post-surgery pathology results

If you have to have cancer, these are (mostly) good results.

Post-op Appointment

My surgeon is already out on vacation, but his surgical nurse saw me and checked the two incision points. Incisions are clean and healing as expected. My levels of pain as well as the numbness from the severed nerves are consistent with expectations. The nurse removed the last layer of suture tape. I am instructed to continue to keep area clean, treat pain with Tylenol and ice, and expect additional nerve pain as they regrow.

Oncology Appointment

Oncologist reports that while the initial testings is good, it isn't clear enough to make an informed treatment plan. The HER2 data isn't clearly positive or negative, and the presence of invasive cells outside of the tumor elevate the risk of spread. She reviewed the pathology results with us and ordered new testing. 

Pathology Results

The Short Version 

• Successful removal of both invasive and non-invasive (DCIS) carcinoma
• Margins around the tumor are clear, so they got all of it
• Cancer cells were present in the vascular system heading toward the lymph nodes, but no cells were present in the lymph nodes
• HER2 identification remains ambiguous

The Technical Version

Left breast, lumpectomy:

• Invasive carcinoma, grade 2, 21 mm identified
• Ductal carcinoma in situ (DCIS) nuclear grade 2, with comedonecrosis identified
• Margins negative for carcinoma
• Lymphovascular invasion present

Left axillary sentinel lymph nodes, excision:

• Four lymph nodes are negative for carcinoma (0/4)

HER2 Testing was returned with the same ambiguous results as with the first biopsy: some of the cancer cells are positive for HER2, and some are negative. 

Next Steps

1. Advanced HER2 testing ordered; results expected in 1-2 weeks.
2. Oncotype testing ordered, which is a risk analysis of the tumor for recurrence; results in 2-3 weeks.
3. Next appointment with the oncologist is June 15, and the goal is to make a treatment plan by then based on the cumulative testing, old and new. 
4. Healing from the surgery. Nothing happens until I am healed from the surgery. 

The ways forward are many. I am stitched, bruised, iced, fed, rested, weary, grateful, unknowing, loved.

Onward. 

~ Sherri

 

McCoy Creek: Cattle 

Long after sunset the afterlight

glows warm along the rimrock.

A wind down off the mountain

blows soft, a little chill.

I've come to love the quiet sound

cattle make cropping short grass.

Day and night are much the same

to them in the pastures of summer, 

cows and calves, they crop and pull

with that steady, comfortable sound

as the light in the rimrock and the sky

dims away slowly. Now no wind.

I don't know if cattle see the stars, 

but all night long they graze

and walk and stand in the calm 

light that has no shadows. 

 

        ~ Ursula K. LeGuin, So Far So Good - Final Poems

operative report

DAY 2 After Surgery: I almost feel myself again. At least my brain is starting to be less foggy. 

Thanks to everyone for your calls, messages, cards, even flowers! I love you all and feel your strength and support. Thank you! Thank you!

Thanks also to Becca for posting the update yesterday. She was correct about my blue pee. The dye injected to identify lymph nodes has to get out somewhere. 

Alternative narrative: Or it's straight-up karma for that one time I was a college freshman and baked some Methylene blue into chocolate brownies for the mean boys in the neighboring dorm. 

What Becca didn't say was that the dye also spread under the skin at the injection sight and turned my boob blue. I go into surgery human and come out part-Smurf. Don't worry--most of the blue is gone now. From all places. 

Operative Report: The doc's report fills in the blanks about the procedure after I was knocked out. 

Short version:  

The surgical team identified two lymph nodes with a relationship to the tumor and removed them for biopsy. They also scooped out the cancer from the left breast, including the tumor marker and the Savi scout that were embedded in the tumor. Patient is fine.

Long version: 

Wide excision of left breast cancer with Savi Scout guidance, left deep axillary sentinel lymph node biopsy with blue dye injection. Allison wan PA-C was necessary for retraction and exposure for both the deep axillary sentinel node biopsy and further lumpectomy. She also assisted with closure of surgical wounds. 

After infiltration local anesthetic incision was made in the left axillary crease and carried down into the deep axillary fatty tissue. Two lymph nodes were identified to contain the radioactive tracer and blue dye. No additional blue dye or radioactive nodes are evident. Multiple clips were used to divide the feeding vessels and lymphatics to the 2 nodes that were removed. Hemostasis appears to be excellent. The wound was closed with 3-0 Vicryl subcutaneous suture and 4-0 Vicryl subcuticular skin closure.

After infiltration with local anesthetic incision made in the medial left breast and a wide excision was performed of the area of the known breast cancer using the Savi Scout for guidance to localize the area of concern. The specimen was oriented with suture and sent to pathology for permanent histologic evaluation. 

Hemostasis was obtained with cautery and the wound was closed with 4-0 Vicryl subcuticular suture. Benzoin and Steri-Strips and gauze dressings were placed. Patient was awakened and transferred to recovery area in stable condition. 

Next Steps: I am looking forward to another low-key day of recovery, including more naps, episodes of Buffy or Star Trek, and some good food that I don't have to cook. 

On Monday I see the surgical nurse for a post-op check and the Medical Oncologist to talk about chemotherapy. I am hopeful we'll have pathology results by then. We'll see. 

In the meantime, the iris, tulips, and lilacs are blooming in my garden. 

Onward!

Sherri

 

Surgery Update

Hello everyone, 

I am Sherri's littlest daughter, Becca. I am spending the week at my mom's offering myself up to whatever Rick and her might need. Which basically means I make the tea when Rick gets distracted in the garden, spend the afternoons whipping up some soup, and hang out on the couch watching Aliens. Not a bad way to spend the week. 

Surgery was today. 

Mom spent her morning sitting on the back deck enjoying some sunshine and her cuppa tea before heading to the hospital. She had to get a hefty dose of radiation and then her and Rick both anxiously waited all afternoon for surgery. Well, mom got a famous nap in while Rick sat with her in the hospital room sending me updates as needed.

Once in surgery, everything went quick and smoothly. She was in and out in about an hour, and home watching baseball on the couch by dinnertime. She is doing well, mostly just tired and in a bit of pain. The tumor is being sent off to Pathology to determine if chemotherapy will be needed. We are all anxious to hear those results, but in the meantime we are just focused on taking naps, drinking tea... and laughing about her blue urine. 

I am thankful to have her home tonight. 

xoxo,
Bec

new tech

Today I am going in for an ultrasound procedure where they will insert a Savi SCOUT into the tumor. This is a piece of technology that (apparently) the surgical team is really excited about. For this team, it has reduced the number of second surgeries after lumpectomies or partial-mastectomies where not all the breast tissue is removed. 

From my own research, this little "reflector" is activated just before the surgery to send out non-radioactive waves that help map the tumor. The surgeon's receiver uses those signals to make sure that they take all the cancer cells during the surgery. 

Today's procedure uses ultrasound to "look" at the body inside-out to place the reflector. Makes perfect sense. 

Sidenote: I find myself apologizing for the cancer (or the news of the cancer?). What a strange reflexive response to other people's discomfort. 

Onward!

Sherri

But that is not the question. What are we doing here, that is the question. And we are blessed in this, that we happen to know the answer. Yes, in the immense confusion one thing alone is clear. We are waiting for...  

     ~ Samuel Beckett, Waiting for Godot