I finally had that appointment with my surgeon. The one that seemed forever and forever away? Maybe I haven't mentioned that here. But take my word for it: I've been waiting for this for a long time. And now ten days have passed since!
One big question has finally been answered: Surgery will be December 13. It's two-plus weeks earlier than I expected. That's been a bit to swallow, I must say. Although I waited for this appointment for what seemed like an age, December 13 just seems so...soon. I guess it depends on what you're waiting for, how the time goes. The good news out of that soon-feeling is that I only have one more round of chemo to go! Hip hip to that. November 11. Last one. The other good news, and what makes the idea of an earlier than expected surgery easier to deal with, is that I'll have two-plus more weeks than I thought for recovery and general non-doing before the next semester starts. So that's very nice!
One big question remains to be answered: What kind of surgery? We are still on the fence about that. My surgeon seems generally willing to have a go at a lumpectomy--you can always take more but you can't take less, after all. The issue rests on both the size and the distribution of whatever remains of the tumor. It no longer has distinct edges, to the extent that it's impossible to measure and difficult even to feel. This is wonderful, of course. The concern is that rather than shrinking concentrically into a smaller and smaller ball, it may have melted into lots of tiny pieces that still occupy a lot of space and, more importantly, are hard to find. The latter is what I suspect, but only testing will ultimately tell. We start that with a mammogram done on November 10. If imaging doesn't reveal much, the pathology reports on the tissue taken via lumpectomy will show whether the cancer cells, if there are any, are concentrated or diffuse. Concentrated means we trust clean margins if we have them; diffuse means we have to be more careful--clean margins around a few pockets of cells could leave other pockets behind. And we don't want that.
The lymph node is still palpable, though now the size of my pinky nail instead of a jordan almond. A lymph node dissection is very likely in my future, no matter the surgery. It is the common protocol when lymph node involvement is certain. They take out the same area of tissue in everyone and whether that catches 9 or 21 lymph nodes just depends on the individual. If done before chemotherapy, this is part of the staging process--figuring out how far the cancer has spread. Although we still want to know that, we'll never know how far it was before chemo and the main goal is to get the cancer out. The removal of my axillary lymph nodes would mean all kinds of lifelong joys: many for the sake of preventing and coping with lymphedema (swelling of the arm caused by the obstruction of the lymphatic drainage), such as compression sleeves, physical therapy, limitations on repetitive motion; and others pertaining to limited immune response, with plausible instructions like, "Avoid infection and sunburn--forever!"
Another option is a sentinel node biopsy, which is a relatively new procedure normally done in women who do not have confirmed lymph node involvement. The closest lymph node responsible for draining the area of the breast with the tumor is identified through a dye injection, and only this and some surrounding tissue are taken and tested. If these lymph nodes are cancer-free, the odds are that those further down the line are, too. It is a much less invasive procedure with fewer side effects, but has the risk of missing (and thus leaving behind) cancerous cells. An even newer idea is that women who have responded well to neoadjuvant (pre-operative) chemotherapy, even with previous lymph node involvement confirmed, may benefit from this less invasive attempt to find and remove the extent of the cancer. My surgeon said she would give more thought as to whether I might be a reasonable candidate. The balance is, as usual, between invasiveness and effectiveness, cost and benefit. Another decision to await down the line--down the ever-shortening line. Imaging, maybe more imaging, and another consultation on December 1.
Well, that is my big news at the moment. I am otherwise generally doing well, though my two good weeks fly by hopelessly quickly! I hope to write again soon, and with less medical mumbo-jumbo. No talk of "catching up" today. The mention of finishing things seems to prevent me from, well, finishing things. So just, Until next time! Take care, everyone!
