Topic: Lumpectomy Lounge....let's talk!

Nov 4, 2020 12:13AM Beaverntx wrote:

kabozzle, while reexcision was not my experience (actually it was but it happened during the surgery as the tissue was checked in the lab) but you will find that many people who post on these threads have had that experience. It really is not unusual, as stressful as it is.

Nov 4, 2020 03:15AM ChiSandy wrote:

Not sure what you mean by "letrozole has slowed the cancer growth by (percent)." How on earth can they tell the "rate" of the cancer "growth" (I assume that's what you meant by "slowed it down")? They don't measure growth rate by percentages; and that's not what letrozole does, and certainly not how it works. (Why were you put on letrozole before lumpectomy anyway)? You had the tumor removed, the cavity was immediately radiated, the nodes came back cleam. Margins for re-excision are exceedingly small--no more than a mm or two (usually no more than one or two speckles on the entire perimeter), and the new standard of a clear margin is "no tumor on ink." So what makes them think that those few tiny cells left behind are growing (especially since they'd been radiated), much less by a certain percentage? Could it be that you misinterpreted what your doctor told you?

Nov 4, 2020 01:29PM kaboozle wrote:

Thank you all for the replies. I am now scheduled for a re-excision Nov 12th, ugh, (soonest I could be fit into the surgery schedule). Because the unclear margin was near the chest wall, they've chosen to go back in.

I'm in Oregon, intraoperative radiation for breast cancer is not considered the standard of care and it's availability is extremely limited. It's only done 4x/month, and has to be fit into both the surgeons and radiologists busy schedule. Since I fit the qualifying criteria, I wanted a shot at this even though it delayed my surgery by approximately a month. My surgeon chose to start me on the letrozole preoperatively.

The percentages I referred to in my original post were based on Ki-67 staining (tissue proliferation rates) checked preoperatively on the original tumor biopsy and again on the excised tumor a month later. (I've included a brief explanation of what Ki67 staining is) Not all physicians utilize this test.

Ki67 is a special stain that gives a sense of how aggressive a tumor is. The pathologist takes the biopsy or surgical specimen, prepares it, puts it on to a glass slide, stains it for this protein, and look at it under the microscope. It's a protein in cells that is involved in cell replication, so if many cells are expressing it, the tumor is growing quickly; if very few cells express it, then it is growing slowly. The pathologist needs to count about a thousand cells and determine the percentage of cells that are Ki67 positive. Therefore, the number that comes back should be a percentage from 0 - 100%.

Nov 4, 2020 03:21PM Cherisse wrote:

Hi, Had a lumpectomy with sentinel node biopsy on Thursday October 29th. Today is Nov. 4 and I finally had the nerve to pull off bandage covering the strips placed over the incisions. I had an interesting finding. Although the radiologist marked my breast where the lump was located, I see that the surgeon made the incision outlining the nipple.

The lump was located 5cm from the nipple at 1:00 o'clock. I had given no requests to keep breast looking scar free before going into Surgery. I just wanted the lump out and surrounding normal tissue removed.

So my question is: Why did the surgeon make an incision to remove the lump so far away from where the lump was located? I'm recovering ok. The pain is not too intense. The incision under the armpit is still quite tender and sore. Been trying to keep my arm moving but not too much. It is my right arm and I'm right handed. So I use my right arm a lot as you can imagine.

I look forward to any insight on the decision to remove lump so far away from where the lump was located. And how do I know that all the cancer got removed? I know, Doctors and Surgeons are extremely intelligent and knowledgeable. But I still feel like a swollen lump area in the breast. I worry that maybe some cancer was left in there. Probably not, I'm just a neurotic at heart.

I wish they had more time to explain and answer questions as they come up on this journey.

The surgery started at 3:30pm and lasted until 5:30? however, I woke up at 7:30pm. So I am wondering why it took so long to wake up? I was under anesthesia for approx. 2 hours. Did the surgery last longer than expected. If so, why?

Based on what I've read, people usually wake up 10 mins after anesthesia is stopped. I was told I would be ready to leave the hospital at 5:30pm. I felt bad about having my driver wait so long. I could have said pick me up at 7:30pm. No one told me anything. The nurse gave me a sheet of paper to inform me when my next appointment would be and what meds to take. That was it.

In the meantime, before my next dr. appointment which will be in approx. 10 days. this is a great resource. Thank you.

Nov 4, 2020 05:32PM AliceBastable wrote:

Cherisse, echoing what edj3 said, it's for appearances. I can't see my scar two years later, although I have a faint one where the node was removed. No big deal except certain bras still aggravate it occasionally. I just don't wear those bras anymore.

Nov 4, 2020 10:35PM Cowgirl13 wrote:

Cherisse, did you have all your nodes taken out?

