Posts tagged Lymph Nodes
Just the Facts: A year ago today I was diagnosed with Invasive Mammary Carcinoma — a “pea” was found. Ironically, I had one of the last visits I’ll need with my plastic surgeon this week. In the course of a year, I’ve discovered I had breast cancer, had a bilateral mastectomy and had two follow-up surgeries to reconstruct my breasts. This journey really has no end, but, thankfully, I am through the rough part. My health is now excellent and on top of that, I’m pretty much looking myself. This year hasn’t been easy but it’s over, and I’m ready to focus on other things!
Details: On February 12, 2010, I answered my cell phone to hear a radiologist’s voice. I knew that since the doctor was calling (not a nurse), this was bad news. He proceeded to tell me that the biopsy I had two days prior had revealed Invasive Mammary Carcinoma. Life changed instantly as I realized what might happen as well as what would have to happen.
Later I would learn that I had not one, but two tumors. They both turned out to be sort of small, each slightly larger than a pea. My choices for treatment were really not too difficult to make. In order to be most aggressive in this fight, I needed to have both breasts removed. Thankfully, I found a wonderful breast surgeon and an equally incredible plastic surgeon. I had a bilateral mastectomy with immediate reconstruction on April 6, 2010. That was the day I conquered the cancer!
Following the surgery, we learned that my lymph nodes were cancer-free and that the margins from surgery were clear. My cancer had apparently been confined to the breast tissue, which was now gone. Later a special diagnostic test was performed on the tumors and it revealed that the cancer would not respond particularly well to chemotherapy, but would be responsive to hormone therapy. We rejoiced at that news! No chemo, although five years on the drug, Tamoxifen, was essential.
Through the summer I went through the strange process of tissue expansion in anticipation of a second surgery to place silicone breast implants. I am thankful such procedures exist, but it was both exciting and highly annoying. On August 31, 2010, the tissue expanders that had been placed at the time of the mastectomy were replaced with silicone implants.
Life with implants is somewhat strange too, but so much better than expanders. At first, I was very pleased with the outcome of the exchange surgery. Then, something went wrong. The internal sutures on the left side did not hold as my plastic surgeon had planned, and the left implant shifted. It was not good. So on December 27, 2010, I had that fixed.
I am technically still recovering from that surgery. It has been about 6 and 1/2 weeks. My plastic surgeon says that 8 weeks is the absolute longest it should take for the implants and sutures to be “set”. I am taking every precaution to make sure that things don’t shift again. For this period, being “careful” has meant among other things: no kettlebell training nor any form of weight training, no heavy exercise, no lifting anything heavier than a milk jug, and sleeping in a recliner with pillows propped all around me for support to avoid any shifting. Yes, I have been sleeping a recliner for almost 7 weeks. (And will continue for another week.) This is that important!
I see my oncologist every three months. I will be doing that for another 2 years, then less often. I go back to my breast surgeon for one more follow-up with him in a few months. And I still have a few things for the plastic surgeon to finish up, though overall we are generally pleased with the outcome of this last surgery. As far as we know (and we certainly HOPE) there should be no more breast reconstruction surgery. Just a few finishing touches. Those will be completed later in 2011, probably.
Sometimes I still can’t believe all this has happened. Aside from some symptoms from the Tamoxifen, I feel great. It’s weird to think that I am a breast cancer survivor. But I am! And as predicted, I am certainly STRONGER now!
What’s coming up: Some more healing, physically and mentally. More doctor visits. More plastic surgery. But the worst is definitely over.
Prayer Requests: A year later, I am cancer-free and strong. Please thank God with me!! The blessings I have received through this trial far outweigh the difficulties I have had to endure. It’s okay to pray that the cancer stays away, too.
This blog: Given that this journey is winding down in a big way, the blog is too. I can’t tell you how much the support from friends here has meant to me. But it is time to move on. I’ll only update this blog a couple more times, probably. It will have to be something huge to do so, and I’m hoping that there really isn’t anything else huge that happens. However, I’m leaving the blog here, in case there is someone who might want to learn about my journey. Unfortunately, breast cancer is running rampant, and we will all know someone who will be diagnosed with it at some time. I don’t know if reading about my journey would help someone else facing a similar path, but it will be here, just in case.
Thank you for reading and commenting over the last year. I pray that everyone who has reached out to me in any way would receive tenfold blessings in return.
Wishing good health and happiness to all!
Just the Facts: The Oncotype Dx test results are in, as are results from the CT scan and bone scan. It’s ALL good news: NO CHEMOTHERAPY for me, and all scans were NORMAL!
