Episode LV: how am I going to be an optimist about this...
It has been a little over a week and I got to meet with the Breast Surgeon to discuss my results. During the lumpectomy they removed over a 8.5 cm mass out of my right breast. That was between 3-4 inches... a lot of boob! Within that, the cancer mass had shrunk from over 3.6 cm to around 1.5 cm from chemo - which was good. My margins around the mass were clear of cancer. That was good. No more breast tissue needing to be removed. That was even better!!!
I also had an axillary dissection of my sentinel lymph nodes to see if the cancer had spread beyond the tumor. They removed 3 nodes that appeared to be the sentinel lymph nodes under my right arm pit. They did find metastatic cancer in one of the lymph nodes, which unfortunately means the cancer went beyond my breast and was obviously not destroyed from all the chemo I have taken. They do not like to go back and remove more lymph nodes as it can create lymphatic problems, so the treatment of that cancer will be radiation. So, not as good news, but glad that we found it!
My husband's work sent multiple flowers to cheer me up after surgery.
Heading out for a girls night of fun!
Some interesting changes were noticed in the pathology (between biopsy & lumpectomy) for you Science Fact Seekers:
1. Cell Type: Biopsy: Infiltrating Ductal Carcinoma - Lumpectomy: Infiltrating Ductal Adenocarcinoma
(Carcinoma is basically a malignant tumor, Adenocarcinoma is basically a malignancy in the epithelial cells lining of glandular tissues, meaning they're tissues that secrete substances into the body.)
2. Histologic Grade: 2 moderately differentiated (both times)
2 means it was growing fast.
(This looks at how abnormally the cancer cells behave and look when compared with normal breast cells.)
Things that make the Histologic Grade (Scale is 1, 2, 3 - the higher the number the faster they grow.):
Nuclear Grade: Biopsy 3 high grade/poorly differentiated - Lumpectomy 2 moderately differentiated
3 means it was growing really fast. The 2 indicates that the chemo was slowing it down.
(This evaluates the size and shape of the nucleus in the tumor cells.)
Grandular Differentiated: 3 high grade/poorly differentiated (both times)
3 means it was growing really fast.
(This evaluates how well the tumor cells try to recreate normal glands.)
Mitotic Activity: 1 well differentiated (both times)
My slower mitotic activity was my advantage, the only thing that keeps my cancer from growing at super-sonic speeds and keeping my Histologic Grade below a 3... even if it still was growing fast.
(This evaluates how much the tumor cells are dividing.)
3. Estrogen: + 95%
My cancer loves hormones.
(Measures if estrogen fuels the cancer.)
4. Progesterone: + 95%
Again, my cancer loves all hormones.
(Measures if progesterone fuels the cancer.)
5. Ki-67 (MID-1): + 40%
The cancer wants to grow.
(Measures how fast the cancer cells are growing and dividing. Over 30% means high values and spreading quickly - also predicts poor prognosis which we will ignore).
6. HER 2/Neu: - - 0%
My cancer doesn't do this.
(Measures growth-promoting protein called HER2/neu.)
7. Intraductal Component: + (not extensive) (Shown after lumpectomy)
(Basically means that the cancer is in the milk ducts.)
8. Angiolymphatic Invasion: + (Shown after lumpectomy)
(If it shows up in these vessels than an increased risk that it has spread outside the breast.)
Tumor Size: Biopsy: 3.6 cm - Lumpectomy: 1.5 cm
I was never given a stage (or so I thought). However stage basically depends on the size and spreading, so the smaller size when removed after chemo could decrease the stage number, but I felt that with the original size makes a more accurate to be stage II and b because it was in lymph nodes. However, my husband told me after I finished treatment that they actually told me my stage. I must have either ignored him, did not want to know, or in a chemo fog... apparently, it was stage III... crazy!!!!
In my head...
Well of course I was hoping that the cancer was isolated to the mass. The doctors thought that nothing was beyond the mass and with the amount of chemo I had taken that if there was it would be gone. So, I was concerned that since I had done chemotherapy first that if it was beyond the mass I would have never know.That was one of the risks and gambles of not doing surgery first.
While it was disappointing, in some ways I was glad that there was still some cancer showing up in the lymph nodes. There may have been a small lingering concern that I wasn't doing enough or that I had not gotten it all. Otherwise they would not be able to radiate me enough and kill it all!
“The real things haven't changed.
It is still best to be honest and truthful;
to make the most of what we have;
to be happy with simple pleasures;
and have courage when things go wrong.”
- Laura Ingalls Wilder
Episode Reference: Pompeii, Bastille song