Sunshine On A Cloudy Day
Today I met Dr. Wagner. She specializes in breast surgery for cancer patients and will be my surgeon for my upcoming surgery. (I still don't have an exact date ... her scheduler will be calling soon). She exudes confidence and patience which are excellent qualities and is one of the top surgeons in her specialty in the area.
When I walked into the waiting room (this is mainly an oncology center treating cancer patients), I saw about twelve other people waiting their turn. There were men and women with all types and all stages of cancers there and some family members who accompanied them. Most of them were older than me. I shuddered with the fleeting thought of which of them may not make another year, but quickly put that thought out of my mind.
After giving the front desk nurse my paperwork with medical history I had filled out the night before and answering their on-line cancer screening/risk assessment survey on a tablet they handed me, I waited another 10 minutes before being called back.
I was taken to a room where the nurse took vitals, asked additional questions, etc. She asked me if I was having any breast pain and I told her I never had any breast pain. I then changed into one of those paper gowns just for the top. Dr. Wagner was in her office next door reviewing my charts and pictures. I guess we could call that her debriefing room.
She walked in with charts in hand and introduced herself. I was afraid I might feel fear and anxiety, but instead I was calm and hopeful. She had me raise my arms above my chest and did an exam of both breasts before having me lay down on the patient reclining chair and repeating the palpitation, but only on the right side this time. It was a little rough there at times because she was really pushing in hard to see if she could feel the tumor from the outside. She then put the goop on and used the sonogram to look at the images on the screen.
She didn't say a lot but spent a good bit of time looking at the ductal papilloma and the cancer tumor before looking at the lymph nodes very carefully. She captured images, made notes and turned the machine off before talking.
She told me she agreed with the Stage 1 assessment and that the cancer was very small; about 1.5 cm. She told me how lucky I was to catch it at this time especially with the triple negative type it is. She was actually wavering on whether to take out the papilloma because it would require another small incision under my areola but after discussing that with me we decided to go ahead. She laid out my options as being a lumpectomy (in medical lingo, a partial masectomy) with chemo and radiation to follow or a complete simple masectomy that would still need to be followed by chemo but no radiation. Especially with the excellent cosmetic result she expected, I had no doubt I wanted the first option. The incision will be made along the side where the breast meets the chest wall and will almost be invisible in a frontal view. In addition, the size of the area to be removed would be no bigger than a golf ball to get clear margins. In smaller-breasted women that might be a big chunk but it will not make much difference with me. That's a win.
We also talked about the lymph nodes. As you might know if you've read my other posts, that is the area of most concern. She agreed with the earlier indication that she didn't think my lymph nodes are involved from what she saw although one looked a little abnormal. They had said something to that effect when I had my diagnostic sonogram. But she said it was not suspicious enough under protocol to change her mind about just doing a sentinel biopsy on the lymph node closest to the cancer. You might guess that cancer presence in the lymph nodes can change your stage rating as well as your treatment plan (and not for the better). It is something of great concern to me so it was to good to hear that someone of her experience who has seen thousands of breast cancer patients thinks it is nothing to worry about. Of course, only pathology can give me an "all clear" as far as the lymph nodes go.
She added that I had cleared the protocol for genome testing because of my age (under 60); family history (three generations in a row); sub-type of cancer (invasive breast cancer triple negative). They would be doing a blood draw to send out for testing. This is good news. Perhaps we can solve the mystery of why so many women in my family have had it and protect my daughter better in the future. If I have the genetic mutation, I got it from my paternal side and my daughter has a 50/50 chance of having that gene mutation also. She can get tested too. She would have no need to get the testing should I not show the gene mutation and her odds drop back down closer to the normal 12.5% lifetime chance of the average woman. Of course, since mother-daughter is the strongest link for familial breast cancer, she will always have to be a little more diligent.
I asked a few more questions about healing time from the surgery and such before she left the room. The nurse came back in with some paperwork which included my genome testing information and blood draw form for the lab as well as the surgery consent forms. I signed everything and headed off to the lab.