Details: Last Friday I spent the day having pictures made. I had a CT scan of the chest, abdomen, and pelvis and a bone scan. Drinking the contrast was only slightly gross. The worst part was that it took most of the day to complete. The scans themselves were easy.
Today I met with a new oncologist for a second opinion. I also met with my original oncologist to receive the results from the Oncotype Dx test. We will be working with her going forward and we realized how much we like her. The best part, of course, was the news she had for us: NO CHEMOTHERAPY. The Oncotype Dx is a test that evaluates the actual tumor (or tumors, in my case) based on 21 genes. It is offered to a certain group of women, who had no cancer in the lymph nodes and whose breast cancer is hormone receptor positive. A result is returned for each tumor, classifying it as LOW, INTERMEDIATE or HIGH RISK for recurrence. Those who fall into the low risk category are NOT given chemo. High risk patients are given chemo, and those who fall in between must weigh their options and make a decision based on all the factors. No decision was needed for me because BOTH of my tumors rated LOW RISK according to the Oncotype Dx test!!!! YESSSSSSSSSSSSSSSS! Radiation will not be part of my treatment either.
That isn’t quite the end of the story, though. Because my tumors were hormone receptor positive (they especially depend on estrogen to grow) any remaining cancer cells will respond well to the drug, tamoxifen. All the doctors agree that this should serve as the “magic pill” for me, essentially stopping the cancer dead in it’s tracks. I am not excited about taking any type of hormone pill, but do understand the need in this case. If I were to reject the drug and do nothing further, my risk of recurrence would double. Tamoxifen is a serious medication and has significant side effects. I am told that I should fare much better than most women who take it since I am younger and active. I will be taking it for the next FIVE years. I’m really not looking forward to it, but I am counting my blessings. I’m also making some other changes in my diet and lifestyle to further support an anti-cancer environment
I have been blessed to get this far without much discomfort. In the last few days, the area below one of the tissue expanders has become very painful, though there are no signs of infection. Research on the ‘net (only partially reliable) suggested I could have a fractured rib caused by pressure from the expander, but my oncologist didn’t think that was the cause. She believes it’s inflammation in the serratus muscle. Whatever the source, it is VERY annoying and is causing me more pain than I have had since the first few days after surgery. I will see my plastic surgeon on Thursday anyway. We’ll see what he has to say. I hope the pain doesn’t continue until I have the expanders replaced (August-ish)!!! I am temporarily suspending kettlebell work until I can get the pain under control (you know it’s serious when . . .) The oncologist made some recommendations for pain management for the time being, which I am embracing!
Me: SO PSYCHED that chemotherapy is not needed!!!!!!!! At the same time, feeling a bit shell shocked. It has been 3 months, almost to the day, since I was diagnosed with breast cancer. I will be taking hormone therapy for the next five years and will be closely monitored (oncologist visits every 3 months for 3 years, then less frequently) and of course, am still in the breast reconstruction phase. I believe most of the hard stuff is behind me. It’s a wonderful feeling, but I also barely know what hit me. In some ways, I am still dealing with my diagnosis!! The bottom line is that the cancer is under control, we have a drug to fight off what may remain, and my future is bright. The rest will fall into place.
What’s Coming Up? One or two more appointments with the plastic surgeon, and then a three-month waiting period. At the end of that, I will have the exchange surgery (implants in, expanders out). Later, further reconstruction will be considered if we choose. Also, I have my tamoxifen prescription. I am told to start it soon. I’ll be blogging about how that goes.
Other: Thank you!! Thank you for the prayers. Thank you for the good thoughts. Thank you for the comments here. Thank you for the tweets and the Facebook comments. Thank you for encouraging me and for just reading the blog!! I purchased this shirt at the oncologist’s office today. Lots of the hard work is already done (WHEW!) but I will continue to do this:
Stay with me as I fight and continue to become stronger.
Just the Facts: Last Friday, Tracy and I went for an appointment with an oncologist. We liked her a lot and will probably not interview any others. She was very optimistic about my outlook but did recommend that we order the Oncotype Dx test in order to make a better decision about whether or not I should have chemotherapy. The fact that chemo is still on the table was a bit shocking to us, but we feel confident things will go well even if I need it. The Oncotype Dx results are expected in early to mid-May.
Details: The end of the week last week was actually quite eventful. On Thursday I went in for my weekly appointment with the Plastic Surgeon. It was my first time having saline added to enlarge my tissue expanders. Quite an experience! A little more will be added each week or so, then a few months later, I’ll have another surgery to replace the expanders with implants.
