Nip, Tuck, and Pray
Biopsies. They are a way of life when dealing with cancer. For those in the HBOC community, who have not had preventative surgeries, you dread the testing…the waiting…the watching. It’s a cycle — a heart wrenching, nerve wringing cycle. But it’s one that we endure in an attempt to prevent cancer.
Two weeks ago, I underwent a cervical biopsy — they sliced off a section of my cervix. I was in pain…I was scared…I waited…and, luckily, it was benign. It got me thinking, though. We go through this, seemingly, endless cycle blind. We are told to go through screenings, so we do. We are told to go through procedures, so we do. We wait and we worry…partially, because we have such little control over the outcome, and partially, because we don’t know what to expect.
The unknown is scary, and there is so much of it with cancer. I can’t help you with the waiting that comes after testing. Personally, I pray and hold my loved ones closer to my heart. But there are no wise words to make it any easier. All of your fears float in front of you, begging to be unleashed. It’s awful and nothing I say will take that away. What I can do, though, is explain what you may encounter during your biopsies, thereby, extracting one unknown element from your pile.
So, what should you expect in a biopsy? A biopsy is taking a sample of suspicious tissue and testing it. There are many types of biopsies you may encounter along your journey. Here is a breakdown of the most common:
After your mammogram, ultrasound, and/or MRI, you may get a call from your doctor, saying they want to conduct further testing on an area of your breast. What type of biopsy is done will depend on how big the suspicious area is, how many areas there are, and what it/they looks like, as well as your personal preference.
Fine Needle Aspiration
This biopsy is very much what it sounds like. A fine needle (attached to a syringe) is inserted into the mass and a small sample of tissue is withdrawn. Your doctor may use a local anesthetic to numb the area before the procedure begins. When the doctor can feel the lump, the needle will be placed directly into it. If the lump cannot be felt from the surface of the skin, an ultrasound may be used to guide the needle. This is a quick and, mostly, painless procedure.
Core Needle Biopsy
In this biopsy, a hollow needle (larger than the fine needle) is inserted into the abnormal area and a cylindrical sample of tissue (core) is removed. This is done under a local anesthetic.
A biopsy with stereotactic mammography might by necessary if the mass is not palpable. During this needle biopsy, you are placed facedown on a mammogram table with two holes for your breasts. Your breasts are compressed and imaging is done to guide the needle. Some medical providers may use a vacuum-assisted probe in this biopsy. For these procedures, the skin is numbed and a very small cut is made. A hollow probe is put in through the cut and guided into the abnormal area of breast tissue. A cylinder of tissue is then pulled into the probe through a hole in its side, and a rotating knife inside the probe cuts the sample. The needle is inserted and removed quickly. You may feel a pushing and pulling sensation on your breast, which can cause some discomfort.
Other core needle biopsies can be guided by ultrasound or MRI. Core biopsies are outpatient procedures that leave little-to-no scarring.
A surgical biopsy is the most invasive and most accurate form of biopsy. There are two types of surgical biopsies, incisional and excisional. You will be taken into an operating room for either form of surgical biopsy. The breast area will be numbed and IV sedation given. There will be scarring and, depending on the amount of tissue removed, the shape of your breast may be affected.
Incisional biopsies are performed on very large masses. Though no longer very common, an incisional biopsy surgically removes a portion of the abnormal tissue. An excisional biopsy removes the entire suspicious area plus a small amount of the surrounding normal tissue.
Ovarian biopsies are more straightforward than breast biopsies. There are two kinds: laparoscopy and exploratory laparotomy. Both are done in an operating room, under general anesthesia. The size of the mass determines which procedure will be done.
A laparoscopy will be performed on small masses. During this procedure, small incisions will be made in the stomach and pelvis. Specialized tools will be inserted and used to remove the entire area.
Exploratory laparotomy will be performed on large cysts, or masses. This procedure is a conventional surgery. Larger cuts will be made into the stomach and abdominal muscles to gain access to the pelvis. The abnormality will, then, be removed.
**For more information, please visit Susan G. Komen and Cancer.org. The link to cancer.org is wonderful. It was written by women, who have gone through biopsies. It has lots of great information and was the main source of the information in this article.