Lumpectomy Lounge....let's talk!
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Dyannah, the first thought that occurs to me is that maybe your onc is planning to be on vacation the entire month of December and does not want you to have to angst through the holidays. I know any shift outside of the ordinary is alarming at this point, but my guess is that this particular shift is innocuous.
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@DWiseley, thank you! The tenderness is bothering me more than the firmness, because it just suddenly came on strong and is very uncomfortable. Maybe I did too much too early - I walk a good distance at work in aged care (between 6-8km, sometimes more) and do need to use some physical strength when assisting residents, though I was conscious yesterday of going easy on my arms and not transporting the heavier residents! Maybe my body isn't at the same stage as my "let's go!" brain. I am feeling pretty good though, regardless!
@Dyannah, I wish you the very best and all blessings. Thinking of you.
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Sounds like it could be a seroma. Nature abhors a vacuum (so do my cats), so when internal tissues (e.g. a tumor & surrounding margins) are surgically removed and a cavity created, the body responds by filling it up with fluid. It can be hard and sore. It will go away, but it'll take a while. Radiation may make it larger temporarily, but patience is key.
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Just dropping in to say hi. My diagnosis was two years ago today. A shock followed by a bigger one when I was diagnosed triple positive. BUT - I'm comfortable with my new normal and am extending warm wishes to all of you. It's scary and awful and... but for those of us who were fortunate enough to get an early stage diagnosis, it will be OK. This community is fantastic so ask all the questions you have and someone will have an experience to share.
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Thank you Taco1946! It's hard to see the end of this when we're in the middle. Thanks for the encouragement.
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I finished A/C and 2 of 12 Taxols. Oncologist and surgeon are discussing surgery after 3rd Taxol. It seems more logical to me to wait until after finish all 12. The A/C definitely worked because 2 of lymph nodes shrunk 1 centimeter each and breast tumor cannot be distinguished from surrounding tissue. Has anyone else experienced having surgery before chemo is finished (not counting usually having surgery first). I would appreciate any input
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I had my dressing removed yesterday and received a diagnosis of a 5cm phyllodes tumour. The first thing my surgeon said to me was "It's very good we removed this!" We (and everyone else who looked at the lump) had previously thought it was a fibroadenoma. It was not malignant, so at the moment I simply need screening regularly. The surgeon did not remove very wide margins, perhaps because she thought it was just a fibroadenoma, so that can increase the chances of regrowth.
My breast actually hurts MORE now that the dressing has been removed! It's not so painful that I need to take medication, but it's tender and there is a hard lump there. Maybe it's a seroma. The doctor said it's healing well, which is great!
Is it gross that I wish I could have seen the lump? Probably yes! 😉
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Congrats that it isn't cancer. If you don't find it gross to have wanted to see the lump, perhaps you should consider a career as a surgeon or pathologist. You're only 26, after all. (My husband started med school at 26).
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Thank you. I actually really wanted to be a nurse when I was younger; maybe someday!
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I'm two weeks post-op and my wound is healing well, but I still can't reach for things with my arm or lie on my side without pain. I guess it takes time! I do have a question about numbness, though - my breast is still numb, especially above where the tumour was. Is this common? Anything I should do or should I just wait it out?
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Sparrowhawk, a lot of nerves were cut/gamaged during surgery so numbness is not surprising. I noticed it more under my arm where the lymph nodes were removed. The nerves will grow back (or not) within a year or so. My underarm ones were back to close-to-normal at 13 months. You never know.
HUGS
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I have not had surgery yet. Im just starting chemo. Im still juggling with after its done whether lumpectomy or MX is right for me. My lump is 2.1 cm in the left breast. I am a TN Grade 3, no nodes. What made some of you opt for the lumpectomy? Im hearing and reading about women choosing lumpectomy and later ended up with the cancer in the other boob then having to do an MX later on. I dont want that at all. I would love to save my breast, Psurgeon says I should be fine for nipple sparing. My surgeon at hosp says my lump is on the left and the cancer never moves from the left to the right breast. Has anyone ever heard of this theory? Its either trust her and go with a lumpectomy or get rid of both just in case. thoughts?
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HopeBry,
My 2 cents, I did LX thinking it is easier to heal from, still have my breast (less a divot), because once you do MX there is no going back. It's a personal decision, I'm glad I did LX.
As for bc not going from left breast to right - would be wonderful, but I think cancer can show up anywhere it wants to.
Best wishes to you!
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I have heard that. Basically that the breasts should not be considered a pair of one thing for this purpose but two separate organs. The path for a cancer to travel to get from one to the other would be way further then the nearest lymph node.
I think when women find things by surprise during an mx, it's usually thought to be two different cancers.
My medical team strongly advised lumpectomy and radiation. If it's true that cancer wouldn't spread from one breast to another, then I think factors must have been that I had already been tested and found clear of all the big known generic mutations that increase risk, no node involvement, and nothing on the (both breasts) MRI taken the day of my initial surgical oncologist appointment except the previously identified tumor. I presume nothing meant no calcification, nothing even remotely suspicious for another location. MRIs gave high rates of false positives - seeing things that are benign - but afaik almost no false negatives - missing things that may be malignant.
