Post-surgical Update and Pathology Report

Drew and I returned early this afternoon from my post-operative appointment with my breast surgeon.  She said I looked great and the wounds seem to be healing well.  We also received a copy of my pathology result from the tissue removed at surgery and discussed the results with her.    Here is page 1 of the pathology results:

Sorry it is a little blurry. 

The Facts:
When the surgeon removed tissue from my axilla, she was generous with the amount she removed due to my sentinal nodes (the first lymph nodes closest to the cancerous breast tissue) testing positive for cancer during surgery.  She ended up removing 8 axillary lymph nodes, 7 of which were still positive for cancer.  Also, it turns out that 3 of the 4 quadrants of my left breast were still cancerous.  It appears that the chemo did work though--it broke up the cancer and began attacking in a sort of sporadic way.  However, I did not have a complete response.   But, I had a TON of cancer to begin with.  The largest cancerous area of the many cancerous areas within my breast was 1.1 cm following chemo.  I am very thankful that my right breast was not cancerous.  The issue is that cancer is in my lymph nodes.  With cancer in my nodes, that means it is circulating in my blood.  I need for it be completely eradicated so it does not rear its ugly head somewhere else in my body--that would be stage 4 cancer. 

My oncologist warned me prior to surgery to expect to see cancerous results from my pathology report and she said she was not concerned by that.  However, I was still hopeful I would receive a complete response from chemo.  Actually though, cancers that are highly estrogen receptor positive like mine (mine is approx 90% estrogen positive) are not typically very responsive to chemotherapy.  The best treatment for patients like me typically comes from the 15 plus years of Tamoxifen treatment that I will be on after radiation is complete.  Tamoxifen works by binding to the cancer's estrogen receptors.  This prevents the cancer from growing. And, if the cancer cannot grow, it dies.

I will meet with my oncologist tomorrow morning to figure out what the next step of the treatment plan is for me. My surgeon said that after discussion with my oncologist, she knows she does not want to put me back on the AC drug.   This news makes me happy.  So, I will likely either start a new type of chemotherapy prior to radiation, or go right into radiation after healing from this surgery.  Radiation is an important part of my treatment plan, as it will target all of the original areas of cancer, including my supraclavicular and internal mammary nodes, which were not removed in surgery.

I asked the breast surgeon how I would ever know if I am cancer free.  Apparently, there is no way for me to ever know for sure from now on if I am completely cancer free.  I will have future regular periodic imaging studies, which will hopefully show no evidence of disease.   But, as we saw from my PET/CT and following surgical pathology, there is no way to know if microscopic cancerous areas are still hanging out in my body.  With breast cancer, there is no blood test that would be indicative of having cancer remaining.  There are no specific tumor markers that are helpful to review.  According to both my breast surgeon and oncologist, ongoing management of my cancer involves periodic imaging studies and the reliance on the patient (me) to tell them of any new symptoms I am having (headaches, a new cough, etc.).  Then, specific imaging tests would be done to rule out cancer if I have any new symptoms.

Another concern that I will have ongoing is my risk for lymphedema.  I can never have my blood drawn, blood pressure checked, or even get a scratch or scrape on my left arm (where my axillary lymph nodes were removed) or I would be placed at extremely high risk for getting lymphedema.  So, I am learning to adapt to this and be extra careful with my left arm.

How I am feeling post surgery:
I am actually healing very well.  I had 4 drains tubes placed during surgery, as well as a tiny catheter that was coiled under my pectoral muscles which supplied some local pain medicine to the area.  Yesterday, I had a quick visit to the plastic surgeon's office, where they removed two of my drains and the pain med catheter.  It feels so much better to be down 2 drains and the catheter.   I feel like the other two are also ready to come out, but I will need to wait until tomorrow or Thursday to have those removed. I haven't had any of the lortab (the hard-core pain meds) for several days now and really am just taking a couple of meds now for swelling and to relax my chest muscles due to the expanders.  The expanders are pretty annoying and uncomfortable, but hopefully I will get used to them.  :-)  I have to keep them for at least six months following completion of radiation.

Today as we were driving from the surgeon's office to Luke's school to pick him up, I was reading my pathology report.  I was fine until I called my mom while Drew was inside the school picking up Luke and I verbally stated the results to her.  Uncontrollable tears began streaming down my face.  I didn't feel overwhelmingly sad, but I guess the emotions of cancer still being present in my body and things being completely out of my control were causing the tears.  But, then after I hung up the phone, I remembered, I am not in control and never will be.  God is in control and knows the end of this.  If it were under my control, I would have zapped the cancer with the chemo and called it a day.  But, apparently there is more for me to learn.  As I have looked back at my life and things that, while they were happening, I didn't understand, I realize it was much better for God to have been in control than for me.  Things worked out so much better in the end, even having gone through some tough trials and tribulations.  (Romans 8:28 says "And we know that in all things God works for the good of those who love him, who have been called according to his purpose.")  I would have missed out on important life lessons which have made me who I am today, should I have not had to go through certain life events.  God definitely knows what he is doing.  Of course, my desire is to be completely healed.  But, I know He is sovereign and has a plan.  The plan could be that I am completely healed, or perhaps I am not.  If He chooses to heal me, it will be in His timing and by His plan, not mine.  I am going to continue to pray and beg for complete healing though.  I would ask everyone I know to do the same.  I want to be around to help raise these precious children of ours.   After I got off the phone with my mom while waiting for Drew and Luke to walk to the car today from school, I wiped the tears and began praying to God and meditating as mentioned above.   I was fine and God showed me His strength in my weakness.  But then, the Holy Spirit decided to speak, once again, through our precious son Luke after he got into his car seat.  Luke said, "mommy!"  I said, "What honey"?  He replied, "I love you!"  He then said that several mores times on the way home and this afternoon.  God knows how to heal me.  My love language is "words of affirmation".  God uses even my three year old to heal me by using words of affirmation, exactly when I need them.     
 
We continue to trust in God's plan and His sovereignty for our lives.  The joy of the Lord is my strength and I remain completely blessed and happy!  We also really appreciate our prayer warriors who continue to pray for our family and for my complete healing.  We love all of you and are so thankful for you.  Mark 5:36:  "Do not be afraid, just believe!"