Met with the surgeon this morning to discuss options and next steps. Short story is that I need to have an MRI (got scheduled for next Tuesday) to really determine whether I can have a lumpectomy or will need a mastectomy. She, like the oncologist is pleased with the softening and shrinking, but, depending on how the chemo has caused the tumor to shrink (eaten holes in it like swiss cheese vs eaten from inside out or outside in and kept the same shape), it can influence the ability to remove that tissue successfully with clean (non-cancerous) margins.
Recurrence rates aren't that different between lumpectomy+radiation and mastectomy, so the determining factor is really the relative portion of tissue that needs to be removed and whether it involves the nipple, as to which approach is warranted. We talked through risks, procedures, etc of both so that after the results come in, we can just chat on the phone. Surgery will be scheduled for the last week in January, giving me a few weeks after my last chemo (this Friday) to continue to recover and build strength. Both procedures, as long as they go well, won't take me out of commission too long in terms of work, which will be great.
As part of either procedure, given the involvement of the lymph nodes, she'll do a sentinel node biopsy. Essentially, a dye is injected so that they can map how the breast tissue drains. They follow the dye to the first nodes and biopsy these to test, in real-time during the surgery, whether cancer cells are present. If they can find at least 3 nodes that are negative, they stop at that point. If they find less than 3 negative (can happen since they may be small post-chemo), or positive nodes, they continue with removing the entire area of nodes under the armpit. This dissection is what increases the risk of lymphedema (swelling of the arm) which you may have seen people wearing compression sleeves to help deal with.
Given the unknown of the procedure, it means that the reconstruction options are also somewhat unknown. There are differences as to whether it occurs immediately (during the same surgical procedure) or delayed (months or even years down the road). Either way, I will discuss those details with a plastic surgeon, and that appointment is set for tomorrow. So the silver lining of a "free" boob job is still a possibility...
After a bit of work at the office, I headed to my familiar Cancer Center but to see the Radiation Oncologist rather than my medical oncologist I've been under the care of. The deja vu kicked in once more with...
...another welcome packet!
With both a mastectomy or a lumpectomy, radiation is called for. And, while I had done some research and knew a bit about it, I think this was probably my most ignorant aspect and I had underestimated exactly what would be involved. Starting 4-5 weeks after surgery, when I am well on my way to healing of the surgical wound, we'll begin radiation treatments that occur 5 times a week for 7 weeks.
That's a long f'ing time.
It's like another semester's worth (and yes I'll probably always track my life in terms of the academic calendar...).
There are some associated risks and potential complications (thyroid issues, tingling, sore throat, etc) and there are restrictions during treatment (anything with bouncing of the chest or chafing of the arm and armpit...so no running...but I can bike with my arm up in the air...). I guess the length of treatment is most frustrating...especially given the limitations for travel, etc. I should be able to sneak my spring break trip in before it starts, but it'll put a damper on the major research conference that I attend, as I'm limited to weekend-only travel. The prospect of an hour or so of my day there isn't overly exciting either, though I should be thankful that the center in convenient to home and work and that Dayton-area traffic is fairly non-existent.
After the appointment, I was just a little 'bummed' for lack of a more eloquent word. I feel like I'm back at the beginning again...more doctors, explanations, diagnostic tests, waiting for results, making plans, etc. And another 5 months ahead of unknown...physically, mentally, etc. I am trying to remind myself that in addition to being poorer, fatter, and having less hair, that I have spent the last 4 months actively "fighting" this cancer...that the chemo did do something and importantly is making these surgeries possible and hopefully staving off any return of the cancer in the future from cells that might have snuck out and elsewhere in my body.
I was ready to kind of get back to "normal" and I realize that I jumped the gun a bit. The balance between being positive and optimistic and just avoiding thinking about reality is delicate. Who knows, perhaps the next months will go as well as these past have, life will be minimally interrupted, and in 15 weeks I'll be blogging again about how I'm looking forward to my last treatment and can't believe how quickly it has come. Let's hope.
Despite the bit of a bummer day, I actually am remaining fairly positive. Because, it could be worse. Much, much worse. I'm sure many people heard of the passing of Stuart Scott, the ESPN anchor who battled cancer for the past 7 years. If you know me, you know I love ESPN, and Stuart was a talented broadcaster. His catchphrases are his public legacy ("boo yah!" "as cool as the other side of the pillow", etc) and based on the moving tributes this weekend, he was truly one of those quality people. Awhile ago, I posted Jim Valvano's famous ESPY speech about not giving up and this past year, Stuart Scott was honored with the Jimmy V Perseverance Award at the same awards show. He gave a speech that I find just as moving and inspirational and takes on a whole new meaning now being in the cancer crowd. I really encourage you to listen to the whole thing: Stuart Scott Video
The often quoted phrase which bears repeating...
"When you die, it does not mean you lose to cancer. You beat cancer by how you live, why you live, & in the manner in which you live"
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