Thursday, December 8, 2016

And the Saga Continues

Ok, so, after getting a preventative bi-lateral mastectomy, performed shortly after both a mammogram and MRI both showed zero cancer, of course they found cancer in the breast tissue sent to the lab. The good news is it's all out, but...

They found two non-invasive tumours about a centimetre each. The surgeon isn't worried about that at all, but I'm baffled that they went completely undetected by either the mammogram or the MRI. That's pretty disconcerting. Both procedures are horrible to go through, and apparently mammograms have a false negative rate of 20% and MRIs aren't much better! Back when I had them done, the geneticist told me the idea is to do both, and then they cancel out the false negatives, but it looks like there are still some exceptions!

But the lab also found one micro-invasive tumour that is more of a concern because it's invasive, but it's not too much of a concern because it's micro. They could only see it under a microscope. It's officially stage zero cancer.

Here's the really frustrating part. Typically with an invasive cancer in the breast, they take out a lump or the whole breast, but they also remove some lymph nodes. There's about 20 lymph nodes in the armpit (who knew?!), but it's best for the patient to just lose 3-4 so they don't have to deal with lymphoma issues. There are tons of leaflets about that in the doctor's waiting room, and it looks like it really sucks. So, before they remove the breast, they inject the breast with dye to find the 3-4 lymph nodes closest and most likely to be cancerous - if any are - and dig them out. BUT, since they already took off my breast, that's no longer an option. Ha! 

Nope, they can't just inject dye into the surrounding tissue. Has to be the breast. Of course it does.

Had I NOT done an MRI - OR if it was positive for cancer - the doctor would have done that dye-and-dig thing automatically. But with a crystal clear MRI, he left all my lymph nodes intact.

There's no way to identify the most affected lymph nodes anymore (I badgered him with potential solutions - basically circling around some awesome guess and check methods I made up on the spot - but all failed his medical standards), so now the options are to take out ALL the lymph nodes on that side or... don't.

Apparently with something this small, taken out so early on, I have a less than 1% chance of having any cancer in my lymph nodes. If I don't remove them, it means checking for lumps in my armpit and on my chest regularly. He said it'll feel to the touch like a stone in my shoe, and without all that fat in the way from my former spectacular breasts, it'll be much more noticeable.

But he added that it might - just maybe - be wise to get radiated and/or take tamoxifen just in case. Yikes. The cancer is estrogen-receptive, so blocking estrogen prevents a recurrence. He told me the only side effect of the drug to be concerned with is hot flashes, but google searches reveal some pretty daunting issues with it. Little things like liver failure. Having my ovaries out already helps a bit to reduce estrogen in my body, but he said even better is that I'm, in his words, "not fat." From what he's seen, it's people with extra body weight that tend to have recurrences of cancer because estrogen is produced and stored in fat cells. I was actually going to go for pizza afterwards, because my doctor works near the best pizza place in town, but then I thought better of it. Now I have one more reason to go completely vegetarian.

This is how it will go down - in my head.
He made an appointment for me to see an oncologist to try to figure out next steps. He spoke to her this morning after getting the results, and she's leaning towards doing nothing more than just monitoring it too. But she said it's a tricky one, so she'll present it at rounds to see what other doctors say in case there are some other concerns or options raised.

And I said, "Just like on House!" all excited-like.

He never reacts much to my yammerings, and this was no exception.

Ack, it's always something!

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