Pathology Report, Part I (Message 5 of 21)

11 Mar 2011
Happy Friday! (again).  Time flies, eh? (No.)  

I am recovering nicely from surgery. I have very little pain, but don't ask me to describe it on a scale of one-to-ten. I am nearly drug free at this point. The PT exercises are easy and much like the upper body stretches you do at the end of spin class. I have almost a full range of motion again and the subconscious desire to "protect" the right side from "unnecessary movement" has almost disappeared. That's the good news.

The lymph node pathology report came back yesterday afternoon. Four lymph nodes were identified as sentinel, meaning that anything traveling the path from my tumor to the rest of my body would pass through these nodes first. No cancer in these nodes would mean the cancer was isolated to my right breast only, so these nodes were removed to examine. (Actually, a fifth, tiny node was also removed because it was stuck to one of the four.) In one of those nodes was a tiny amount (a few millimeters) of tumor, my doctor said. 

This is where it gets confusing for me because we had one course of treatment to follow if I were node negative, and another to follow if I were node positive. Dr. Barrio says that the amount of tumor in the one node is so small that this is still considered a node negative result. However, we will be doing the long course (6 week) of full-breast radiation treatment instead of the localized, one-week treatment option for node negative patients. That works for me. I certainly don't want to skimp if there is a chance we need to to more. And, we were not going to engage an oncologist to discuss chemo options unless I were node positive, but now I will see an oncologist. I'm sure you can see how my over-thinking brain would short circuit over this.

So, whether or not I receive chemotherapy as well as radiation therapy is still to be determined. Because my result was technically "node negative," the tumor still gets the trip to Redwood City for gene mapping. That test is only for invasive cancer that is ER+ and node negative. Here's a video that explains it. It includes such educational phrases as "...gene specific florescent dye-labeled bio-probes." But don't worry; most of it is in English!

The info from this assay will be extremely useful for the oncologist to determine if chemotherapy would have any impact on my chances for recurrence.  (Only 4 out of 100 women receiving chemo  with early stage invasive breast cancer actually have recurrence rates that are better than women who don't receive chemo!)

Next up: 

1) Surgery follow-up appointment with Dr. Barrio next Thursday at noon.

2) Meeting with oncologist when results come back from CA (about 10 days). 

3) Radiation therapy begins when my skin is completely healed from the surgery -- about four weeks. With skin as painfully fair as mine (nearly transparent!), she wants to be sure we start out on the healthiest possible foot. Six weeks of sunburn will be a new record for me.

As usual I have you all to thank for the distractions and perspective that keep me on a positive keel. I was really counting on getting some peace of mind from that report, and  I about crumpled when that didn't happen.   


More than just empathy and sympathy, you guys came through with actual useful things to consider and concrete reminders of reasons to feel positive again. And with stories and such that make me laugh. Good, good stuff. Saying "thanks" is so inadequate. 

Love,

Diane