on both sides by ultrasonic detection. The scar tissue structure in the left breast seemed to present itself somewhat differently. A comparison with the ultrasonic picture of last year's examination nevertheless showed conformity of the structure. The investigation therefore revealed nothing disturbing.

 

 

August 24th, 2006: Osseous density measurement.

Two years have passed since the last DXA measurement. After discontinuing the long-standing hormone substitute therapy and after "Arimidex" during one year, it was important to know how the osseous density is. Indeed, the values have got worse, nevertheless, a specific treatment is not necessary.

Recommendation: more alimentary supply of calcium and vitamin D3, as well as a regular bodily/sporty activity (exercise).

 

 

Aftercare appointment of September 1st, 2006 - one year after the last mammograms:

Mammograms of Septemer 2006

 

Mammograms of August 2005

There is a difference

between the former pictures

and those of this year:

 

the current ones are digital.

 

two PICTURES

 

 

 

The mammography and the ultrasonic investigation of the breast and axillary lymph nodes did not show a suspicion for malignant changes.

Detailed mammography findings:

 

 

Aftercare appointment of February 1st, 2007:

Breast and axilla lymphnodes were again examined very carefully with ultrasound on both sides. The scar zone at left at 2 o'clock was more distinctly visible than in former times:

Ultrasonic findings left breast 8 mm, solid US-findings. US-classification US-BIRADS 3.

 

Could this be something malignant?

Probably not - during the initial operation, tissue was removed that extended far into the healthy parts, and subsequently the breast was irradiated.

To be really sure, an absolutely painless core biopsy was presently performed.

The picture shows on the right the biopsy needle in front of the lump before penetrating through it (not shown).

When it is pulled back, the needle has gathered tissue from the node.

 

The picture on the left shows the bleeding trail through the node.

(please click on the picture for enlargement)

 

Histology mamma at the left at 2 o'clock:

Fibrous tissue of soft parts. No proof of DCIS or invasive carcinoma.

 

 

Aftercare appointment of September 3rd, 2007:

Ultrasonic picture:

tissue structure breast right and left

 

Ultrasonic picture:

axilla lymph nodes right and left

 

The examination of breast and axilla did not show anything uncommon in the ultrasonic investigation.

 

(please click on the pictures for enlargement)

 

 

The digital mammograms did look the same as the ones of September 1st, 2006, and did not show a suspicion for malignant changes.

Detailed mammography findings:

 

 

Aftercare appointment of January 25th, 2008:

Breasts and shoulder lymph nodes on both sides were again examined very carefully by ultra-sound.

Thereby, the scar zone in the left breast could be clearly discerned. It did, however, not seem altered compared to the findings of February 1, 2007 (at that time a biopsy was performed with negative result). The shoulder lymph node at left is quite conspicuous and has to be watched (however, it is not clear to me if this observation concerns the next post-operative appointment). In the shoulder region on the right side, no lymph nodes could be found, only a non-conspicuous one in level 3.

 

 

Aftercare appointment of July 21st, 2008:

Scar zone left breast

Scar zone right breast

Axilla lymph nodes

MG (two PICTURES)

 

The mammography and the ultrasound investigation of the breast and the axilla lymph nodes do not show malignant changes. There are several benigne changes which should be controlled again. The recommendation: ultrasonic investigation in 6 months and mammography in 1 year.

Detailed mammography findings:

 

The scar zone in the left breast did not change the appearance in the meantime. Therefore the diagnosis of the biopsy of February 1, 2007, will still be valid.

In the right breast the scar zone is not conspicuous. The lymph nodes left and right have about the same size, nothing to be anxious about.

(please click on the pictures for enlargement)

 

 

Aftercare appointment of December 3rd, 2008:

The scar zone at the left still looks according to the ultrasonic picture of February 1st, 2007. Therefore another biopsy doesn't seem to be necessary.

