Surgery

As I stated in my first post, it was assumed that surgery was the next step after being diagnosed.  I did go ahead and schedule a consultation with the surgeon, but I had not made up my mind whether I would have surgery or not.  This may seem ludicrous to some of you, but it is important to understand that standard medical procedures and treatments for cancer are not guaranteed to cure cancer.  There are no guarantees with cancer.  I was told this by my family doctor as well as my oncologist.  It is also obvious when you just look around and take note of how many people are still dying of cancer despite the medical community's best efforts to cut it out, burn it out, and poison it.  I also found it very telling when my family doctor told me that she wasn't even sure what she would do (as far as treatment) if she was diagnosed with cancer. 

I educated myself about my specific diagnosis and all of my treatment options before my consult with the surgeon, and I was glad I did because I was already familiar with 90% of what he said during the consult.  I remember the one thing that surprised me most was the fact that both a lumpectomy and a mastectomy were outpatient surgery, and I would go home the same day.  I had anticipated at least a one-night hospital stay, especially for a mastectomy!  I was happy about it, though, because my mindset is "the less time in the hospital, the better!"

As I looked into surgery, I found that there is some evidence that cutting into cancer can cause it to spread and grow, and also that removing primary tumors can cause secondary cancers to grow faster (primary breast cancers can secrete a substance that blocks other cancer cells from growing).  Some medical websites definitively state that surgery does not spread cancer; others admit it does under certain circumstances, but that it's rare; others say it can and does.  The belief that cancer being exposed to air during surgery causes it to spread, however, seems to be just a myth.  Surgery is not a cure; it can miss some cancer cells, and it may spread cancer.  The following link provides some good information:  http://www.canceractive.com/cancer-active-page-link.aspx?n=2976.

With that in mind, I still decided to have surgery because it made sense to me to get rid of the mass that we knew was there, and then give my body a better chance to fight off any remaining cancer cells without also having to fight a large mass of cancer.

It is not uncommon for women diagnosed with breast cancer to make treatment decisions stemming from their fear of cancer; they want to do everything they can to beat this, and they want it started yesterday!  Although this is completely understandable, I think it is unwise and counterproductive.  Almost all the information I read (and my surgeon agreed) stated that in most cases, there is no reason to rush into surgery (or any other treatment), and the patient can comfortably schedule surgery 2-3 weeks out and use that time to make an informed decision.  Who will perform the surgery?  What type of surgery/how extensive will it be?  What are the pros and cons to each type of surgery?  

Surgery types include a lumpectomy (also called "breast sparing surgery" where only the tumor and a safe margin of normal tissue around it are removed, leaving the rest of the breast intact) or a mastectomy.  There is also the likelihood of having axillary (underarm) lymph nodes removed.  There are different types of mastectomies:  1. 'Partial' or 'segmental' (quandrantectomy) removes the segment of the breast containing the tumor, which could be up to one fourth of the breast.  2. 'Total' or 'simple' removes the breast tissue, but not the muscle or lymph nodes.  3.  'Modified radical' removes the breast, chest wall muscle lining, and some axillary lymph nodes.  4. 'Radical' removes all that a 'modified radical' would remove plus all the muscle--this surgery is not often used anymore.

If a mastectomy is done, then there are decisions regarding reconstruction--whether or not to have it, what type, and when.  Again, I would recommend researching all the options and the respective pros and cons and making an informed decision.   This decision does not have to be made before the mastectomy.  While some women choose to have reconstructive surgery done at the same time as the mastectomy, there is nothing wrong with waiting.  In fact, some women feel better about their decisions and have more confidence in them if they wait and take the time to make their decision some time after surgery.

The surgeon's recommendation for me was either a lumpectomy and sentinel lymph node biopsy followed by radiation treatment, or a simple mastectomy.  Sentinel lymph node biopsy is when a radioactive dye is injected near the nipple to track where fluids from the tumor area drain, allowing the surgeon to see the primary (or sentinel) 1-3 lymph nodes to which the ducts drain.  The surgeon will then remove those 1-3 lymph nodes so that a biopsy can be done to determine if cancer has spread to the lymph nodes.

