A long time since my last update! I suppose it should come as no surprise that chemotherapy really takes it out of you! And then the up-and-about weeks are (were) really crammed full of things to do. So I am writing to you finally from the uphill side of major treatment! Chemotherapy is done (thank goodness!!) and it looks like the worst of the surgery is, too.
After the mammogram of November 10 I had another consultation with the surgeon on December 1. At that time I learned that she was willing to do whichever breast surgery I wanted—a mastectomy, to be on the conservative side, or a lumpectomy, to preserve the breast. I had long since decided that I would gladly accept mastectomy over undue risk of death, but if a lumpectomy had a reasonable chance of extracting the disease then I thought we should at least try it. She was willing and she wouldn't have offered if it seemed a waste of her time and mine. Lumpectomy, then.
About the lymph nodes I did not have the same options. The sentinel node procedure I mentioned last time (where dye is injected to identify the node which drains the affected area, which is then removed) turned out to be too risky in my case. I had the one node we knew was diseased from the first biopsy and there were two nodes in the area that looked suspicious on the ultrasound. Sometimes there is more than one sentinel node, but there was no telling whether the suspicious nodes were fellow sentinels or further up the line from the positive node. So, the sentinel node procedure was not guaranteed to find all the trouble spots, and this was, as the surgeon said, not the time to push the envelope. You do *not* want to leave cancer in the lymph system. So, as I had suspected, a full axillary lymph node dissection was the safest option.
Between grading and the end-of-semester social flurry, I was so insanely busy in the week before surgery that I hardly had time to contemplate whether I was nervous or not. I think I wasn't, generally. I like my surgeon a lot and everyone I meet in the hospital who has asked me who I've been assigned raves about her skill and kindness. She's been involved in my case from the beginning; she knows my face and has spent time answering many of my questions. I was very confident going in about her abilities and her intentions. I was more worried about recovery—what it would be like, how long it would take—than I was about the surgery itself.
The other worry, brought on by the choice to forgo to the decisiveness of a mastectomy, was the path report! This is what you get after they take the tissue excised by the lumpectomy and stare at it under a microscope to see if or where there are cancer cells. What they want to see is a concentration of cancer cells with clear, negative margins around them or, if it's a particularly good day, they might see nothing at all. What they don't want to see is an overlap of cancer cells with the edge of the tissue sample or, worse, scattered cancer cells without clear boundaries at all. The results of this report is what determines whether you need another surgery—a second lumpectomy or a mastectomy.
As you might imagine, we waited on this news with bated breath! We were told it would take about a week, and on day number eight we were told that the lab needed to do another round of tests, which would take another day. Noon, they said. This probably meant—the surgeon hazarded a guess—that whatever they were looking at was so small it was hard to identify. Ultimately good news, although even tiny bits of cancer in the wrong areas would mean more surgery. So we waited some more and tried not to assume too much. Noon the next day came and went. Harumph. Day ten was the Friday before Christmas and after seeing one of the nurses waiting for the bus and calling the office to find the receptionist gone, I paged the nurse practitioner. They were in conference at that very moment—the tumor boards meeting where all the care team gets together and talks about all the cases, and mine was up that day along with fourteen others and the pathologists were there and they would call just as soon as they could. Aaah! Any second now. And the second arrived, eventually, in its inevitable fashion.
The first news was excellent. There was no invasive disease left in either the breast tissue or the lymph nodes. They found nothing?!, I nearly squealed, but I had gotten ahead of myself. Not nothing, she said. Oh. Down girl. But the news was still nearly as excellent as that. Chemotherapy had eradicated the invasive ductal carcinoma. I'd had what they call a full pathological response. It happens in a minority of cases and it makes for an excellent prognosis. What they did find under all that invasive disease—or the scar tissue left behind by it—was a bit of ductal carcinoma in situ (DCIS). This is cancer isolated in the duct and not, or not yet, the invasive variety that I was originally diagnosed with. It was probably there all along and might have even been the kernel of the cancer we knew about, but was masked by the size of the invasive disease. The biopsy cores just never caught any of those cells. DCIS is not susceptible to chemotherapy, so it isn't surprising that it was left behind beyond the surprise of it being there at all. More good news: The margins around these cells was negative. Now the bad news: The margins weren't quite negative enough on one side, so they want to go back in and excise a little bit more.
A second surgery. Not the most fun one could have, but it's not really so bad. The vast, vast majority of my discomfort and recovery time is because of the axillary lymph node dissection, which has all kinds of lovely effects I'll rave about another time. The lumpectomy is a less complicated procedure. It should be straightforward and not impinge much on my recovery time. I don't yet know when that will happen... Almost certainly sometime in January. If this surgery does what it's supposed to do, they'll finally certify me cancer-free! I'll still have radiation and hormone therapy to contend with. But, still, that will be pretty cool.
Thank you to everyone! To those who've visited, written, called, cleaned, gifted, fed, offered, delivered...or spared a good thought, prayer, or wish for me during this trying and eventful year. I am decidedly blessed.
