Lumpectomy - Positive Margins

Got the surgical pathology report back this week and there was bad news - positive margins.  This is a time when the word "positive" is not a good thing.  During the lumpectomy the surgeon removes the tumor as well as margins around the tumor to ensure all the cancer is removed.  The size of the tissue and the margins is planned based on imaging.  My tumor was originally ~3.9cm plus the tail and a ~2.5cm tumor in my lymph nodes.  Based on imaging the main tumor had shrunk to ~1.6cm and the tumor in my lymph nodes was no longer visible.  The surgeon removed the main tumor, the necrotic (dead) cells around the original tumor, plus margins so basically something the size of a hamburger bun. Unfortunately upon analysis of this tissue there were positive margins meaning evidence of invasive cancer all they way to the edges of the tissue sample.  This couldn't be seen from imaging.  Not only were there positive margins, in response to the chemo the tumor shrunk like "swiss cheese" meaning there were still 0.3cm or less alive invasive cancer cells throughout the tissue sample.  In addition to that, there was evidence of DCIS (pre-invasive) tumor growth in most of the ducts they sampled.  In the lymph nodes they found invasive cancer in 4 of 10 nodes. With positive margins, residual invasive cancer, and extensive DCIS there is little chance (<20%) that a re-excision lumpectomy would be successful.  Plus it'd leave a strange cosmetic result.  After talking with my surgeon today I will be having a mastectomy.  Now the question is one or both, and reconstruction or not.  These decisions could lead to one surgery and done by years end, or multiple surgeries spread out over ~1 year.  There is no further surgery needed in the lymph nodes.  Good Lord, I'm only 38 and I'm making decisions about body parts to remove due to disease.

We also learned that my tumor is marginally estrogen receptor positive (ER+).  To this point we have been told it was ER+.  My oncologist is ordering the tissue be retested for this receptor.  His goal is to understand why the tumor was not 100% killed by the chemo.  He's thinking one of three things happened - it became resistant to the chemo, I could have used more chemo, or the tumor had poor heterogeneity (not all ER+).  This additional test should help rule out the latter.  If it is poor heterogeneity, that would make some of the cells triple negative which is the hardest kind to get rid of.  He's still waiting on the test but has started talking to me about using Xeloda, an oral chemo pill taken 1-2x/day during and after radiation, as an extra measure.  That means side effects and longer time dealing with this cancer business.

On top of all that, this morning I woke up with "cording" in my underarm where my lymph nodes were removed.  Cording occurs frequently in younger patients who undergo auxiliary node dissection due to how quickly the cells attempt to heal.  Basically a long cord forms from your armpit, through your bicep, and into your forearm.  Literally looks like a tight violin string and is fairly painful.  My surgeon gave me a prescription for PT and stretching exercises.  When it pulls it's a sharp pain and makes me kind of light headed.  As I stretched it also felt like the tight ball in my armpit was unrolling, it was pretty strange.  The good news is this cording should go away on it's own in a few weeks.

This was one of those days where I just needed to go for a run.  I ran for 4 minutes, holding my left arm to my chest the whole time, then walked for 20 min with Mom.  The incision on my breast was still sensitive and it felt like the ball was swelling in my armpit.  I would have walked/run/walked more but didn't want to push it.  Long gone are the days where I could run 3-4 miles without issue!

I'll be having the mastectomy in 1-2 weeks, followed by 3-4 weeks recovery, then radiation for 6.5 weeks along with oral chemo.  At this point I hope to have this behind me by Christmas.

Healing auxiliary node dissection and drain site

Hair regrowth - chemo has turned my hair white and fuzzy