Before the consult I was already certain that I was going to refuse radiation and chemotherapy (I will discuss those treatments later), which affected the surgical procedures I chose.  I briefly considered having a mastectomy due to the fact that in my case, follow-up radiation wasn't recommended with a mastectomy, and I had the cowardly thought that I might be able to avoid a confrontation on refusing radiation if I just had the mastectomy.  As I said, I only briefly considered that option; in the end, I decided to go with the less invasive lumpectomy and sentinel node biopsy. 

I had learned that for tumors up to 4 cm in early stage breast cancer, mastectomy offers no advantage in survival rates over lumpectomy with or without radiation--survival rates for all three options are exactly the same.

On a side note, choosing to have a mastectomy or double mastectomy purely as a prophylactic--to prevent breast cancer from occurring even when there is no evidence of breast cancer in one or both breasts (like Angelina Jolie's highly publicized double mastectomy because she found out she carries the 'breast cancer gene')--has not proven to be at all effective.  Removal of the breasts does nothing to guarantee that breast cancer won't occur.  In fact, by removing the breasts, since the more easily treated breast tissue has been removed, the cancer can appear in the chest wall muscle or other areas which are much harder to treat.

Just a couple days before my scheduled surgery, I discovered another bit of information that changed my decision again.  I learned that the only reason for doing the sentinel node biopsy is to use the results to stage the cancer and recommend further treatment (i.e., if the nodes are positive for cancer, chemotherapy would be recommended).  Therefore, if a patient has already decided to refuse chemotherapy--or, conversely, has already decided to have chemotherapy--no matter the result of the node biopsy, then it is a better option to just keep the lymph nodes in tact and avoid the more invasive surgery which has a longer recovery time and potentially more negative side effects.  I knew I would be missing the information about whether or not the cancer had spread to my lymph nodes, but my decision regarding chemo wasn't based on that information anyway, and the results of the node biopsy wasn't going to change it.  It made sense to me to keep my lymph system in tact so that it could function optimally, to not deal with a longer recovery due to muscle and tissue being cut under my arm, and to avoid further side effects like lymphedema. 

I had assumed that one purpose of removing lymph nodes was to remove more cancer if it was present in the nodes.  After looking into it a little more, I called my surgeon and told him that I was now leaning toward having just the lumpectomy without the sentinel node biopsy.  I explained why and then asked him if it was true that the purpose of the node biopsy was for staging and treatment recommendation as opposed to removing more cancer.  The surgeon confirmed that this was indeed the case.  I was surprised at how quickly he accepted my request to skip the node biopsy.  He didn't try to convince me to change my mind or indicate by word or even voice inflection that he thought I was making a foolish decision.  He may have thought me foolish, but I really appreciated the way he handled it, and it was a huge relief for me.  There were no outward signs of cancer in my lymph nodes--no swelling, redness, etc.--but I wouldn't be surprised if the cancer had spread there due to the tumor being located so close to my armpit.

The surgery was scheduled on Thursday, June 20, 2013.  The admissions process went very smoothly since we had experienced it all just 17 days earlier when my husband, Bob, had surgery on his broken ankle.  Bob's experience didn't go nearly as well as mine, but we learned a lot from it and were much better prepared when it was my turn.  Our 17 year old daughter also accompanied us--she wanted to be there with me, plus we needed a driver since I wouldn't be allowed to drive after the surgery, and Bob couldn't drive with his broken ankle.  Our pastor and his wife met us at the hospital.  Pastor read Scripture and prayed with us, and we visited for a bit before they left.  It was a huge encouragement having them there, and we are very thankful for them and the rest of our church family!  I didn't feel nervous at all, but apparently I was more nervous than I thought because my blood pressure was higher than normal when the nurse took it--which we joked about.  After surgery when she took it, it was back down to normal. 