I'm not sure how/whether the TN versus HR+ would impact. That would be a big question for me.
Have you had or will you have an MRI to look at both breasts?
The other question I would think about asking your surgeon is about the cosmetics of a lumpectomy for you. No one ever discussed it with me, which I guess is because of the location and size of my tumor, the visually apparent changes to my breast should end up pretty subtle. I hope that will be true even after radiation. But either way, now I've learned that women can and do have plastic surgery either as part of the lumpectomy or as follow up to even up the breasts, where applicable.
Overall the impression I have from doctors and reading studies is that where lumpectomy plus radiation is recommended, it's completely equal to mastectomy for long term disease free and survival outcomes. (Maybe even slightly better, though no one study has claimed a statistically significant difference yet. But all the ones I saw were slightly better, and at some point a meta analysis might be able to confirm). There's also lower rates of physical complications, faster recovery times, and generally easier psychological impact. Also, you can change your mind afterwards and go back and get an mx, can't do that the other way around. If you did do that long enough after the initial treatment, I guess you could have the MX and reconstruction all in one go, which could also have physical and psychological advantages.
Of course there are cases where an LX is clearly not called for and an MX is the best course. But if your doctors are not strongly pushing you for an MX, then I think it makes sense to do due diligence about your reasons for opting for it, and probably to get a second opinion.
My radiation oncologist was pretty judgmental of women who could have an LX and opted for an MX. I don't agree with that at all. I think each woman is the expert on her body and health and her choice should be respected. Everyone has a different emotional relationship to their body and breasts and health, and that impacts things hugely. In the states especially, if a woman suspects that she has better health insurance now than she will in the future, going all in on the MX and reconstruction right away seems like it could be very prudent.
You are doing the right thing by asking questions and informing yourself. There are more resources than available to support you than I realized until after my own surgery. The medical center had a social worker I could have spoken things through with (for me that's a helpful part of a decision making process) and lots of other organizations do too. They can also help you do your own research or connect you with women with a similar diagnosis who are further along in the process or recovery than you are, so you could talk with women who also had smallish node negative TN cancer and who chose each way on the surgery, and learn from their experiences
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HopeBry, I have never heard of BC not travelling from one breast to the other. BC does what it wants as near as I can tell. But like Cindy said, most of us choose an Lx. Why? Because it works just as well as a mastectomy in most cases. And even those who have had Lx's and recisions and eventually need an Mx don't regret starting with a lumpectomy. Do as little as possible for surgery. Of course, your surgeon will weigh in. But it is YOUR decision. You can't grow another breast but you can remove it if it becomes necessary down the road. A mastectomy does not guarantee you will not have BC recur. Nothing guarantees that
Also, would you please enter all your information - Dx, treatments, location even and make each of those settings PUBLIC? It sure helps us give you information that is pertinent to you. Thanks.
HUGS!
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Thank you all for your feedback..
And yes I got and mri on both breast. Its only in the left.
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From everything I've read, contralateral breast cancer is neither a recurrence nor mets--it's a new primary tumor, even if the cell biology is the same. The lymph duct across the collarbone doesn't drain the breast, so the tumor doesn't "cross" over to the other breast. Each breast is a separate organ.
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I was relieved that I found my lump early and got it removed before it got too big, but now that it's out I'm told the tumor is too small to test (.5 cm) and the treatment plan will be based off of the biopsy pathology and my clear margins and lymph nodes (no obvious need for chemo). I certainly wasn't looking forward to a more aggressive treatment, but I was interested in the pathology and oncotype score. My surgeon was not concerned and said that the oncotype is mostly to determine the need/method for chemo, which I didn't need.
Is it normal to not test? I've seen posts where small tumors like mine have surprising oncotype scores, but I know that's worst case scenario. Are other members of the care team (RO/MO) likely to revisit the need to test the tumor and I should relax and let things follow the natural course of treatment or should I just rest assured that the tumor is out and margins/lymph nodes were clear?
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Thank you ChiSandy. I justvwant to make the right decision. Ive read of women getting lumpectomy then having a cancer in the other breast and regretting not getting the MX the 1st time. I would hatebto go through it again. My 9 yr old lost her dad to colon cancer and my BC news got her scared of losing me. To possibly go through this again would be the worst for my baby and me. I will have time during chemo to decide.
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JB, as my surgeon's NP explained to me before my lumpectomy, OncotypeDX is done on tumors that are in the "gray" area between obviously no chemo and go-straight-to-chemo-(do-not-pass-go-do-not-collect-$200). Yours is definitely not in a gray area. The combination of 5mm, node-negative, clean margins, LuminalA (ER+/PR+/HER2-) and low-grade means chemo is not necessary and would probably not be effective. (It is possible to get a testable sample from a tumor that small, though in your case it's unnecessary). In my case, my tumor was tested because it was 1.3cm and Grade 2, and my score (16) exempted me from chemo (had I been 50 or younger, though, chemo might have conferred a small benefit). Had I positive nodes or been Grade 3 I would have been advised to skip Oncotyping and go directly to chemo.
