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
6./7. 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 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
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).
Yearly investigation of the womb with pap test elsewhere.
The results:
Aftercare appointment of August 16th, 2004: three months after the radiotherapy (6 ½ months after the surgery):
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:
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: skeletonscintigraphy
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)
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.
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:
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.
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.
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.
Again the aftercare was carried out during a course with students, this time with mammography of the left breast. 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 is not conspicuous anymore.
The half dosis of Livial 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.
