Surgery plan

So, surgery is booked for 14th March, I have to be in for 7.15am......that's crazy!  My tumour is now just over 1cm in size, so has shrunk considerably, and my surgeon wants to try for breast conserving surgery.  So the plan at the moment is to remove the tumour and a section of tissue surrounding it plus samples from either side of what's left.  This will then go to pathology to be assessed.  Beware, this is where this post is going to get technical, please skip the rest if you don't need to know!

It's amazing the new knowledge and vocabulary you pick up on a journey such as this.  So the first thing I need to enlighten you about is 'margins'.  Basically I need to have 'clear margins' from this surgery.  This means there is a sufficient area of 'normal' cells around the excised tumour and surrounding tissue.  If there is not a safe margin then further surgery will be needed.  It doesn't end there though....next I need to teach you about SNB.

So SNB is Sentinel node biopsy.  On the day of my original diagnosis (well the week before the diagnosis was confirmed) at the ultrasound they looked at my lymph nodes which run all the way from the breast right up into the arm pit.  Nothing suspicious could be seen - great :-). But they can't rule out spread to the lymph nodes without looking microscopically at the cells.  So I need to have a node removed and sent to pathology.  This is a separate operation, but will be done at the same time as the WLE (that's wide local excision....basically removal of tumour as surrounding tissue).  The sentinel node is the first node that the breast tissue drains into.  The way they find this node basically turns me into a blue smurf from what I have read!  They will inject me with radioactive blue dye, the dye then travels through the lymph nodes and they can use a radioactive sensor thingy to detect which node is most radioactive...this is the sentinel node......clever don't you think?  They then take this out and it goes to pathology for assessment.  If anything is found, again I will need further surgery, this time to remove the rest of the nodes.  Oh, I almost forgot to explain the fun bit.....the radioactive funky stuff turns your skin blue....my breast, under arm and part of inner upper arm will be blue.  Apparently it can last for up to 6 months!!!

As things stand I don't really know the time scale of things because it all depends on the pathology results from surgery.  At some point after surgery I will be haveing between 3 and 5 weeks of radiotherapy (again, the number of sessions will depend on path results).

I have had a bit of a turmoil accepting the surgical plan as I was quite set on the fact that I would have a full mastectomy to remove all breast tissue.  However the survival statistics are identical for mastectomy and WLE plus radiotherapy.  Also, unfortunately, even with no breast tissue you can still have recurrence in the muscle and skin.  Recurrence is the same cancer returning in surrounding tissue.  This can be treated, usually by surgery.  This is different from secondary (or stage 4) cancer which is the breast cancer spreading to other parts of the body.  Whatever type of surgery is done doesn't make a difference to the chance of developing secondaries, hence why the 'survival rate' statistics are the same.

The harsh reality is that if I'm going to get secondaries, the damage is already done, cancer cells could be lurking in parts of my body, ready to spring into action at some unknown time in the future.  Believe me, I am not being defeatist or negative, it is what it is.  Hopefully the nastiness of chemo has blasted all the blighters to kingdom come, but I do have to learn to live with shadow of worry.  My plan is to be too busy having a fun filled life that I don't have to time to worry :-)

So that's the technical details as I understand them at the moment.  I'm hoping to hear what the plan for my eye lump is on Friday when I go to Oncology for POST.....yes POST not PRE chemo ..........boy does that feel good writing that, might just have to do it one more time POST CHEMO!  I received a letter to say my scan had been sent to the 'Wessex Neuro Centre' at Southampton hospital.  It sounds very impressive, I just hope there is a Boffin there who has a vague clue what it might be and what to do about it!

I'm feeling very determined this week.  Mostly determined to be able to walk to school and back at a reasonable pace without feeling like I am going to collapse!  This is the first week in a very long time that I will have done the school run every day. I've only done two days so far but, as I said I'm determined so it will be completed and I hope to report by Friday that I am able to do it without puffing and panting like an old man.  Watch this space!

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