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I had an appointment today with my oncology surgeon, Dr. Turk. I hadn’t met with him since the day I was diagnosed. All of my appointments since then have been with Dr. Limentani, my oncologist. To give you some background, I have several different cancer doctors:
Dr. Turk – Oncology Surgeon – Surgery
Dr. Limentani – Oncologist – Chemo and Other Treatment
Dr. Mcall – Radiation Oncologist – Radiation (haven’t met with him yet)
……plus others for the radiology appts, scans, etc.
Anyway, today’s appointment with Dr. Turk went GREAT!!! He agreed with Dr. Limentani and said I responded great to the chemo and Herceptin treatment and recommended a lumpectomy instead of a mastectomy, which is FABULOUS!!!! The difference between a lumpectomy and a mastectomy is HUGE. For a lumpectomy, they only remove the affected cancer area whereas for a mastectomy they remove the whole breast. There are several different ways to do a mastectomy but I won’t get into all that since I no longer need one!!
Here is a link that describes the differences of a mastectomy vs. a lumpectomy:
And a more detailed overview of a lumpectomy: http://www.breastcancer.org/treatment/surgery/lumpectomy/
We talked for a while about the risks and benefits of a lumpectomy vs a mastectomy for my specific situation. In the beginning, they were recommending a mastectomy due to the size of my tumor area (about 5cm), my age (risk for recurrence is higher in younger women and higher if you have a lumpectomy vs a mastectomy), and the fact that my tumors are HER2+ (grows/spreads faster and higher risk for recurrence). Now, they are recommending a lumpectomy because the tumors have gone down in size so much and for breast conservation purposes. I’m having an MRI on Monday to confirm that the tumors are indeed gone (until now, they’ve just determined this through physical exam) and determine the size of the tumors (if they are even still there). There’s a small chance they could change their lumpectomy recommendation back to a mastectomy if the tumor area is still showing signs of cancer spread out over a wide area but their expectation/hope is that the cancer is gone.
If I got a mastectomy instead of a lumpectomy (which I could do if I wanted to but am not), my risk for recurrence would be lower but due to my age, the fact that my BRCA1 and BRCA2 genetic testing came back clear (with no mutations of known significance), and the fact that I’ll get annual mammograms, ultrasounds and MRIs, Dr. Turk said I’d be fine with just a lumpectomy. Thank God, Dr. Limentani and Dr. Turk for that!!
Either way, I will still need to have most of my underarm lymph nodes removed (axillary lymph node dissection). That’ll be the most invasive part of my surgery now (which would have been the was invasive part had I had a mastectomy too I think). Here are some links that explain the lymph node removal:
Dr. Turk said they don’t usually say beforehand how many nodes they’ll remove but it’ll probably be around 12-15. They instead remove the whole cluster area where they reside. He said some of them may have been destroyed already by the chemo.
After the surgery, they’ll run a pathology report on the tissue they remove. If they find cancer cells, they may go in a week after surgery and remove a wider margin. If they don’t find any cancer cells, then I’m free and clear.
Three weeks after surgery, I’ll have radiation. This is to kill any lingering cancer cells and is recommended either way (lumpectomy or mastectomy) due to the HER2+ part and my age. This will be every day for 6 weeks but will only last 15 minutes and I can do it on the way into work first thing in the morning or last thing in the afternoon on my way home. Side effects from this are burning on the skin at the site and slight fatigue starting about half way through the 6 weeks. But the fatigue should be manageable and nothing close to the chemo fatigue, which is where I feel like I’m 500 pounds and am really weak, etc.
My MRI is scheduled for Monday and my surgery is tentatively scheduled for August 6. Recovery time will be 3-4 weeks but I’ll be able to work from home after 2 weeks (I just can’t drive for the following 2 weeks due to the lymph node removal surgery).