Pathology Report

My surgical oncologist called me this morning with my pathology report from the tissue and nodes removed during my mastectomy surgery completed last week.  I've been praying I would be told no additional cancer areas were found, and all the nodes removed during surgery would be all clear.  I didn't get the good news I was hoping to get; but overall, the news was good.  I remind myself it could be worse.

I had a bilateral mastectomy, meaning both breasts were removed.  My breast cancer was only in the left side; but I chose to have the tissue removed from both breasts due to having the BRCA1 gene, which increases your chances significantly for a recurrent in your other breast.  The tissue removed from the right side was completely clear of cancer.  This was fantastic news as I constantly had a nagging worry that there was a tumor hiding on that side.

I had a MRI of my breasts after I completed chemo.  This revealed the tumor, which was 8 cm before I began chemo, had responded very well to my chemo treatments and had shrunk to being smaller than the size of a pea.  I was told I had responded very well to my chemo treatments and I was very near a response of 100%.  The lab, however, did find scattered tumor cells in the area in which the tumor was.  These scattered tumor cells were residual cancer cells from the original tumor.  While they did find scattered cancer cells we didn't know were there until the tissue was put under a microscope, the margins around the breast tissue that was removed were 100% clear of any cancer cells.  This is very important as it means the cancer cells were all removed from the breast tissue.

I had a sentinal node biopsy October 2013 before I began chemo.  This consisted of my surgical oncologist injecting the tumor in my breast with a radioactive dye.  During surgery, he then used a light while looking at my lymph nodes in my arm pit.  The dye, which was injected into my tumor, would drain into the first lymph nodes in which the tumor drained.  The idea is to determine which lymph nodes the tumor first drains into so they can be removed to look for cancer cells.  This is how the physician determines if the cancer has spread to your lymph nodes.  15 nodes were removed during this sentinal node biopsy, and 5 of the 15 contained cancer cells.  1 had a small tumor on it, and the other 4 contained micro cancer cells.  This news devastated me as I wanted to hear I had no lymph node involvement; but after the initial shock of hearing this, I accepted this as MY personal results and found the positive in this news.  5 out of 15 isn't bad odds.  That meant 33.3% of the nodes removed had cancer.  That's less than half, so I was thankful for this.  During this surgery, only the nodes that lit up using the light were removed.   Therefore, there were still lymph nodes remaining in this area.  These would be removed during my mastectomy surgery.  This is called an auxiliary dissection.

During my auxiliary dissection last week, 15 additional lymph nodes were removed.  3 of the 15 removed revealed microscopic cancer cells.  Once again, I was hoping and praying I would be given an all clear on the remaining lymph nodes; but once again, I wasn't given the exact news I wanted.  However, I am thankful for the results I was given as 3 out of 15 isn't bad, and it certainly could have been worse.  Additionally, the cancer cells found in these 3 nodes were micro cells meaning it was such a small amount it could only be found under a microscope.  Based on my results from my first node biopsy and the remaining nodes, I had a total of 8 nodes positive for cancer out of 30 total nodes.  This means 27% of the total nodes removed were positive for cancer.  I was upset at first to hear the news that I've been walking around with nodes that had cancer for the past 6-7 months.  To me, this meant the cancer has had 6-7 months to be spread from my lymph nodes by my lymphatic system to other areas within my body--meaning metastasized cancer is a very real possibility in my future.  However, after a few moments, I forced myself to stop focusing on this and consider the overall odds.  My overall odds are now better than they were before.  Having 33.3% cancerous nodes before compared to my overall rate I now have of 27% is actually good news.  My overall node involvement is lower than it was before.  THAT is what I choose to focus on.

I'm healing well from surgery.  It's been 8 days since my surgery, and while I am still doing nothing besides sitting on my couch letting my body heal; I am slowly feeling better.  I can now stand up from the couch on my own without someone assisting me.  Yes, I still have pain on my chest, and I'm still very sore overall; but it's much better than it was last week at this time.  It is tempting to begin doing some things around the house, but I still have three drains intact; and if I begin doing things too soon, it will increase the fluid draining (which we have to dump and record for review) into the drains.  They won't remove drains that are putting out too much fluid.  Therefore, I will keep my butt planted on the couch, so I can hopefully get these three drains out at my upcoming appointment on Wednesday.

I get my first expander fill on Wednesday as well.  For those that don't know what this means, tissue expanders were placed during my surgery last week.  Only 40 cc's of saline was placed in my expanders, so I essentially came home very flat chested.  My surgeon had to remove a great deal of skin from my breasts to ensure he got clean margins around the tumor.  This didn't leave a lot of room for the expanders to be filled much at the time of surgery.  I don't know how much my expanders will be filled on Wednesday.  They will base it on what I can tolerate and what won't put too much pressure on my incisions, which are still healing.  the expanders will continue to be filled weekly until my desired size has been reached.  I will then have surgery to remove the expanders and replace them with silicone implants.  I hope this process doesn't take too long as expanders are not comfortable at all.  They feel nothing like implants and feel very hard beneath your skin.