
After grousing around for a couple of days, wondering what the heck I was going to do about my breast surgery, I finally came to a decision. I took my surgeon's (Schultz) advice and spoke to my oncologist (Silva) today about what the rationale is for advising a mastectomy instead of a lumpectomy, Schultz's choice. Silva explained that either choice is a good one for me. Both will do the job. All my tests came back with no evidence of disease. The reason for his siding with a mastectomy in my case is that for someone with my type of breast cancer: estrogen and progesterone (hormone) negative, grade 3 (irregular cells and aggressive), and Herceptin positive, multi-focal and strong family history of breast cancer, the "Standard Treatment" after neo-adjuvant (chemo before surgery) therapy is mastectomy followed by radiation therapy. That type of cancer is at "high risk" for recurrence. Also, I have a lousy family history of breast cancer in my family - mother and 2 sisters, plus myself. (Side note: I was tested for the BRCA gene mutation and it came back negative. That means I don't have that hereditary breast cancer gene, but who knows what gene we may all share that has not yet been identified.) (Second side note: I didn't miss my mammograms. Had one every year, sometimes every 6 months when indicated, yet I went from a good mammogram in 2006 to all this cancer in 2007.) There also had been axial node involvement - cancer seen initially in the axial (armpit) area. Even though I will have the radiation therapy that would kill any remaining microscopic cancer cells, and the Herceptin will continue through infusion for 9 more months, perhaps there may be the slightest edge in opting for a mastectomy. Dr. Silva is very much a statistics man. When a question comes up, he always goes to the data to find out what the studies say, so that is the answer I would expect from him. It's not that he dismisses other points of view regarding cancer treatments, it's just that he is so thorough that he always looks to the research to see what the data shows, which is a good thing. Guess work and hunches aren't his style.
I thought over what he told me, and decided that it is my job to do the best I can to maximize my chances for a complete recovery. It wouldn't be fair to myself, or to Jim, who has stood beside me through every treatment over the past six months, to take the easy way out and chance it that breast cancer wouldn't recur. If it does come back, and I had opted for a lumpectomy, I would always wonder, suppose I had had a mastectomy, could this have been avoided? It would be unfair to put Jim or myself through this again through an easier choice. If I still end up with a cancer recurrence after a mastectomy (nothing is 100% guaranteed) I would at least know, hey, I did everything I possibly could to avoid this. It wasn't through a wrong/bad decision that I made.
After my chemo treatment I went up to Dr. Schultz's office and told him that although I would much rather have a lumpectomy, I thought it was in my best interest to have the mastectomy. He said he knew how much I wanted to have the lumpectomy and wanted very much to be able to give that to me, and was thinking with his heart instead of his head. In other words he knew what he SHOULD do, but he was pushing for what he wanted to do for me. No one will know the answer to the question until after the operation and the pathologist's report comes back. If the report comes back clear, I will have had the mastectomy for nothing, and could have gone for the lumpectomy. But if there are any microscopic cancer cells in evidence, the mastectomy was the right decision. And believe me, a mastectomy is a much more complex surgery, what with the follow up surgeries that will need to be done, than a lumpectomy is.
Another topic we discussed was the Sentinel Node Biopsy, which will be done at the beginning of surgery. A dye is injected into the node drains to identify all of the nodes that drain from the breast (as opposed to the arm, the shoulder, the hand, etc.) Each and every node that is connected to the breast will be removed, opened up and studied under the microscope for evidence of cancer cells. What's interesting to me is that from woman to woman, the nodes aren't anatomically the same. They don't match up, so he goes into each SNB and selects just the nodes he needs based on the ones that are stained by the dye. The numbers can be many or few.
We also talked about follow-up reconstruction surgery and he gave me the name and phone number of his best plastic surgeon, who works along side him during surgery. I will make an appointment with him and go over lots of information. And I have quite a few questions to ask.
One thing I learned that had been confusing to me is that my larger tumor, not the one Dr. Schultz biopsied during the sterotactic biopsy on 4/19, but the one discovered afterwards on 4/24 by the breast MRI test was "sigificantly large" - a 3.5 cm x 3.0 cm x 0.3 cm mass. That's huge! I didn't know about that one, I only knew about the sterotactic biopsied one that measured 1.2 cm. Dr. Silva also mentioned other "highly suspicious lesions." Ignorance is bliss? So now the pieces of the puzzle are falling into place. Dr. Schultz had told me that I had other tumors and multi-focal calcifications, but he didn't specifically talk about the large tumor, which was actually the much bigger problem. Now that I know the size of that tumor, the fact that in less than 6 months it was totally gone is even more amazing!
I learned about something else that had been on my mind. What about the other breast? There was no evidence of any tumors in the right breast, but all this tumor activity in the left. Would the right breast be next? Was it just a matter of time? The answer is that the specific cancer tumor I have only expresses itself in one breast. It doesn't happen in the opposite breast. Dr. Schultz said there was a journal article addressing this very topic recently. I find this very interesting, and would like to read the article. First I have to email Dr. Schultz and find out the name/identification number of that tumor cell line. His favorite "Pain in the Butt" - he knows that I obsess over things. He's probably expecting an email from me even as we speak.
Well, I know this is long, but we went over a lot of information today, and I needed to get it all down before I lose it to "chemo brain."
PHOTO: Jim on the John Deere on the front 40.