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Filling in the gaps January 25, 2014

Posted by Judy in Musings.
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Starting sometime on the 11th, maybe the 12th, this is what my body will be doing: filling in the gaps. I met with the surgeon this week and the deets for my lumpectomy, scheduled for February 11, were finalized. The biggest task for my body will be to fill in the gaps left by the double lumpectomy. (I say “double” because two lumps will be removed from the same breast, not because each breast will have a lump removed.) My tumors are 1cm and 1.2cm. In order to make sure that all of the cancer is removed, the surgeon needs to take more than just the exact tumor size. He’ll be removing 1.5cm/tumor. This will give him the best chance of having the necessary zero margins. (As a refresher, zero margins means that there is tissue all the way around the tumor that is healthy/non-cancerous.) He needs to have at least 2 millimeters of clear margin all the way around. Once the lumps are removed, I’ll be left with a dumbbell-shaped crater. The breast tissue will be rearranged and pulled over the crater, thus providing an excellent barrier to infection, and allowing the body to fill the crater with fluid and eventually scar tissue.

Some of you maybe be thinking, “Wow, 1.5cm, that seems pretty small. How does he know he’s actually getting the right spot?” I wondered the same thing. Surgery is a team effort. In this case, the surgeon has to rely on the radiologist the help him locate the tumors. When I had my biopsy back in December, they placed a titanium clip in each of the tumors to mark their location. The day of the surgery, I’ll first see the radiologist, who will place 2-3 metal wires in each of the tumors, using ultrasound and the metal clips to guide him. My understanding is that at least one of the wires will be placed right in the center of the tumor. The surgeon will then use these metal wires to locate the tumor and to measure the correct distance from the center of the tumor. So you can see that the surgeon really has to rely on the radiologist and hope that he is accurate because he’s operating on something that he can’t see. The surgeon said that sometimes, you do have to go back in and remove more tissue because there aren’t negative/zero margins. According to him, nationally, about 33% of women have to have further surgery in order to get negative margins. At the Mills Breast Cancer Institute, only 5-10% have to have further surgery. I’m confident that both doctors will be spot on. [As a brief aside, I’ve realized that I am receiving care from a top notch cancer center. Having access to a cancer center has been really convenient since I didn’t have to go shopping around for an oncologist, for a radiation oncologist, for a breast surgeon, for a geneticist and for a social worker. Everyone is in one building and the doctors all specialize in dealing with the breast. This is a huge advantage to me as a patient.]

I should make one modification to the above information. One tumor will have 1.5cm removed, while the other will be 1.6 or 1.7 centimeters. The reason for this is that one of the tumors is lobular cancer, while the other has both ductal and lobular features. (More on that in a future post). As a refresher, lobular cancers are tricky because they don’t grow in neat little packages. Instead, they have little finger-like protrusions, making it trickier to ensure zero margins. As we were signing the consent form, the surgeon mentioned the possibility of having to re-operate, “but that’s usually only a problem with DCIS and lobular cancers.” Wait . . . . I have lobular cancer. I was confused. Not one to let that slip by, I asked “Isn’t one of my tumors lobular?” He replied, “It has ductal and lobular features, but still more clearly defined edges.”

Hmmm . . . . that still didn’t sit right. “I’m sorry, can we go back to the lobular thing? I thought one of my tumors was pleomorphic lobular something or other. Is that not lobular cancer?”

“Oh, yes, that is. I must’ve been thinking about another patient. If yours is lobular, then I’ll remove an extra .1 or .2 centimeters.” Ah, okay, much better. Yes, he did make a mistake, but I’m giving him the benefit of the doubt. I’m betting he didn’t carefully study my chart immediately before my appointment, and I”m betting that he will do so before the surgery. So, it should be fine.

Anyway, so the surgery will basically be outpatient since I won’t be having an overnight hospital stay. I’ll have a one week post-op visit where he’ll make sure all is well and we’ll discuss the final pathology results, which will tell us the exact size of the tumors, the regeneration rates and a few other things that I can’t remember.  Knowing these results will then allow the medical oncologist to craft a definitive plan of action to “cure” the cancer. The surgeon also said that I would be free to travel on a plane after the one week post-op visit! I’m hoping to go to a conference for young women with breast cancer at the end of February. It’s looking like I’ll likely be able to go to the conference and that recovery may be not as dramatic as I had thought it would be.  Praise the Lord!

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