A Plan For Treatment

Yesterday I met with the surgeon, Dr. A., who will begin the treatment of my breast cancer. I also consulted with her nurse practitioner, MG. The treatment will begin with surgery. It will happen in the next couple of weeks. I will get a call later today to give me a schedule. Fortunately, Dr. A. thinks I am a good cadidate for a lumpectomy. This is a breast sparing surgery. She will remove the lump and a margin of healthy tissue around it. At the same time she will also examine the lymph nodes that drain the breast area using a technique called sentinel node biopsy. Using a radioactive substance she will track the drainage pattern from my breast and take out the first lymph node in that pathway. It will be quickly examined while I am still asleep. Ideally, no cancer will be found. If there are cancer cells in the lymph node then a section of tissue, mostly fatty tissue, will be taken from under my arm. Contained in that tissue will be the majority of the clump of lymph nodes that drain the breast and arm. The breast lump, surrounding marginal tissue, and any lymph nodes will all carefully examined by pathologists. Results take about 5 or 6 business days.

Lumpectomy alone will allow me to go home the same day and will probably not take a long time for recovery. Taking the lymph nodes, if necessary, will be more extensive surgery and will be at least an overnight stay in the hospital. The resulting recovery will be longer and more difficult. I may need help from visiting nurses to care for drains that would have to be placed.

Sometime following surgery I will have radiation to destroy any possible remaining cancer cells in the breast. Lumpectomy and radiation are the alternatives to masectomy. This combination of treatment has the best chance of reducing the risk of re-occurance of cancer in this breast in the future. Of course, I realize that no treatment can guarantee a 100% cancer free life. Then after surgery I will be in the care of a radiation oncologist and a medical oncologist. They will help me make further treatment plans.

If no cancer is found in the lymph nodes, I may not have to take chemotherapy. On the other hand, I may need chemotherapy. The findings from pathology will give information that will guide me and the doctors in that decision. Surgery and radiation are the treatments for the local occurance of cancer in my breast. Chemotherapy would be treatment for my whole body to eliminate any possible breast cancer that may decide settle in some other location. I may also go on to have hormonal treatment for a period of time in the future to guard against further breast cancer. Again, as good as treatment is at this time in history, nothing guarantees never ever facing cancer again.

So, a plan is outlined, although some of the details are still fuzzy. Further information, which will come from the surgery and pathology studies, will bring the situation into greater focus.

It is difficult to wait for these developments. I do not feel greatly anxious - more like medium anxious. I am having trouble sleeping through the night. I tell myself it is to be expected after the "slap in the face" of hearing the breast cancer diagnosis. I am also limiting myself to small amounts research per day. I am fortunate to have great resources at the medical school library (just down the hall and accessible through my computer at work). There are some days when I want to read and read. But, it gets overwhelming. Other days I am content to rest, knit, read for pleasure, and live my life. I have a great desire to experience change through this journey. I want to be different in many areas. I find that I am questioning what I eat, how I spend time, how I relate to the world, relationships, values, priorities, etc., etc. I have begun a graduate course in the meaning of my life, with additional studies in biology, pathology, cancer treatment, nutrition, etc. I was always a very good student. Hope I get an A+ in this course of study.