This Princess Has A Pea
Posts tagged Pathology Report
Research, Options, and Back to my Kettlebells
May 1st
Just the Facts: This week I saw my plastic surgeon for more “expansion” and may now be done with that. We’ve been thinking through all that was said at the oncology appointment and doing lots of our own research as we wait for the results from the Oncotype Dx test. In the meantime, I have set the wheels in motion to see a second oncologist. Happily, I have been given the OK to proceed with my kettlebell workouts.
Details: Every week seems to have at least one fairly major thing going on and this week is no different. This week we have been doing lots of research on tamoxifen and chemotherapy, recurrence rates and natural therapies. We wait to hear results on the Oncotype Dx test, which will have a big impact on whether or not I take chemotherapy. We have discussed our options with each other, with friends who have gone through the same or similar things, and have read lots about our choices. There really is no “good” option. We continue to work through it all and try to figure out what is right for me.
As usual, I visited my most-excellent plastic surgeon this week to have more saline added to my tissue expanders. This may be the last “expansion” for me since we seem to have achieved a look that fairly closely resembles the former me. Of course, we have the option of looking different, which is what we are considering now.
What a crazyweird decision THIS is to make! In contrast to the drug/therapy decision, this one is definitely more fun, though still nearly as confusing. Once we have reached a point we are happy with, the clock starts for a 3-month wait. I will then be able to have the quite-uncomfortable and very fake-feeling expanders exchanged for real implants in outpatient surgery.
This week I also started the process of getting in to see another oncologist. We really like our first oncologist and may choose to stay with her, but wanted a second opinion. Once the second doctor has reviewed my pathology reports, we will be contacted with an appointment date. I expect that to be in about 2-3 weeks.
My plastic surgeon has given the OK for medium-weight kettlebell workouts. (Next week I can move up to my “normal” routine.) I’m so happy to be building my strength back!
What’s Coming Up? On Tuesday I will see my surgeon for the last visit with him for a long time. His portion of this is basically complete and I know he’ll be happy to see how well I am doing. On Friday I will have a CT of the Chest/Abdomen/Pelvis and a Bone Scan. The oncologist ordered these imaging tests as a baseline. I am not looking forward to them due to having to drink large amounts of contrast fluid. It will go fine — it’s just one more thing, and a minor one, at that. The Oncotype Dx results are expect the following week, and we’ll have our appointment with the oncologist on May 11 to discuss those results. Also that week, I will return to the plastic surgeon for another regular visit.
Prayer Requests: Please pray for discernment for us in our decision making. Also, I am still having trouble sleeping well. This will pass with time, but please pray for that remaining discomfort to pass quickly.
First Oncology Appointment
Apr 25th
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.
Doctors and Drains
Apr 14th
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.
Post-Surgery Pathology Report
Apr 9th
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!