The scar zone in the right breast is again not conspicuous. The lymph nodes seem to be normal looking.

 

 

Aftercare appointment of July 1st, 2009:

Scar zone left breast

Scar zone right breast

Axilla lymph nodes

MG (two PICTURES)

 

The scar zone in the left breast has become "more dense", in mammography and ultrasound. The physician didn't think this to be alarming.

Again a lymph node at the left shows enlargement under ultrasound.

To be certain, Trucut biopsies have been made - the results two days later:

Scar zone: no indication of Mammaparenchym,

Lymph node: no indication of carcinoma cells (diagnosis report of both biopsies: )

Detailed mammography findings:

 

It is recommended to control the several benign changes again in 6 months by ultrasound and also in 1 year by mammograms.

 

 

Aftercare appointment on December 18th, 2009:

The examination of breast and axilla did not show anything uncommon in the ultrasonic investigation. The well known "shadow" in the scar zone at the left still is visible, also an enlarged lymphnode. It will be kept under observation.

 

 

Aftercare appointment on April 28th and October 13th, 2010:

The examinations were carried out during a course for medical students, in which (as previously) I was at disposition as a "model" for palpation and for first ultrasound experiments. The number of students varies from semester to semester: 2 - 9 women and men gather around me, wish to learn more about breast cancer.

The yearly mammography was for the first time divided up between two courses. Until now, a mammography on both sides in June/July was normal. In this new way, each student course gets the mammograms of one breast for surveying (for examination and study).

The pictures show the implant under the breast muscle as a light surface.

For a mammography to be possible, the apparatus must be adjusted with correspondingly less pressure.

 

The ultrasound examination and the mammography have given no cause for worry, neither in April nor in October.

Detailed results of the mammography examinations:

Mammography of the left breast with implant

two PICTURES

 

Aftercare appointment on March 9th and October 12th, 2011:

Again the aftercare was carried out during a course with students, in March with mammography of the left breast, in October of the right one. The texture of the breast appears consistent.

 

Mammography and ultrasonic examination on both sides don't give reason for suspicion of malignant changes. Also, the former enlarged lymphnode in the left axilla is not conspicuous anymore.

Detailed results of the mammography examinations:

 

 

Aftercare appointment on April 25th and October 3rd, 2012:

In April the mammography of the left breast and in October of the right one again took place in the presence of some students. Because of the silicone implants, the apparatus was set with less pressure.

The right breast glandular tissue appears dense = slightly restricted evaluability.

 

In the ultrasound of October a dark shadow can be seen in the left breast in the region of the former tumour/scar. To be on the safe side a Truecut biopsy of three layers of the findings is performed (certainly interesting for the students) with the result:

Scant mamma tissue with vast fibrosis. Conventional-morphological evaluation, no malignity - report:

 

The lymph node shown in the left armpit, which earlier had been conspicuous, was again enlarged in April, a new biopsy has not been made, however.

Detailed results of the mammography examination:

 

 

Aftercare appointment on May 22nd and November 20th, 2013:

As in previous years, the follow-up was again carried out in the presence of students: in May with mammography of the left breast and in November of the right one. The left glandular tissue appears dense with slightly restricted evaluability.

Detailed results of the mammography examination:

 

Ultrasound findings left: intramammary no definable findings, enlarged lymph nodes, unchanged;

right: a harmless fibrosis zone, otherwise intramammary no definable findings, unsuspected lymph nodes.

Prosthesis both sides without evidence of leakage, moderate capsule formation.

Classification: Class 2 = benign

Connected measures: none

 

My back pain has become much worse - without daily pain medication I can hardly hold up.

Ten years have now passed since I've been on both sides operated because of breast cancer. So far, all follow-up results had been good, with no evidence of metastases.

A bone scan should now indicate whether metastases can be excluded on the increased pain.

Findings: no evidence of metastatic typical skeletal lesions.

