surgeon consultation

On Monday, January 18, mom had her surgery consultation. It went really well. Mom's surgeon was very knowledgeable, thorough with information, and only does breast cancer surgeries. We were all very impressed with her track record. We are also very happy with her staff. They are friendly and timely in scheduling the surgery.

I have summarized the takeaways from the meeting in the notes below.

Mom has infiltration ductal carcinoma. This is the garden variety breast cancer. 80% of women with breast cancer have this one. That is very encouraging. The lump is <= 2cm. Dr Nancy considers this small. Because the lump is small, the doctor has concluded the following:
1) mom is a perfect candidate for a lumpectomy with radiation after the fact. She would not need a mascectomy.
2) The doctor has put mom at a Stage 1 until the results of the surgery.
3) No additional scanning is needed. The doctor says it is rare for carcinogens to turn up else where in the body based on the size of the tumor. She also indicated that liver cancer in the family history is irrelevant.

Mom will be having a breast MRI performed on Thursday 1/21 at 6am. The doctor has ordered this test to identify if there are any additional tumors that might not have shown up on the mammogram. Results of the the MRI will come within 1-2 business days. I believe the MRI will also give the doctor a better indication of the size of the tumor.

The surgery will take place on Thursday 1/28. Mom will arrive at 8:30. She will receive a nuclear dye injection at 10am. The surgery will be at noon.

The surgery is an outpatient procedure with general anesthetic. A localization wire will be given prior to surgery. Then, she will be given total anesthesia. Dr. Nancy will perform the lumpectomy and then send it in for lab work. We will want to know if the margins are clear. (This means that we will want to make sure there are no cancer cells on the outer layer of what she has removed. If this is the case, we will know that Dr. Nancy has got the entire tumor. If this is not the case, mom will need to go in for another surgery in order to take out more.) Dr. Nancy indicated that less than 1% of her patients need to come back for additional surgery. She makes sure to take out a generous amount to ensure the margins will be clear.

The lymph nodes will need to be checked in order to ensure it is free of carcinogens. As a little background info, the lymph nodes filter fluid throughout the body. There are approximately 30 nodes under each arm. These nodes are grouped in 4 'levels.' For removal of the nodes, a separate incision is made in the armpit. Dr. Nancy will remove the sentinal lymph node prior to removal of the tumor.
The sentinal node is the first node that the breast drains to. If the sentinal node is free of carcinogens, the remaining nodes will also be free of carcinogens. Dr Nancy will be able to identify which of the nodes is the sentinal node with the help of a radioactive dye. This dye will be injected 2 hours prior to surgery. The dye flows in the breast fluid. The dye will go to the sentinal node first. Dr Nancy will remove this node and then send it to the lab during surgery. She will have the results before surgery is completed. That way, she can take out more nodes if it is necessary. If the sentinal node turns up positive, Dr. Nancy will need to take out Level 1 and 2 nodes.

The surgery will take approximately 1 1/2 hours. It will not be too painful of an operation.

A final pathology report will come after surgery. We will need to ask:
1) Is the sentinal node still negative?
2) Are the margins clear?
3) How big is the tumor?

Mom will meet with the surgeon 2 weeks after surgery.

Mom will also be meeting with a radiation oncologist and a medical oncologist on 2/3 at the Breast Cancer Clinic.

Mom's biopsy report showed a couple notable items. One, the progesterine receptor tested negative. Two, the estrogen receptor tested positive. This means that mom will be needing to take an antihormonal pill. Three, the HER-2 tested positive. This means the tumor is aggressive. The oncologist will most likely recommend chemo as a treatment. The great news is that there is a great drug that will take care of HER-2 from recurring. This drug is called Herceptin.

After surgery, mom will be able to walk around. she will be able to take long walks by the next day. She will be able to resume her exercise classes the following week. Exercise is encouraged.

Mom will be participating in "Reach to Recovery." This is a support group that will match mom up with a breast cancer survivor from the American Cancer Society. The selected woman will be contacting mom.

All in all, the prognosis is very encouraging. Keep praying that Dr. Nancy is able to remove all the cancer next thursday and, more importantly, that the cancer has not spread to the lymph nodes.