Friday’s appointment with the oncologist went very well. She spent about an hour with us, going over my pathology report bit by bit. She pointed out the details that were great (there were several) and the parts that were a little concerning (there were a couple). The most important thing in the whole pathology report was, of course, that my lymph nodes were clear. However, that is not the end of the story with regard to whether or not chemo will be necessary, and this was news to us.
She explained that some women with Stage 1 breast cancer can still benefit by chemo. (For many, the risks of chemo outweigh the benefits.) In order to figure out if chemo would be right for me, she wanted us to order the Oncotype Dx test. We already had planned to order the test, but neither Tracy nor I truly understood exactly what it tested, and what it would tell us, until the doctor explained it. The test will return a a numerical score of 1 to 100, indicating whether my risk is low, intermediate or high for a recurrence of cancer. Chemo will not be recommended if the score is in the low to low-intermediate range. For a score of anything above low-intermediate, chemo will be recommended. We were surprised to hear that this was completely independent of the fact that the nodes and margins came back clear. The doctor made an educated guess that my score would come back in the low risk range, but she said NOT to count on it, because the actual tumors are genetically tested in this process, and sometimes there are unexpected results.
If my score does come back to in favor of chemo, my course of treatment will be relatively “easier” since my nodes were clear. It would be 4 rounds of treatment, 3 weeks apart and would include just 2 drugs. This is a much lighter regimen than it would be otherwise.
The doctor also discussed at length the hormone therapy that I must have. I went in to the appointment with many questions and reservations about the drug I will be prescribed, tamoxifen. She could not make me feel good about taking it (impossible) but she did make it clear that this drug is essentially mandatory for my cancer fight. The side effects that are seen with it pale in comparison to the good it does. I still do not want to take it, but am basically convinced that I should.
Prayer Requests: That the Oncotype Dx test would come back indicating I am at low risk of recurrence and therefore, do not need chemo. I do not want a high risk score or intermediate score. An intermediate score also may bring the difficulty and stress of having to make a tough decision, so please pray that the result would not be such that we’d have to face that.
Me: I’m focusing on Romans 8:28, And we know that in all things God works for the good of those who love Him, who have been called according to his purpose. I’m eager for the test results to come back. I’ll take a deep breath and charge forward if those results are in favor of chemotherapy.
Last week’s “expansion” did give me some extra soreness, though it wasn’t exactly as I had expected (not as bad in some ways, worse in others). A pain free night of sleep is still something I haven’t managed since surgery. I keep trying new pillow arrangements and what not. Since I received the OK to do some light workouts, my brain-fog is decreasing. I’m ready for that to be GONE but suspect I still have a couple weeks of it left. All in all, I am doing great.
What’s Coming Up? Every Thursday includes an appointment with my plastic surgeon. I also see my surgeon again in early May, then will see the oncologist for the test results on May 11.
Just the Facts: It has been a busy couple of days. I had my post-surgery follow up appointment with my surgeon yesterday (Tuesday), which went very well. Then I went to my plastic surgeon to have my four surgical drains removed. Today I went back to be checked because it seemed like I was retaining too much fluid, but all is well.
Details: I am 8 days post-mastectomy and reconstruction surgery as of today. Yesterday I saw my surgeon for a follow-up visit. He was very pleased with how I am doing and we mainly ended up discussing the pathology report and our next steps. He referred me to an oncologist and had an appointment set with her for April 23. We will meet and discuss the pathology report in greater detail, then she will most likely order an Oncotype DX report for me, which will boil down all my decisions about chemotherapy and hormone therapy into hard numbers. The surgeon reiterated that most likely, chemotherapy won’t be recommended since my lymph nodes were clear. Hormone therapy (tamoxifen) will VERY likely be recommended.
Here are some “highlights” from the path report for those who have an interest in such things:
- There were two tumors (This princess actually had two peas.) One was 1.5cm and the other was 1.2cm. They were both invasive carcinoma. There were also a few occurrences of In Situ Carcinoma (not invasive) that accounted for the other worrisome spots on the MRI.
- The margins were clear with a range of 2-5mm, which is excellent.
- Three lymph nodes were removed and all were cancer free.
- The left breast was completely benign.
- Both tumors are highly estrogen sensitive and at least partially progesterone sensitive, which makes the cancer highly treatable with hormone therapy.
- The tumors were HER/2 negative, another reason chemotherapy is likely not needed in my case. HER/2 positive cancers are always treated with chemo.
- The tumors were a low grade, meaning very slow growing.