For further clarification of the lumbar spine, however, an MRI is recommended.

This shows a severe multisegmental degenerative change and more of the lumbar spine and narrowing of the nerve roots...

And now - how to treat?

November 11th, 2014: microsurgical extension of the nerves along the lumbar spine - the nerves are not clenched anymore, the radiating pain is gone.

The degenerative changes in the lumbar spine are still there, also the back pain...

Aftercare appointment on March 12th, 2014:

The mammography of the left breast, with a few students watching this, showed nothing alarming.

Ultrasound findings left and right:

scar, implant without evidence of leakage

and overlying tissue without delimitable findings, unsuspected lymph node.

Classification: Class 2 = benign

Connected measures: none

eye-catching arrangement of some lymph nodes

 

Aftercare appointment on November 25th, 2014:

Mammography at the right and bilateral ultrasound were not accompanied by some students this time.

There is no detectable calcification, no enlarged lymph nodes. Nothing to be concerned about.

Detailed results of the mammography examination:

 

 

Aftercare appointment on June 8th, 2015:

No further students courses: mammography of the left breast is thus postponed until December and will be carried out simultaneously with the other breast.

Ultrasound findings:

implants without evidence of leakage

and overlying tissue without delimitable findings,

right side: one borderline lymph node on level 2 with 8 mm Ø,

left side:two lymphnodes as seen before Classification: Class 2 = benign

Connected measures: none

Lymphknoten

Lymphknoten linke Brust

 

right breast

left breast

 

Aftercare appointment on December 8th, 2015:

Mammography on both sides with coarse-grained roundish calcifications,

no focal compression = BI-RADS 2

(clearly visible: the implants as a bright semicircle)

 

Detailed results of the mammography examination:

 

oblique

cranio-caudal

Ultrasound findings:

implants without evidence of leakage and overlying tissue without delimitable findings,

right: slightly enlarged lymphnodes on level 1 and 2, no suspicion

left: slightly enlarged lymphnodes as seen before, no suspicious findings

Classification: Class 2 = benign

Connected measures: none / proposal: mammography and ultrasound after one year

 

 

Aftercare appointment on November 25th, 2016:

has been held as part of a student course at the Frauenklinik Kantonsspital Frauenfeld/CH (since I was there at student courses the years before, however the aftercare took place in the breast center Zurich from 2004 - 2015).

Mammography on both sides with isolated vascular calcifications as well as macrocalk mainly left.

No microcalk group and no star figure.

Detailed results of the mammography examination:

Ultrasound findings:

Axillary, on the left, shows a lymph node of about 5 mm transverse diameter without a clear fat-hilus, which is already known in the history of the disease. Otherwise, regular residual gland tissue without suspect space requirement.

Signs of the capsular fibroses with some retractions of the mammary prosthesis, wavy configuration of the prosthesis edges.

Assessment: no prosthesis rupture, no evidence of a recurrence or a secondary malignancy = ACR b, BI-RADS 2 both sides.

Recommendation: Mammography and ultrasound in 1 year

 

The half dosis of Livial/Liviella with the effective ingredient Tibolon accompanies me to this day, and I feel very well with it. The mucous are no longer dried out, the skin has also again become more attractive and looks more taut.

 

The delivery of the drug may not occur arbitrarily, it must be clarified exactly whether a patient is suitable for it; also it may not be prescribed to women less than 40 years old.

How do I feel? to learn more see reflections

 

Neu und hilfreich - new and helpful, but only in German language:

Der Verein, der bei Verdacht oder Diagnose Brustkrebs weiterhilft

mit Kurzbeschreibungen wichtiger Themen und eigenen Erfahrungen, mit Links zu medizinischen Informationen und Wissenswertem aus dem Internet. Ergänzt mit e-mail-Beratung und unterstützt von einem Ärzte-Beirat - alles an einem Ort:

www.wissen-hilft-weiter.info/vor_nachsorge.htm