Lumpectomy and SNLB tomorrow

webstertoo · October 2009

Just saw my surgeon and had the radioactive substance shot. This time he talked percentages and for the first time I realized that some women don't make it. He also started saying that it could be stage II, not I. I haven't cried; I'm keeping everything inside of me and staying upbeat for family and friends. I feel that is what they expect from me, stay positive. Guess today I just woke up to the fact that I have a serious disease and I can't keep pretending for everyone that this is just a simple surgery tomorrow. I'm single and no one to put their arms around me and allow me to cry.

Sydney6 · October 2009

webstertoo - I wish I could be there to give you a great big hug. You have come to the right place for suppot. I did the upbeat thing and it can be exhausting! My son was applying to college around the time I was diagnosed and it seemed I had one medical issue after another. He kept giving me a hard time about not helping him with applications (I think because I was downplaying it) and finally I just lost it and said, "Do you realize I have cancer and am a bit preoccupied with myself right now!" They can tell you have cancer, but it's so surreal. One day I was cleaning my bedroom and all of a sudden I sat on the bed and said, "I have f***ing cancer." I think that was the first time it sunk in. I'm sure tomorrow will be a long day. I will be thinking of you and will say a little prayer tonight that all goes well. I hope you'll update us on how you are. Sending you good thoughts - Sue

unklezwifeonty · October 2009

Dear Webstertoo,

I wish I could be there to give you a hug too like Sue.

Your doctor should have been smart enough to gauge your emotional state and use the appropriate supportive words. Unfortunately the reality is that surgeons typically have poor interpersonal skills. What he really meant to say is that until your lumpectomy and SNLB is completed, the exact stage won't be known. But no matter what he finds during surgery remember that there are thousands of women who were diagnosed with much larger, more aggressive and much more proliferative BC several years back who are living full, healthy and happy lives after treatment.

Good luck for tomorrow.

one-L · October 2009

Getting past the point that you are in today was one of the hardest for me. The waiting and waiting for each test, test result and then the dr appointments seems to take forever.

At the point we are, it seems to be never ending. You will also journey thorough this and everyday is one more day you have made it through and you have to be happy about that. I will not tell you that it gets easier, but it is all doable.

I am so sorry that you have to go through this alone. Stay in touch on this site and you will receive comfort and help when you need it.

Hugs and more hugs

Juannelle

webstertoo · October 2009

I'm home from the surgical center and feeling good with pain pills. Will have to wait till next week for results. Thank you for the all of the hugs. My emotions are better today.

unklezwifeonty · October 2009

Good to hear from you Dear Webstertoo. Keep taking the pain meds till you need them. Don't try to be a hero and quit taking them too soon! Did they tell you if they did frozen section biopsy on SNL and how many nodes did they remove?

one-L · October 2009

Good to hear that you are home. Take those pills, there is no reason to be in pain.

Hope all goes well for you in the next couple of weeks.

Hugs,

Juannelle

webstertoo · October 2009

I was told to call in 5 days for the results but I have a question? I thought the doctor said the lymph nodes would be taken from my arm pit area but the incision is on the side of the breast. It's great because I have no problem with my arm though that incision on the breast is more painful then the one where the cancer was removed. Anyway, is this the normal area where the nodes are removed?

unklezwifeonty · October 2009

Dear Webstertoo,

I had a total of 4 incisions. 2 on the breast and 2 in the underarm region. The size, number and location if the incisions depends on the locations of your sentinel nodes relative to your tumor.

webstertoo · October 2009

I called the doctor's office this morning and they have the pathology report but he's seeing other patients and will call later. I did fine this whole week but now that I know the report is in, my stomach is doing flips. I just want the surgery to be over with and get on radiation but I keep thinking that if he won't call, it's because the results are not as good. I read all of your posts and know that I'm in the same boat with other wonderful woman. That's what keeps me going.

nancy258 · October 2009

Waiting is the hardest part! Webstertoo you will find a lot of support here. Even close people at home don't understand exactly what you are going through. The women on these boards do, and I have to tell you it brought me so much comfort while I was going through diagnosis and treatment. Lean on us!

Hugs,

Nancy

unklezwifeonty · October 2009

Dear Webster,

You are in my prayers. Waiting is the hardest part of this disease especially till you are fully diagnosed. Good luck and please do not read anything into the surgeon calling or not calling till later in the day.

webstertoo · October 2009

My doctor called and said that one of the two lymph nodes removed contained 1 mm of cancer. Since it's very small he's not sure if I need more lymph nodes removed or have radiation to the breast and lymph node area. Also we don't if I will need chemo. He will present my case at a conference next week and I need to get opinions of medical oncologist and radiologist. Has any one had this small amount of cancer in the lymph nodes and what did you do? Also I have a lump above the incision for the SLNB. Should I massage the lump?

unklezwifeonty · October 2009

Dear Webster,

It is called nodal involvement at micro level.

Till recently, this would have been called node negative now they call it N1mi (mi for micro). I also had N1mi. My surgeon (from Sloan) removed 7 more nodes all of which were found -ve.

The lump in the breast or axilla are most likely hematoma (internal bruise). Get it checked out by the surgeon for confirmation. My surgeon had asked me to use hot compresses after 4-5 days. It took 5 weeks to fully dissolve.