Today a bit of sunshine shown through those dark clouds. It was a good day.
When I walked into the waiting room (this is mainly an oncology center treating cancer patients), I saw about twelve other people waiting their turn. There were men and women with all types and all stages of cancers there and some family members who accompanied them. Most of them were older than me. I shuddered with the fleeting thought of which of them may not make another year, but quickly put that thought out of my mind.
After giving the front desk nurse my paperwork with medical history I had filled out the night before and answering their on-line cancer screening/risk assessment survey on a tablet they handed me, I waited another 10 minutes before being called back.
I was taken to a room where the nurse took vitals, asked additional questions, etc. She asked me if I was having any breast pain and I told her I never had any breast pain. I then changed into one of those paper gowns just for the top. Dr. Wagner was in her office next door reviewing my charts and pictures. I guess we could call that her debriefing room.
She walked in with charts in hand and introduced herself. I was afraid I might feel fear and anxiety, but instead I was calm and hopeful. She had me raise my arms above my chest and did an exam of both breasts before having me lay down on the patient reclining chair and repeating the palpitation, but only on the right side this time. It was a little rough there at times because she was really pushing in hard to see if she could feel the tumor from the outside. She then put the goop on and used the sonogram to look at the images on the screen.
She didn't say a lot but spent a good bit of time looking at the ductal papilloma and the cancer tumor before looking at the lymph nodes very carefully. She captured images, made notes and turned the machine off before talking.
She told me she agreed with the Stage 1 assessment and that the cancer was very small; about 1.5 cm. She told me how lucky I was to catch it at this time especially with the triple negative type it is. She was actually wavering on whether to take out the papilloma because it would require another small incision under my areola but after discussing that with me we decided to go ahead. She laid out my options as being a lumpectomy (in medical lingo, a partial masectomy) with chemo and radiation to follow or a complete simple masectomy that would still need to be followed by chemo but no radiation. Especially with the excellent cosmetic result she expected, I had no doubt I wanted the first option. The incision will be made along the side where the breast meets the chest wall and will almost be invisible in a frontal view. In addition, the size of the area to be removed would be no bigger than a golf ball to get clear margins. In smaller-breasted women that might be a big chunk but it will not make much difference with me. That's a win.
We also talked about the lymph nodes. As you might know if you've read my other posts, that is the area of most concern. She agreed with the earlier indication that she didn't think my lymph nodes are involved from what she saw although one looked a little abnormal. They had said something to that effect when I had my diagnostic sonogram. But she said it was not suspicious enough under protocol to change her mind about just doing a sentinel biopsy on the lymph node closest to the cancer. You might guess that cancer presence in the lymph nodes can change your stage rating as well as your treatment plan (and not for the better). It is something of great concern to me so it was to good to hear that someone of her experience who has seen thousands of breast cancer patients thinks it is nothing to worry about. Of course, only pathology can give me an "all clear" as far as the lymph nodes go.
She added that I had cleared the protocol for genome testing because of my age (under 60); family history (three generations in a row); sub-type of cancer (invasive breast cancer triple negative). They would be doing a blood draw to send out for testing. This is good news. Perhaps we can solve the mystery of why so many women in my family have had it and protect my daughter better in the future. If I have the genetic mutation, I got it from my paternal side and my daughter has a 50/50 chance of having that gene mutation also. She can get tested too. She would have no need to get the testing should I not show the gene mutation and her odds drop back down closer to the normal 12.5% lifetime chance of the average woman. Of course, since mother-daughter is the strongest link for familial breast cancer, she will always have to be a little more diligent.
I asked a few more questions about healing time from the surgery and such before she left the room. The nurse came back in with some paperwork which included my genome testing information and blood draw form for the lab as well as the surgery consent forms. I signed everything and headed off to the lab.
Today a bit of sunshine shown through those dark clouds. It was a good day.
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