December 2011 Surgeries - want to wait together?

Awesome news, chrissilini!

CookieMonster - looking forward to your post....

 Kam170 - Can't remember - do you have another surgery date scheduled?

Chrissilini...you got an awesome oncologist!

Chrissilini - Am I wrong about this?? Looks like your initial dx was Grade 3 and now it is possibly Grade 2??

Blessings - yes, my surgery is postponed from previous Dec 13 (lump) to Jan 20 (BMX) due to BRCA.

Anyone? - Chrrisilini's "lymph vascular invasion" negative - this seems like a biggee to me??  Does anyone now the real signficance of this one thing, medically?

Eve,

Hang in there. We all heal at different rates but it often takes more time and patience than anticipated. I hate the narcotic pain killers too but they did their job when needed. Sleep is very healing and a mastectomy is major surgery.

Caryn

Hi Ladies -

I just got back from my first Oncologist meeting.  

Two lymph nodes taken, both negative, I have DCIS, LDIS and IDC.  They belive that with my UMX that they removed all of the IDC - no residual in left breast.   All clear margins. 

He is recommending Hormonal Therapy. 

My Oncotopy DX is not back yet.. if low score, no Chemo.  High Score, then I receive Chemo.  A middle score is most likely no-Chemo. 

No need for Radiation. 

I will still need to keep my right breast in check....Mammo every 6mos or yearly.  I sometimes second guess my decision to have a Uni vs. Bi.  There is a probable chance that I have LCIS in other breast and I will need to keep an eye on it.  For now, my right breast is still staying. 

I am extremely happy with the good news that I have received and my MO believes that my Oncotype DX results will be low.  So, good to go with just HT. 

I want to once again say that these posts have been with me daily.  I have looked forward to the messages I see here in the December surgery postings.  I love reading your messages and I love seeing your progress.  Much love to all of you!

Carol Ann

Sounds like some good news was heard today...wondering about you Cookie?

FYI- this is info on lymph vascular invasion from an abc news report:

Question:What Does Vascular Invasion Mean?

Answer: Before a cancer can spread to the rest of the body, it has to get into the channels that go through the rest of the body; that's lymph channels or blood channels, particularly the venous system. If the cell gets into the veins, it can go to the heart, and the heart can pump those cells to the rest of the body; and it might grow in those places.

One of the indicators that we have that cells have a tendency to go into the vascular system and to spread to the rest of the body is called 'vascular invasion.' And when we see, under the microscope, cells that are actually getting into blood vessels, this gives us some indication that these cells may have a tendency to spread; and we should use drugs that kill cells wherever we find them that goes through the blood stream, such as hormone therapies and chemotherapies.

I am exhausted after a day in preshcool and climbed in bed at 5pm.

I know my final surgical report said no vasuclar invasion and 0 node involvement...at least in the 4 nodes taken. But, my oncologist said as she studied the biopsy pictures that it looked as if there might be vasclar invasion with the initial biopsy of 2 C. I need to ask her if it's on the initial biopsy report. I didn't read it. It seems that if there is no evidence of vasular invasion or node involvement then the mx is treatment enough for stage 1 cancer.

How do you determine if you are stage 1a or stage 1b? I figured I'm stage 1a in that there is no node involvement or vasular evidence.

Mid January I'll meet with my oncologist who will explain my pathology report as it is difficult to understand it all. I am happy that the cancer didn't spread outside the breast area.  

eve- they thought they saw vascular invasion on my initial biopsy as well but it was not in the final pathology and they said that is the one they go by. Not sure why it would be on one and not the other but I trust my drs.

Eve, what do you mean when you say that "the surgical report rules" make you a stage IA? 

I know that in determining the tumor size for staging purposes, if the tumor is multi-focal and there are two (or more) separate tumors, the size of all the tumors is not supposed to be added together to determine the tumor size and staging.  Instead, it's the size of the largest of the tumors that is used for staging purposes.  However if you have a single tumor that is partially removed in one surgery but the margins aren't clear and then the rest of that tumor is removed in another surgery, my understanding is that the size of the tumor for staging purposes will be the combined size from the two surgeries.  That is the reality of the size of the tumor.  That fact that it wasn't all removed during one surgery really isn't relevant.  

Was the area of cancer that was removed during your mastectomy part of the same tumor as what was removed during your lumpectomy, or was it a separate area of cancer?

I completely understand that you prefer to be Stage IA because it has a better prognosis but if that turns out to not be the reality of the situation, you would want to know, right?  So it's probably worth talking to your oncologist about. Same thing with the vascular invasion. My understanding is that if something is definitively found (actually found, not just speculated) during a biopsy or lumpectomy but then the same thing is not found during a subsequent lumpectomy, re-excision or mastectomy, that doesn't mean that what was found in the first place never happened and isn't incorporated into the staging and/or treatment plan.  In my case, my microinvasion of IDC was found during my excisional biopsy.  No further invasions were during my mastectomy - that was DCIS only.  But my staging is Stage I and not Stage 0, because of that microinvasion.  And the discussions with my oncologist about my prognosis and any subsequent treatments all considered the fact that I had that microinvasion and did not have pure DCIS.  So in my case, my diagnosis was based on the combination of my surgeries and in fact more so on my excisional biopsy than my mastectomy. 

How long do you need to rest after a mastectomy with reconstruction? It's been a few weeks and I still have the drain. I want the drain removed but the surgeon won't remove it until it stops draining so much...so I do almost nothing for now hoping the rest will heal the wound and stop the drain thing.

I feel trapped...can't drive or do much. This is all part of the healing process...just wonder how much longer until life returns to normal?