What did he say about your margins?

Also, now is a good time to find a reputed medical oncologist who is not related to the surgeon. Look for one in a university/teaching/research hospital and make an appt. This medical oncologist should be in addition to the one your surgeon recommends.

webstertoo · October 2009

Thanks for both of your answers. My margins were clear. Unklezwifeonty, did you have chemo and what did you mean by -ve. Couldn't find it in the list of abbreviations. I will put some warm compresses on the lump and tell the doctor about it on Tuesday, my next appointment. Did you have multiple oncologist and did your insurance pay for both. Unfortunately, I turn 65 in November and must go on Medicare in the middle of this.

unklezwifeonty · October 2009

Dear Webstertoo,

Good to know your margins are clear. I used a non standard abbreviation. "-ve" is negative or not involved.

Yes I'm getting chemo because I had a bigger tumor and I am not eligible for hormonal therapy. Your tumor was smaller and you are eligible for hormonal therapy (being ER+/PR+). Exactly how big was your tumor? That may help decide whether chemo is needed.

webstertoo · October 2009

Dear unlezwifeonty,

Its 1.5 cm which is good. See you are from N.J. I'm heading over the bridge on Saturday to attend a Genealogy conference. Trying to keep busy. Thanks for your knowledge on this.

unklezwifeonty · October 2009

Dear Webstertoo,

Did he say anything about OncoType DX test (or 21-gene RT-PCR assay)? With tumor of 1.5cm and 1 node involved at micro level that test finds how likely it is for the cancer to recur and that tells them whether chemo is indicated. The test is done using 1 of the slides from your surgery and I think they should have ordered it already. Hormonal therapy is a definite.

Grade 1 breast cancer is slow growing and I'd take a few weeks to decide/get second opinions etc before commencing treatment.

Hope this helps.

webstertoo · October 2009

I saw a medical oncologist today who said that because I'm young (65) and healthy he wants to treat me aggressively with four sessions of AC every two weeks and four sessions of Taxol, again every two weeks. I asked about the Onco Type DX Test and he said that it's not given to women with positive lymph nodes.

I see everyone talking about %,when comparing different treatments. I asked him about this but he lost me. I had my sister with me and she too felt that he didn't explain things well. Are there specific way I should ask the questions about the different treatments. I'm definitely finding another doctor if I stay with this center but am thinking of getting another opinion.

I found the lump the third week in August and it's now almost November so I wonder if I need to start the chemo soon or l have time to wait for second opinion. I understant that chemo is normal for a positive node. He also left decision up to me about getting a port, or not. Is that normal.

Sorry for all of the questions. I've learned so much in the last month reading the threads.

Debbie

unklezwifeonty · October 2009

Dear Debbie,

We are here for you. Feel free to ask any number of questions.

You definitely should schedule a second opinion. Chemo is started typically 4-8 weeks after surgery so you have time.

When you say % I think you mean 10 year disease free survival %. That is provided by the oncologist using OncoType DX and/or Adjuvant Online and it helps decide whether chemo would help and if so how strong. Any benefit of chemo has to be weighed against the risks and long term side effects. Yes Chemo is recommended for positive node. But node is considered positive when the spec in the node is greater than 2mm. Your post of October 15 indicates 1mm. If the spec in lymph node is less than 2mm, the NCCN guidelines for Breast Cancer recommend the 21 gene RT-PCR assay (Oncotype DX). Also previously you indicated Grade 1, your signature today says Grade 2. Can you check the pathology report and clarify please.

You should decide on chemo first before thinking about the port.

webstertoo · October 2009

Thanks so much for the help. The results after the core biopsy said well differentiated but when I received the pathology report it was written as well to moderately differentiated. The Nottingham score was grade II. I was also told that its T1cN1, stage II. The comment on the node said "largest tumor deposit measures 0.1cm. There was no lymphovascular invasion.

Yes, you're correct about the survival rate %. That was what I was looking for from him. My surgeon put my numbers into an online porgram and said the recurrence rate would be 8%.

I see the radiologist today and hope I get better feeling from him.

Debbie

unklezwifeonty · October 2009

Dear Debbie,

A second opinion with a different medical oncologist is timely and recommended.

You should know that the prognosis (disease free survival %) are excellent with ER+/PR+/HER2- BC compared to any other BC.

Good luck for your meeting with the radiologist (or radiation oncologist?).

webstertoo · October 2009

I had a great appointment with the radiation oncologist today and he got the oncologist to agree to getting the oncoType DX test done. The breast cancer coordinator at the hospital will also get me an appointment with a different oncologist. So now I have a surgeon and radiation oncologist that I like and trust so feeling better and know I will find a good oncologist.

I was wrong about the 8% for recurrence, it was 8% chance that more lymph nodes are affected. We've decided not to remove any more nodes and radiate the area along with the breast.

Debbie

unklezwifeonty · October 2009

Dear Webstertoo,

Excellent to hear you are getting clear direction now and are assembling a medical team you are happy with. Make sure to ask for copies of all reports as you get each test done.

Lumpectomy and SNLB tomorrow

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