I had a procedure done before the actual surgery--which surprised me because I had not been told about it ahead of time.  They took me to radiology where they used ultrasound to locate the tumor and insert a thin wire into it to mark the exact location for the surgeon.  I felt like a Cyborg with the four inch piece of wire sticking out of my chest (they did tape it down, so I wouldn't lose an eye!).  The surgery lasted one hour twenty minutes; I awoke in recovery less than an hour after surgery, and I left the hospital to go home less than two hours after that.  Other than a dry mouth, I felt great!  I drank and ate right away, walked down the hall to use the bathroom with no problem, and felt completely lucid and awake.  I don't know how it could have gone any better or faster!  I never experienced any pain after surgery, so I never used the pain meds they prescribed.  I was a little tired later that day and snoozed in the recliner for a bit.  I had taken the following day (Friday) off work, but I seriously could have gone to work--I felt that good!  I attended church on Sunday, and returned to work on Monday as normal.

I was again impressed with the attitudes of all of the medical personnel at the hospital.  Every single person with whom I had interaction was very kind, considerate, and understanding, yet willing to show some humor.  I specifically remember two nurses.  The first one wheeled me into surgery, and when we came to a very steep downhill incline on the way I said, "This could be fun!  Do you ever run down the ramp?"  She answered that she actually did, especially when the patients are children.  So we had a laugh about that.  The second was the O.R. nurse.  While she was getting me set up on the operating table, we were chatting, and she mentioned the procedure.  I told her I actually wasn't getting the sentinel node biopsy and explained why.  Her enthusiastic response astounded me.  She said, "Good for you!  I see women come through here all the time who are scared and just blindly follow their doctor's recommendations--not that you shouldn't listen to your doctor, but so many women have no clue what's going on or what their choices are.  That's great that you did your research and are making informed decisions!"  Let me tell you, that was a big confidence booster!

When I had scheduled my surgery, it was for three weeks out, allowing me three weeks to detox and strengthen my immune system as much as I could.  I also had two acupuncture treatments a week up to and following surgery.  The acupuncturist told me that acupuncture helps with bleeding during surgery and with pain and faster recovery after surgery.  This was interesting because since I currently had no symptoms whatsoever, I could not gage whether or not the acupuncture treatments were actually doing anything.  They were relaxing, but I never really felt any different.  The proof for me was after surgery when I came out of recovery amazingly fast with no side effects other than a dry mouth.

The "side effect" of surgery that bothered me the most was not being able to play basketball for awhile!  For the past few years I have been playing basketball at an open gym at the high school every Tuesday and Friday starting at 5:00 a.m.  Other than one high school girl who used to play occasionally, I'm the only female who plays, but I'm pretty much considered "one of the guys" now.  The early morning time is perfect since Bob is usually leaving for work anyway, and I'm usually home before the kids even wake up, so I don't have to give up spending time with my family to participate.  Besides that, I love playing basketball, and it's easy motivation to get up and get a workout.  I waited about a month after surgery before I played again.  My incision healed quickly and well, and during that time I walked every day for my exercise.  After a couple weeks I started jogging some as well to build up my endurance and test how things felt while I was running.  When I was pretty comfortable with everything, I started playing again. 

Only a couple of the guys knew about my diagnosis and surgery before I stopped playing, but I figured they would spread the word while I was gone.  The first morning I showed up after surgery, it was pretty heartwarming.  I was a little late, and they had already started playing the first game.  When I walked in, several guys called to me and waved from the floor while they were playing.  When there was a pause in the action, they jogged over, greeted me and gave me fist bumps and high fives.  No one made a huge deal out of it, but they did make it clear they were glad to see me back--which was perfect.

The surgical margins around the tumor were clear, so to the best of our knowledge, the surgeon got all of the cancer that was there.  At my two-week follow-up appointment with the surgeon, everything looked great, and he said he didn't need to see me again unless I developed some concerns.  Next step--the oncologist.