Stage II...how soon do you have to have surgery?

Lifeafter · January 2012

My MIL's sister was diagnosed with Stage II breast cancer. She had a lumpectomy two weeks ago. I went with her to her oncologist appointment today to be her ears and to ask questions. The oncologist painted a dire picture (I'm so tired of oncologists!) and agreed with her surgeon that surgery has to be this Friday. She is with Kaiser. She has a lot of things to get in order and to prepare, FMLA, disability, care, where she will stay (she rents a room). She is 62/63 years old. I took notes from her path report, hopefully someone here can shed some light. Can she wait a week or so? I've been through this but I'm not stage II (See my sig line). I'm a little taken aback that they are saying it has to be now. You should know they are expecting a nursing strike next week for a couple days. I think they are just trying to schedule and line patients up like cattle before it happens. These are my notes:

two tumors excised (2cm/3cm)

4 nodes removed, all positive

some dcis, grade 2

multi-focal

I have more detailed notes but this is the shorthand.

Michelle

TifJ · January 2012

Michelle- It does seem a bit fast, but I think most women would prefer to have surgery ASAP just to get the cancer out. I am stage 1B, multifocal, but no nodes positive and it was about 2 weeks between diagnosis and surgery for me. I see it as the sooner you begin the process, the sooner it will be over! Best wishes to your friend!

Lifeafter · January 2012

Thanks, TifJ, it's not a matter of preferring unfortunately. She's in a position where it's just not possible. She has no care system set up, her job, etc. She needs a week to get everything in order. She's being scared out of her wits that doomsday is tomorrow.I don't think that's fair to her. She could lose her job which leads to her insurance. I think the drs are pushing her because of the strike. The drs are not coming across very sincere to her but more like just trying to get another patient off their list. It's frustrating. I had/have awesome care from my drs (with exception of one). It's eye opening that not everyone has that.

Michelle

Mallory107 · January 2012

I could be wrong here b/c I am fairly new to all of this but my guess is that this is more about the doctors and what is convenient for them. From what I have learned about BC is that it is not usually a medical emergency...the tumor/s have been growing for a long time and the cells take a long time to duplicate. At least that is what I was told when I complained that it took too long between DX and surgery. I could see if it were a stage 4 but not what your MIL has. So odds are that they want to put her in when they have an opening in the schedule and they know they will have nurses. Also-maybe the next opening that they have is far off and they don't want her to wait THAT long either. I feel bad for her-how stressful this has to be. She is lucky to have you to help her. Could she switch to your docs?

Lifeafter · January 2012

We met with the surgery/nurse coordinator yesterday. She's nice but when I kept bringing up that she needs to get this paperwork taken care of, she kept saying well she still has to have the surgery... Well DUH! I said, we need to talk to the surgeon. She said he's really busy and I said...he can't do a phone consult? I know he's busy but this would take a few minutes out of his time to explain why this has to be Friday and why it can't wait two weeks (at the most).

Mallory - She's with Kaiser, I have Blue Shield HMO. Completely different animals. I'm glad I don't have Kaiser.

Michelle

ProudMom_Wife · January 2012

Michelle - I think the possible strike is having an impact on them pushing for the surgery for this Friday. However they also probably want to start chemo ASAP since she has 4 positive nodes. I know with some Stage 3 breast cancers they do the chemo first at Kaiser. Can you ask her oncologist if they can do the chemo first and then the surgery. Her particular pathology may not meet the criteria for that approach, but at least you could have the discussion. This could give her more time to get things in order. If not, I know it is going to be difficult, but she should go ahead with the surgery on Friday. Best wishes.

Edited: After I wrote this it occurred to me, what type of surgery are they wanting to do on Friday? ALND or mastectomy or both?

Lifeafter · January 2012

Proudmom - We met with the oncologist yesterday. He said chemo isn't an option first because they already removed the two tumors they found when they did the lumpectomy. They were 2cm and 3cm, approximately a 1cm from the nipple. I thought they did chemo first also, but he said it wouldn't be a benefit. I also asked if it was necessary to take all the nodes. If they did chemo first, would that not kill the cancer that was lingering in the others. They said because she was positive 4/4 that they really needed to go in and take those out now. The surgeon is going to remove all nodes in her left side and her left breast. She wants her other breast removed also, they are discouraging her against that. They say her chances of another cancer attacking her other breast is around 10/20 percent. In my case it was 40 percent (no brainer for me). She is worried about asthetics also. That to me is a personal decision and I wouldn't tell her she shouldn't if she wanted it. All I cuold tell her was what to expect pain-wise after. She will be in more since she will have all her nodes removed, I only had three removed. I think it comes down to whether she thinks it's worth it.

Michelle

Lifeafter · January 2012

These are the notes I took from her lumpectomy pathology report:

left aux node biopsy - 4/4 nodes w/metastatic adenocarcinoma, largest focus 2.2cm, rare focus suspicious for extranodal extension, crush artifact, precludes optimal evaluation

Left upper breast - Invasive mammory carcinoma (ductal/lobular mixed), nuclear grade 2, two foci (2cm/3cm), few foci intermediate grade dcis

left lower - multi focal (7) IMC (duct/lob mixed), nuclear grade 2 (.1cm)

superior margin - small foci (1mm) IMC

medial margin - multi foci (4) IMC, lobular features (.2 to .8 cm)

deep/inferior margins - benign

Michelle

ProudMom_Wife · January 2012

Hi Michelle - With regards for her decision for a unilateral or bilateral mastectomy, that is her choice, not her doctors. She needs to do what she thinks is best for her. My guess, and this is only a guess, they are pushing for the surgery this Friday because of the potential strike. Because usually they want to start chemo within 4-6 after a mastectomy. So the doctors might worried about a long protracted strike. Don't know what the situation is, but that could be a factor. Hope this helps. Tell her that you both are in my thoughts and prayers.

Lifeafter · January 2012

Thank you all, this really helps. I just got off the phone with her. I passed on allthis info. She doesn't have access to the Internet so this is very helpful to be able to pass this on. She has a pre-op appt this afternoon. I told her she should keep the appt even if she decides to have them schedule fir the week after. I also told her to see if she could talk to the surgeon and ask him point blank if the urgency is because of their convenience or because of the medical implications. She needs to let them know that if she can wait a week, she has to get things together so she is covered. There is nothing worse than going through recovery with all the other undue stress. She needs to focus on what's going to lie ahead of her.

Michelle

Stage II...how soon do you have to have surgery?

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