First Follow Up with the Surgeon–January 10, 2012

Follow Up with the Surgeon

Written Jan 10, 2012 8:02am

I went to see the surgeon on Friday, but since the visit happened to coincide with my 44th birthday and beautiful weather all weekend, I spent the weekend celebrating and I haven’t had any time to give an update. I’m sure you all understand! 🙂

Friday’s Follow-Up

The surgeon was very pleased with his work. He feels that the mastectomy looks good and that my body is healing well. His nurse removed my staples, and frankly it was a piece of cake. I thought it would be extremely uncomfortable, but it wasn’t. She didn’t even need to use any localized pain killer. Come on, those metal staples looked pretty ugly–and painful to come out! 🙂

The only issue is that they weren’t able to remove my drain. The average drain is able to be removed in 3-7 days post surgery, but some take several weeks. My surgeon won’t remove the drain until I have less than 10 ccs of drainage in a 24 hour period–and won’t give me permission to return to work until that happens. And frankly, I haven’t wanted the drain out early, because if there is a build-up of fluids with no drain, my surgeon would have to use a syringe to remove. No thanks.  I had a drain of 12.5 ccs in the past 24 hours…it’s getting close!!!! I know I am not supposed to overdo it and that I shouldn’t rush back into things, but there is an impatience to get my life back to normal–or at least my new normal–as soon as I can and that means going back to work!

My surgeon and I discussed the preliminary report from the pathologist while at his office on Friday. This is preliminary!!!!! There were 2.5 significant tumors in my right breast as well as the calcifications and the pathologist had only analyzed the largest of those tumors. The surgeon has asked the pathologist to go back and look at the others which he will do this week. Also, samples were sent to a special lab out in California to be screened with ultra violet rays and those results won’t be back until this week.

That said, here is my surgeon’s preliminary readings:

•The sentinel node was clear. He did take 4 nodes all together.
•The chest wall is clear of cancer
•The main tumor (which was biopsied 4 weeks ago) was 1 cm
•With the initial information, he thinks this is Stage 1 cancer. At this point, it looks like I won’t have to have radiation.
•ER/PR positive which is good
•HER-2 is negative (unamplified) and this is also good
•KI-67 gene panel is 30% (20% or above is high) not so good

Why he is having the pathologist re-analyze the information is that if a tumor is 2.5 cm or more in diameter, chemo is usually the next step. Chemo is also the next step if a tumorous area is more than 2.5 centimeters. Tumor 1 + Tumor 2 + Tumor 3=???  So we don’t know yet.

My oncologist already discussed this with me, but with my being ER/PR positive, it means that I am able to go on hormone therapy for 5 years. My next meeting with my oncologist is next week, and we will continue to discuss this adjuvant therapy. If I have chemo, hormone therapy starts after chemo.

From The American Cancer Society’s website:

A woman’s ovaries are the main source of the hormone estrogen up until menopause. After menopause, smaller amounts are still made in the body’s fat tissue, where a hormone made by the adrenal gland is converted into estrogen.

Estrogen promotes the growth of about 2 out of 3 of breast cancers — those having receptors for the hormones estrogen (ER-positive cancers) and/or progesterone (PR-positive cancers). Because of this, several approaches to blocking the effect of estrogen or lowering estrogen levels are used to treat hormone receptor-positive breast cancers. Hormone therapy does not help patients whose tumors are both ER- and PR-negative. For women with hormone receptor-positive cancers, taking tamoxifen after surgery for 5 years reduces the chances of the cancer coming back by about half.

Now the HER2 gene and mine being unamplified:

human epidermal growth factor receptor 2 or HER2 gene (sometimes called HER2/neu)
this oncoprotein is present in very small amounts on the outer surface of normal breast cells. About 25% to 30% of breast cancers have too much of this protein. HER stimulates cell growth, and breast cancers that produce too much of this protein tend to be more aggressive (they grow and spread faster).  So my being HER2/neu negative, again is good.About the KI-67 Gene Panel.
The Ki-67 protein (also known as MKI67) is a cellular marker for proliferation.[5] It is strictly associated with cell proliferation. During interphase, the Ki-67 antigen can be exclusively detected within the cell nucleus, whereas in mitosis most of the protein is relocated to the surface of the chromosomes. Ki-67 protein is present during all active phases of the cell cycle (G1, S, G2, and mitosis), but is absent from resting cells (G0). Ki-67 is an excellent marker to determine the growth fraction of a given cell population. The fraction of Ki-67-positive tumor cells (the Ki-67 labeling index) is often correlated with the clinical course of cancer.

There is what is called a ‘Ki-67 gene panel’ that has collected data related to the Ki-67 protein and the rate of recurrence in women. There isn’t the same kind of information on this diagnostic as on so much else related to breast cancer so I’m limited in my understanding. Basically, more than 20% is considered high…however, some women are up at 60, 80, even 90% and so my 30% is high, but…

At this point, I probably won’t have to do radiation, but it is 50-50 as to whether I do chemo. Hormone therapy is 99% probable on the other hand, where I take a drug (most likely tamoxophin) daily.

General speaking about health…
Overall, I’m feeling better than I would expect at this point and have taken very few Tylenol in the past 4 or 5 days. There is definitely numbness and prickliness and discomfort at the surgery site, but not well-defined, I-can’t-ignore-you, pain. Being off the pain killers, I can drive (but I haven’t yet–too many chauffeurs around!) and walk as much as I feel up to, but I can’t lift heavy objects, shower at the surgery site until the drain is out, or do any vigorous exercise where I break a sweat. The real challenge is finding clothes that don’t put pressure on the surgery site in any way until the drain is out, but can camouflage the drain–and the rather lop-sided result of my mastectomy. Double tank-tops have been the most successful so far.

And on to other things…
Wow! I know why I waited until this morning to try to put this on paper/email!!!! I was able to spend the weekend playing and yesterday was all about catching up on grading (my school’s first semester ended Friday and I had been a bit preoccupied to get to the grading I had brought home to do over vacation), so now it’s time to get some housekeeping in the form of correspondence done! And since my parents kept Terry and my home in such excellent shape the past 2 weeks, I don’t really have any actual housekeeping to do! Yeah!!!!!!!

However, my parents left yesterday and they are definitely missed. Their support has been awesome!!!!!!!!!!!!

Frankly, I’ve been pretty amazed by the love, support and encouragement that I’ve been receiving throughout this experience. I feel so blessed!!!!!!

And on that note, it’s time to wrap up today’s entry.

Cheers!!!!!

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