After discussing the report with my surgeon, he asked that I make another follow up appointment with him for three weeks from now. After that he won’t need to see me for a year.
The plastic surgeon’s office is where we’ll be spending lots of time in the coming weeks, and that’s where Tracy took me right after we left the surgeon’s office. They ask you to monitor and measure the amount of drainage that you have each day that you have the drains and come into the office when the output is at or below a certain level. By Tuesday I had been at the magical level for 48 hours and called to see about getting the drains taken out. (Managing life with them is no treat!)
The nurse called early Tuesday morning and said I could just come in whenever it was convenient. So we headed there about 11:00am. Sparing the ugly details, I will just say that having those drains removed was gross and awful in many ways. Afterward, I was relieved but also felt very disoriented and off-balance. For the last week I had grown used to them, my 4 new appendages. Further, they had been there since the loss of another major part of me. Somehow the mix of adding and subtracting plastics and parts left me quite out of sorts. After some lunch I felt better.
However, by late afternoon, I noticed that I was beginning to look quite fluffy and puffy, especially in the post-surgical area. The fluid that would have found it’s way out via a drain was beginning to pool in the area and I started to get nervous. My doctor had mentioned that the success of the reconstruction was dependent on keeping the fluid retention under control, in order to avoid infection and general failure of the effort. I knew some fluid retention had to be expected, but it seemed too much, too fast. I called the plastic surgeon’s office and the nurse asked me to come in today (Wednesday) because she wanted a doctor (mine wasn’t in the office) to check it out.
Through the evening it seemed to get worse, then better, and back and forth. I really did not sleep well, partially trying to monitor the puffiness as I slept, as if there were anything I could do about it. I somewhat expected the doctor to tell me that I would need to go back to the OR and have the drains put back in.
However, the opposite turned out to be the case. The doctor I saw said that the retention was really very little, in the spectrum of things. He said that it would 1)begin to be reabsorbed by my body or 2)be removed by needle if it persisted or 3)be pushed out as we proceed with the tissue expansion process. I already had an appointment to see my plastic surgeon tomorrow (Thursday) so he will check the situation again then and decide what, if anything, else needs to be done. Whew!
Me: I feel good. The ordeal with the drains has left me, well, drained. (I couldn’t resist.) But generally I feel strong, energetic and healthy. The after effects of 6 hours of anesthesia are not unnoticed, though, as I do get sleepy and groggy when I really don’t think I should. I have been told that those effects could take 6+ weeks to wear off. I plan to ask my plastic surgeon for details tomorrow about EXACTLY what types of exercise I can safely do right now, because I want to move again, in that way, and I know it will help clear my groggy head!
What’s Coming Up? Plastic Surgeon tomorrow and every Thursday for a while, Oncologist on 4/23.
Other: Our family has been so hugely blessed by all the support and good wishes and prayers from friends. Thank you. Thank you. Thank you. I am not able to answer most blog comments but I do read them all again and again. Thank you so much.
Just the Facts: I want to SHOUT for joy that the pathology report CONFIRMED all of the following: 1) the left breast was cancer free 2) the margins were CLEAR and 3 )the lymph nodes were CLEAN!! This fantastic news came late this (Friday) afternoon, several days earlier than expected!
Details: I received a call late this afternoon from my surgeon’s nurse. She said they had just received the pathology report from my surgery and my doctor asked her to call me to share the news. Basically, the pathology report confirmed all of the preliminary findings from the biopsies and the surgery. It seems that the cancer was confined to the right breast. It was confirmed that the lymph nodes were cancer free and the margins were clear. I did not ask the exact size of the tumors, but I will be able to find out that information next week, when I go back for a follow up appointment on Tuesday. We will still wait for the official word on a recommendation regarding chemotherapy and other treatments, but expect to hear that chemo will not be recommended. The surgeon had told us before that if this were the outcome, my cancer would probably be considered “cured” by the surgery alone. YES!!!!!!!!!!!!!
Me: That news definitely helped! I do feel better today, after a good night’s sleep last night. I am resting a lot more during the day, which is difficult, since I do feel good, but I know it is the key to feeling even better sooner. The surgical drains (sorry, eww!) are the biggest annoyance, moreso than the pain. The good news is that the drains will only be there for another week or two. That is really not much time at all and after that, I should feel MUCH better.
Prayer Requests: PRAISE God for bringing me through surgery so easily, for having it go well and for excellent news from pathology. Aside from a difficult first night home from the hospital, this whole thing could not have gone better. Thank you for your prayers and good wishes!