Next I met with Dr Gadd and one of her assistants in surgical oncology. We reviewed the surgical path report in detail. For a mastectomy they look at anterior (forward) margins and posterior (back) margins. For the left side it was <0.1cm clear anterior. This is less than MGH standards for 0.2cm however Dr Gadd wasn't concerned given the tissue is removed, it's fairly porous, then dipped in ink, so <0.1cm is a fairly gross measurement. At other hospitals this is acceptable. She also removed all the tissue so there was nothing left to take. The potential of any residual will be sterilized in radiation. It was a similar story for the posterior against the chest wall. Here the margins were 0.2cm or greater, which meets MGH standards. All the tissue was removed. There's also a membrane between the tissue and the pectoral muscle which was removed and did not show any signs of tumor penetration. Again, while the chances are low, any residual cells will be sterilized by radiation. Overall the path report showed at least 50 foci of live cancer cells in the removed tissue, the largest at 0.9cm, spanning 7.5cm across the upper central/outer, so a mastectomy was the appropriate surgery. The right side showed no evidence of malignancy.
Everyone's body and cancer is different. When I originally met with the team at MGH, and the second opinion at Dana Farber, both hospitals recommended chemo prior to surgery. Based on how my body responded to the chemo (swiss cheese) it really didn't make a difference doing chemo first. Some women have a complete response, meaning chemo kills all the tumor, and they can do the lumpectomy and save their breasts. That wasn't in the cards for me. But looking back on it not sure I would do much different other than skip the lumpectomy and extra surgery. AC chemo has been the hardest on me so far, glad I got through that when I was at my strongest.
At this point I need to continue to take it easy for another 2-4 weeks so I can fully heal and put my body in the best position to handle radiation. Radiation will administer a lifetimes worth of radiation to that portion of my skin over 6.5 weeks. My skin will harden, will grow a sizeable sunburn, and will weaken my immune system and increase my fatigue. Hopefully the 6.5 weeks will go by quickly and I can finish before Christmas and New Years. Dr Gadd's team recommended I don't travel for 1-2 months after radiation so I can build back up my immune system. We did talk about lymphadema when I travel, but it is unlikely. If I start feeling tightness of my jewelry or sleeves on my left arm it may be a sign. It's not life threatening but would warrant a follow up with Dr Gadd's team when I returned. It's also not recommended I spend any time in a hot tub until things have had more time to heal. The biggest long term concern is infection to my left arm. Given I will have some level of permanent numbness in my underarm area where the lymph nodes were removed I won't have the normal sensation of an infection. For me now, signs would be more systemic like fever or aches, and maybe some redness in the infected area. Will have to watch for insect bites, cat scratches, etc and how my body responds.
I'm enjoying my free month off work and making the best of it while still resting. I still haven't been able to sleep through the night since surgery so feeling a bit tired. Not sure if that's because I've been confined to my back or the itchiness from the antibiotic that's going away, or both. Doesn't seem to change if I nap or not so I'm trying to nap more. It's also been nice to catch up on my house projects, but definitely couldn't make it as a stay at home mom!
Getting into the Halloween spirit with snapchat
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