Not What We Were Thinking

We went to see the surgeon (Dr. Kilkenny) today. He wants to send us to see a medical oncologist, which is a doctor that uses chemotherapy to treat cancer. He wants us to discuss the possibility of using chemo to try and shrink the tumor and possibly kill the cancer cells in the lymph nodes.

Using chemo before surgery will do one of a few things...

1. It will shrink the tumor none and do nothing to the cancer in the lymph.

2. It will shrink the tumor some and do nothing to the cancer in the lymph.

3. It will shrink the tumor a lot and do nothing to the cancer in the lymph.

4. It will shrink the tumor none and kill the cancer in the lymph.

5. It will shrink the tumor some and kill the cancer in the lymph.

6. It will shrink the tumor a lot and kill the cancer in the lymph.

If #1 happens, the surgeon will have to do a *full mastectomy and take out all the lymph nodes.

If #2 happens, the surgeon will do a **partial mastectomy and take out all the lymph nodes.

If #3 happens, the surgeon will do a ***lumpectomy and take out all of the lymph nodes.

If #4 happens, the surgeon will have to do a full mastectomy and leave the lymph nodes alone.

If #5 happens, the surgeon will do a partial mastectomy and leave the lymph nodes alone.

If #6 happens, the surgeon will do a lumpectomy and leave the lymph nodes alone.

Obviously, we hope that if she goes through chemo first, that #6 is what ends up happening. Though any of the situations #4-6 would be good. If she can get through surgery without having to take out the lymph nodes, that would be awesome. The drawback to #2,3,5 and 6 is that she would have to go through radiation after the surgery. With #4, she would do the chemo and have the surgery and NOT have radiation, but she would lose the entire breast. With #1, she would go through the chemo and have the surgery and NOT have radiation, but she would lose the lymph nodes.

The lymph system "is part of your immune system. It consists of a series of vessels which run along side your circulatory system (veins) and lymph nodes which are located around major organs and in certain tissue (under your arm for instance). The lymph system helps to filter out dead cells, protein and waste products in your veins. It also plays a role in mobilizing your immune system to fight off an infection." (http://cancer.sutterhealth.org/information/index.html)

Losing the lymph nodes put her at risk for a condition called lymphedema. Lymphedema is "the collection of protein-rich lymph fluid in the tissues of the hand, arm and/or chest wall on the side of the breast surgery. Lymphedema causes painless swelling of the hand, arm and/or chest. The condition occurs when the normal lymphatic drainage in the chest and arm are injured during surgery and/or radiation therapy." (http://cancer.sutterhealth.org/information/index.html )

Lymphedema is usually not painful, though the arm does get red and swollen. It can be a chronic condition that she would have to deal with forever, off and on over the years. It is not a dangerous condition, just bothersome as it can occur due to overuse of that arm, infection, a bug bite on that arm, a cut or scrape to that arm, or any other type of injury that causes a build up of excess fluids. It is something that can treated with massage that manually drains the lymph fluid, wearing custom-fitted compression sleeves or garments with or without pumps attached, and with antibiotics.

* full mastectomy: surgery where all of the breast tissue and nipple is removed.

** partial mastectomy: surgery where the cancerous tissue and a generous margin of normal tissue is removed (more breast tissue is removed with this than with a lumpectomy)

*** lumpectomy: surgery where the cancerous tissue and some surrounding normal tissue is removed.

I think I covered it all...