breast surgery plan and lab report

To say I’m relieved cannot even mildly relate the feeling I have since meeting with my surgical oncologist at UCI. After he examined me and looked at all the reports, the films, the slides and consulted with his chief resident who was also involved equally, he told me my prognosis is good.

Simply, here’s what I can remember off the top of my head. The mass is invasive but smaller than we’d thought from the previous reports: it looks more like a 2.8-3.0cm mass instead of a 3.6. It appears not to be invading the chest wall or other structures. The lab report does not indicate nodal involvement, but he said they can’t totally determine that until surgery. He will do the sentinal node surgery; he said that if he determines when he’s operating that it looks like the nodes are involved, he will take out whatever seems to be involved up to and including the typical axillary dissection of the nodes. In examining my axillary nodes, he said one feels a little hard; however, he added that sometimes the trauma of the biopsy and other diagnostics to the breast can cause that.

I don’t have the BRCA1 or BRCA2 gene. I forgot to ask about HER2neu, but I’m guessing he would have covered that if it were positive. The tumor is ER positive. The grading is intermediate on a 3-point scale of low, intermediate, high.

Here is the plan:

  • MRI of the breast/s (optional protocol I’ve volunteered to participate in)
  • light/laser type diagnostic protocol (also optional for studies in improving diagnostics of BCA)
  • lumpectomy plus sentinal node and then whatever is required for the nodes if they need removal — a one- to two-hour surgery, maybe longer depending on nodal involvement; sometimes patients stay 24 hours, otherwise they leave after this outpatient surgery, performed at either the breast center or in main hospital
  • chemo for 2 or 3 months — don’t know what kind yet; he said it will be determined later along with the protocol of how much per session and how many sessions per week; the oncologist who will later join my treatment team will be the one deciding this part of my therapy
  • radiation five days a week for five to six weeks
  • hormonal therapy: Tamoxifen for five years (with checkups for uterine changes, bleeding, etc.)

My surgery will be scheduled maybe the end of the week next week. In the meantime, I’m going for the various pre-op tests — today blood, EKG and chest x-ray. My EKG had something on it that they said didn’t need to alarm me, but they asked if I had a base EKG somewhere. I don’t. I know Dad has a murmur; maybe I have something like that.

My impression was very positive. I felt like everyone was what I expected from an NCI cancer center. Of course, my need to feel confidence in my surgeon was most important. Doctors that I work with and our department administrative who had BC ten years ago and went here for her care went a long way in helping to boost that. Of course, today was critical in confirming it. Dr. B inspired my confidence with his manner, both professional and personal. He answered Marvin’s and my questions and asked again if we had any more questions before he left. The surgical oncology nurse came in afterwards and took my anesthesia questionnaire and talked to me about what to expect. We talked about the length of time of the surgery, the possibility of staying overnight and the anesthesia. She was also thorough, professional and very cordial. She called the social worker, who came and talked to me about the support options: the buddy system, the meetings and other things that the cancer center and breast center offer.

By the time I left, I was nearly giddy at being so optimistic and confident that I am going to be treated by the right doctor in the right place. When I went to get my chest x-ray and they asked why I was there and I told them, they were surprised that I was in such a good mood. I wanted to tell them that based on what I knew could be the worst outcome, I was deliriously happy with my prognosis.

We didn’t get out until after 4:00, and we went home after an errand or two. I am exhausted till I feel like I could fall down. I don’t want to go to sleep too early, though, because I want to sleep the entire night and not wake up at 3:00 which is what I’ll do if I go to bed too early.

I’ve been busy, too, reading some material one of my residents sent me. He’s so sweet. He sent me three e-mails with lots of details on breast cancer. At this point, I’m amazed that mostly everything I read was what I have already read, if not totally absorbed yet. It’s clear info, medically written, so it was good objective reading. I was ready for it tonight. I guess I must be learning some new things. It’s like starting to teach a class the jeté: you start with little moves of transferring weight from one foot to the other with a little lift. That’s how this feels. Like a little jeté.

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