October 10, 2013 -- Surgical Consult

Jess and I met with Dr. Sarah L. Blair of University of California – San Diego (UCSD) Moores Cancer Center on October 10.  It was supposed to be an hour-long consult, but it turned into four hours as Dr. Blair, who was my second opinion consult, wanted my mammograms and ultrasounds redone.  Apparently, my first films showed the two masses in two separate places, different from what I was told.  Also, they use the films to measure the size and placement of the tumors, using those measurements for where to make the incision to find them in the breast tissue – we are actually talking about a relatively small group of cancer cells.  The new films did show the tumors differently than the first set.  Both tumors are much smaller than the small hematoma left behind by the needle biopsy.  Altogether, both tumors and safety margins are less than 2 centimeters in diameter.  That’s about the size of a shelled peanut.  Which was a huge relief, because the first doctor had offered me a choice of a full mastectomy or a partial, and that had me thinking I might be losing a lot more of me than I had originally thought.  Now that we’ve acquired a lot of reading material on the subject of breast cancer, we’ve got a context to place the terminology in.

The most commonly done mastectomies are called simple and modified radical.  During these procedures, the chest muscle is not removed.  As a result, arm strength continues.  Keeping the chest muscle also makes reconstruction easier.  Total or Simple Mastectomy removes the breast tissue, skin, and nipple.  Modified Radical Mastectomy removes the breast tissue, skin, nipple, and some or all of the lymph nodes.

I will be having a lumpectomy (also referred to as partial mastectomy or segmental mastectomy) to remove the cancer.  It is a breast-conserving surgery, meaning that the breast remains intact.  Separate incisions will be made for a sentinel node biopsy.  During the surgery, the first lymph node or nodes that cancer cells could reach will be removed and screened.  This will reveal whether or not the cancer has spread outside the breast.  Where the first surgeon wanted to remove all of the lymph nodes to screen, Dr. Blair will only take the first one or two to check.  This leaves more of my immune system intact, which is a definite plus.

So, the terrain gets mapped and treated like this: Local is the breast, treatment is lumpectomy with radiation therapy to destroy any cancer cells left behind.  Regional is the lymphatic system, response is sentinel node biopsy.  Distant is the whole body, treatment is anti-hormone pills.  We’re hopeful that the surgery will be scheduled on either October 22 or October 29.  Healing time is usually four or five weeks, which would have me starting 4-6 weeks of radiation therapy the first week of December and finishing the beginning of January.  I will be on the anti-hormone pills for five years, and will just have to put up with the night sweats and hot flashes returning.

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