Wednesday, 16 July 2014

Mastectomy and then into the unknown

Be careful what you wish for.

In a previous post, I weighed the difficult choice between taking the chemo path in order to shrink the tumour before a lumpectomy versus simply having a mastectomy.  I have also been heard to say that I hoped I wouldn't have to make a difficult decision.

So here is what they told me: I'm booked in for a mastectomy in a week's time and I'll probably need chemo afterwards and possibly radiotherapy too.  Hooray!  No difficult choices after all.  I'm going to have a fake boob AND fake hair!

It seems that there is some confusion about my lymph nodes.  The last agonising aspiration produced lots of fluid and when they tested it...they did find Cancer cells.  The shock of hearing that made my face burn, it sounds like my Cancer decided to go travelling after all.

But nothing is ever as clear as you'd like it to be in the world of medicine (which, of course, could turn out to be a good thing so I suppose I should be grateful).  They didn't actually find any lymph cells in this fluid.  So it could be from some weird ectopic breast material or glandular fluid (depending on which doctor you listen to) and not from my lymph nodes at all, which still look quite normal.  The only way to find out is to operate, remove one and test it.

And so, to the operation.  They have a three stage grading system for tumours: below 2cm, between 2cm and 5cm, and over 5cm.  Mine is weighing in at a hefty 5cm at the moment but it's only a best guess.  Lobular cancer mimics the shape of the breast rather than forming a hard lump like ductal cancer, so it's difficult to see the tumour even on the MRI.  It might turn out to be bigger.  Or some of the material might actually be pre-cancerous and the tumour itself might be smaller. 

But they all agree on one thing - the tumour is large and it's been there a while.  As the doctors candidly, but politely, pointed out, the tumour may be large but my breast is not.  A lumpectomy will leave me with a miniscule, misshapen breast that will be difficult to reconstruct so the surgeon said with a shrug, mastectomy is better.  Reconstruction of a small breast is easy, she said lightly, so I'll get a better cosmetic result in the end.  Not so easy, I suspect, but that's another bridge for another day.

I'd mentally prepared myself for a mastectomy so I took the news without weeping for my poor breast.  In a way, I'll be glad to be rid of this treacherous breast tissue in case it betrays me a second time.  What shocked me was that it might not be enough.

I might still need chemo.

Of course, if it's in the lymph nodes, then I will need the works: radiotherapy to blast it in location and then chemo to deal with any drifting cells left wandering in my system.

But even if it's NOT in my lymph nodes, I'm still likely to need chemo because there's a risk that a large tumour will have found a way to send cells wandering out of the breast.  I hadn't understood that.  I thought clear lymph nodes meant a clear body.  Unfortunately not.  At least in this scenario I won't need radiotherapy because they will only have found Cancer in my breast and...there won't be any breast left to blast.

I had hoped that results day would set out the path to follow.  But it only took us to the next junction: mastectomy and more waiting for results.  From there, I might be sent down the roughest path through the jungle of radiotherapy, chemotherapy and hormone treatment.  We'll just have to wait and see.

Oh yes. Hormone therapy. I'm going to need that too, but I think I'll cover that in another post because if you are anything like me, you head is probably spinning by now.

Yes, I'm spinning but I'm holding up alright for the moment.  I admit to leaking a few tears in the doctor's surgery when they told me mastectomy plus probable chemo.  But there is such a relief in getting on with it all that it's giving me strength to keep smiling and counting my many blessings

In one week's time, they will cut this killer from my body and I then I've just got to do whatever it takes to make sure I am here to enjoy my blessings for many years to come.

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