HopeBry, a contralateral tumor (one appearing in the opposite breast) is not related to the original, even if it is of the same type. My surgeon showed me several charts, which illustrated the actual impact of recurrence and survival statistics: each had 100 grayed silhouettes. The one for ipsilateral (same breast) recurrence or metastases for lumpectomy+radiation had 4 out of 100 silhouettes highlighted, the ones for both BMX and UMX (unilateral mastectomy) each had 2 silhouettes. The one for contralateral recurrence had 3 silhouettes highlighted for LX+rads and UMX, and 2 for UMX. Overall survival (survival until death from any cause, not necessarily breast cancer) stats for all three options were the same.
Now, 4% chance is twice 2%, which sounds like a major difference. But the sight of only 4 highlighted silhouettes among 100, vs. 2 highlighted ones, put it into perspective: 4% is still extremely low. At my age, I'll take it. Especially when the difference between a lumpectomy & BMX is same-day ambulatory surgery and return to regular routine in a few days vs. overnight stay (in my friend's case, 2 nights), much more pain, longer time on the table under general anesthesia even if no reconstruction, much more restriction of range of motion, and 1-2 weeks of cumbersome drain care and infection risk. And I had the 16-day hypofractionated rads protocol (at the time offered only to women around or over 65 with Stage IA Luminal A tumors, but now recommended regardless of age for Stage IA Luminal A), with very mild side effects (no pain, itching, skin breaks, or fatigue) that didn't interfere with my daily life.
How can there be an ipsilateral recurrence if a breast has been removed? Because not all tissue can be removed by even total mastectomy: cells can remain in the chest wall, clavicle and axillary tail.
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Jon808,
I had my lumpectomy in Jan. In March, I had 10 radiation treatments in 5 days, receiving the same amount of radiation as those who do 33 treatments. At the 8 month point, my left breast shrunk by a cup or more. My oncologist wasn't worried by it. It shocked me, but I would still choose lumpectomy and radiation over mastectomy if I had to do it all again. Recovery is much faster, less painful, and less complications. There is a thread on here for women who had masectomies... go read about their experiences, you'll probably be glad you chose this route, too.
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Apparently different doctors have different cases where they'll order an oncotype. I thought this was really interesting - they asked 8 different very high level oncologists about ordering an oncotype in four different scenarios. There are very few where they all agree: http://www.researchtopractice.com/COCB13/1/Commentary1
I had 1.8cm tumor, grade 2 (2/3 nuclear, but 1 mitotic), ER+PR+HER-, node negative, no invasion, clear margins, age 39. They sent to oncotype. The medical oncologist said that if they I had been node positive, I would have gone to chemo without testing for oncotype. This is at MSK, but not with the MSK oncologist in the article. My oncotype came back 9 and I'm not having chemo.
I didn't seriously consider an MX after I was told that LX+radiation had equivalent outcomes. That was before I was at the stage of reading and researching. In retrospect, it makes me feel better that my breast surgeon told me I have very fatty (rather than dense, more common for my age) breasts, which makes the mammograms very easy to read. So I feel more peace of mind with keeping my breasts and continuing to screen. I'm going to have offset mammograms and MRIs (because of family history) and that makes me feel better too.
But, I also don't have and probably won't have children. And to be honest going through this again, where this is relatively early breast cancer treated with surgery and radiation, doesn't seem so bad to me. What really scares me is distant recurrence, and MX doesn't really impact that anyway.
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Hi, I had a lumpectomy just over a month ago and have been healing well, but last week started getting pain in my breast to the point that even light pressure hurts and I can't sleep on my side. Is this just likely to be usual healing?There's a hard area (feels like a lump) near my incision which could just be fluid. I am going to the doctor to check it out...would rather be safe.
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Either a seroma (fluid filling the tumor cavity) or scar tissue could account for that lumpy area. Breast lymphedema is a possibility, but even if so it'll eventually dissipate with therapy. And don't freak out about sudden sharp, stabbing "zappy" pains: they're nerve endings, which had been severed in surgery, reconnecting.
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Sparrowhawk, I just posted it this in the radiation thread, but I have a lump above my incision that is about 3 by 3 and it is solid. today after my last radiation treatment, I had my doctor check it out and he said it is the leftover of the huge hematoma I had after my surgery. So what you have could be a hematoma or a seroma.I was advised not to have mine treated because I have a bleeding disorder and anything that I have done could cause further bleeding and further complications. But ask your breast surgeon if you should have yours drained.
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Thanks so much. I can feel some lumpiness especially when I lie down and it's still very tender. I'm getting some zaps from time to time but they're okay to deal with. I'm going to my GP on Friday.
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My doctor did an exam and felt the lump which she said is mobile and feels like it has fluid inside. Touching it was painful. In her view it could be an abcess. She's sending me for a blood test and an US next week.
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Sparrowhawk, I hope they can easily clear that up!
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Howdy,
I had a lumpectomy last friday and still waiting on result. Has anyone experienced sharp pains followed by a cold water sensation in the breast. A pink rash below the surgical excision that burns, itches and is warm started coming up as well. I've emailed the PA but just thought I would see if anyone else has experienced this.
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