Pathology Report

My husband took the kids to a music festival, where they will camp out for the weekend. I don't camp even when I'm not recovering from surgery, but it was nice to have a legitimate excuse not to go. Somehow the I don't camp and you can't make me excuse seems to wear off after a while.

Anyway, I was settling into a quiet evening of alone-ness, trying to figure out what type of food I could possibly keep down, when my cell phone rang. I didn't recognize the number, but I answered it, and it was Dr. L. calling me with the pathology report. At 6:30 PM on a Friday evening. (Did I mention that I love this woman?)

As soon as I realized it was her, my heart started pounding and I immediately started trying to read her voice for any signs of good news/bad news. I couldn't get a good read, though, either because she is a seasoned pro, or because she was delivering a mix of good news and bad news. Fortunately, she delivered the bad news first, which is the way I like it. 

The bad news is that the pathology report shows that were extensive regions of ductal carcinoma in situ (DCIS), more than expected. (I'm not even sure any DCIS was expected.) DCIS is sort of a weird beast; it's not invasive, but it can become invasive, and it is a definite risk factor for the development of invasive tumors in the future. And since I HAVE an invasive tumor, we know I am prone to developing invasive tumors, so basically DCIS is not something to fuck around with. 

Dr. L explained that the tumor of invasive ductal carcinoma was 1.3 cm in diameter, which is almost exactly as expected, based on the many measurements I had done through many different scanning processes. However, the area including DCIS was 4.5 cm. And while she did think that she got all of it out, the margins were not what she would want - only 0.5 mm. Apparently that's a small margin. She explained that any margin was technically a 'clean' margin, but... she would feel more comfortable if we got a little more. Which means she wants to go back in and do another surgery and take more tissue out. UGH!! She said that if I were 60, she would be perfectly okay with a 0.5 mm margin, but since I'm only 40 and obviously 'high risk' due to the fact that I HAVE an invasive carcinoma, she thought it would be safer to go back in and take a little more out. Did I already say UGH?! On a side note, it's hard for me to believe that she took out over 4.5 cm of tissue and my breast hasn't, like, collapsed in on itself or something. (For the record - in case you are wondering, lol - I don't have particularly large breasts.)

But, that is the bad news, and in the large scheme of bad news, it isn't too bad. Honestly, I think I'm dreading the f-ing shots in the stomach more than the surgery itself. Have I cursed my orthopedist recently?

The GOOD NEWS - and I know you've been dying to hear this :) - is that she took out seven lymph nodes, and they were all free of cancer. (!!!) This, more than anything, is what I was hoping for. This means it is unlikely that I will have to do chemotherapy, which is... awesome. That's the thing I want the most - not to have to do chemo. I will need to do radiation therapy, and that's not a walk in the park, either, but I really, really don't want to have to do chemo.

I'm not completely off the hook yet, though. Dr. L thought that we should send the tumor off to get an oncotype, which basically predicts the probability of a tumor coming back, as well as how likely I am to respond to radiation and/or chemotherapy. She said this would give us more information as far as treatment goes, then added jokingly 'unless you just really want to do chemo.' HA HA! I assured her I did not, to which she replied, 'Yeah, I didn't think so!' 

I asked her what the timeline was for the second surgery and she didn't really give a definitive answer. It's sort of STAT and sort of not. She said it would be helpful to have the results of the oncotype at the time of surgery, because if chemo were recommended, she would insert a port during the surgery. (Ugh, I do NOT want to think about this!) In the end, we decided to discuss everything in more depth at my post-surgery appointment on May 28th. 

Overall, it is not the absolute best news, but it is very good news, probably as good as it gets these days. Because the cancer has not spread to any lymph nodes, at least that we can tell, it is considered Stage IA, which is the best thing you can have with an invasive cancer. The tumor grade, which is different from the stage, and essentially determines how aggressive the cancer is, is a G2, on a scale of 4. This is a slight downgrade from the original biopsy that stated the tumor was 'well differentiated' (which would be G1), but the good news is that hopefully it doesn't matter, because it is OUT OF ME. As far as I'm concerned, it can keep on growing in the jar if it wants to. LOL. 

On a final note - I was going to write about this in my last entry, but then Dr. L called - I/we (we being my husband and I) decided to shop around for medical oncologists. My parents kept the kids the Saturday before my surgery so my husband and I could have a nice dinner together. It's amazing what type of conversation can occur in the absence of children. Ha. We both agreed that we weren't crazy about Dr. U, and even though we have no idea what an oncologist 'should' be like, we felt like something was missing. I hope Dr. L hasn't spoiled us to a point where no doctor will ever meet our standards now, but we figure we have to try. This is life or death, after all. And that's worth a shopping trip, in my opinion.