Nov 5, 2020 01:12AM ChiSandy wrote:

Cherisse, please go to your "dashboard" for instructions as to how to fill in your diagnosis, surgeries, & treatments--then post it as a "sig file" aka "sig line" which will appear at the bottom of your posts. We can't give you informed advice without getting the full picture.

The whole reason for a sentinel node biopsy is that those are the first lymph nodes to which cancer would spread should it (hypothetically) spread. Hence the term "sentinel." Back in the day decades ago, they'd take the entire first level of axillary nodes, sometimes all the axillary nodes, without knowing their status (they used to cut first and ask questions later). Taking the sentinels for biopsy is the only way to know for sure if they're negative for cancer. It's much less invasive--and if 0-3 are positive, no need to dig beyond them. As Beaverntx says, you have dozens more nodes remaining to do their jobs.

Not at all unusual to need a re-excision to get clear margins. (The latest definition of "clear" is "no tumor on ink*," so much less tissue needs to get removed on that second pass). I went "under" at about 1:30 pm, and "came to" in the recovery room about 4. Even though lumpectomy is less invasive than mastectomy and is outpatient surgery, it still has to be done under general anesthesia (not just the "conscious sedation" such as propofol you get for, say, a colonoscopy) because you have to be perfectly still for the duration. That includes a powerful muscle relaxant injection and intubation.

Needing a re-excision is NOT a slam against the skill of your surgeon. It's not always possible (in fact, usually impossible) to determine margins with the naked eye while you're on the table during surgery, and the only way to know for sure they got it all is by post-op biopsy by a pathologist. Those "leftover" cells are not visible except via a microscope.

And it also doesn't mean those straggler cells are going to metastasize. Breast cancer doesn't spread that fast.

*"Ink?" They use a surgical marker to draw the boundaries of the tumor and surrounding tissue to remove. Used to be a margin wasn't "clear" unless there was at least 2-4mm between the marker line and any tumor cells. Now (beginning in 2017) so long as there are no tumor cells touching that marker line, the margins are considered clear. But some surgeons are still kickin' it old-school.

Nov 5, 2020 07:30AM keywestfan wrote:

Perhaps, because of age I had conscious sedation, not general, and,perhaps also because of age ,they did not take my sentinel node. There was no tumor on ink, but narrow < 1 mm on one of the margins, < 2 on another. It was decided during tumor board that a re-excision might be a good idea to help me, again because of age, to avoid radiation. I remember looking forward to it so I could sleep for a little while. Margins were widened but 3 mm of residual IDC and LVI were present. MO thought I could either not have radiation and if it came back locally, I could then have another lumpectomy and radiation then, or radiation right away which he thought might be better. So 16 rounds of partial hypofractionated radiation.Dana Farber, where I got second opinion, said their standard is still 3mm from margin. Tomorrow I see so cute and skilled BS for routine checkup. Will be, as always, nervous.

Nov 5, 2020 03:11PM Springdaisy wrote:

In a month after radiation I will be prescribed arimidex. I am deciding if I want to take it or not. Will it really prolong my life and by how much andis there a way to determine that? I am 67 with stage 1A, grade 2, lobular, no node involvement.

Nov 5, 2020 03:45PM - edited Nov 5, 2020 03:48PM by Springdaisy

thank you for your input. I am sure I will take arimidex. Did you have bad side effects or not?
I've usually had good health so

Nov 5, 2020 03:49PM Springdaisy wrote:

oh thank you that makes me feel better. And hugs back to you also!

Nov 5, 2020 09:44PM Mymomsgirl wrote:

Mskiles it is probably all the nerves starting to wake up. Be warned you might even get some intense itching, that is another sign of healing. Good luck!

Nov 6, 2020 02:12AM ChiSandy wrote:

I always take my letrozole at bedtime.

Nov 27, 2020 08:29PM PontiacPeggy wrote:

FionaScottie, I get that too occasionally. I had physical therapy in January for not exactly lymphedema but for aches and pains from my surgery and how things were "re-arranged." That did wonders. I know what to do so that my side, back, breast, etc don't hurt. It was really worth doing. My NP who is my PCP recommended it when I was complaining about all these annoyances. I was sure they were from the surgery (yup even after 6 years). And they were. I had a breast cancer specialist. I also find that I have to wear a different bra (or actually wear a bra rather than a padded cami) some days for the support. It's all just a PIA. You might see if one of your doctors will prescribe therapy for you with a breast cancer specialist.

I'd have taken Arimidex for 10 years if my MO had recommended it. But he thought 5 was appropriate given my age (74 when I quit it after 5 years).

Hope that this info helps. Glad you have been doing so well!! Love hearing from you!

HUGS!

Dec 6, 2020 04:43PM - edited Dec 6, 2020 04:49PM by Sher60

Hello datagirl,

I had a lumpectomy 10/23/20, and am experiencing the same thing. Thankfully, it is lessening each day. I was concerned enough to call my drs office. It was causing me a lot if discomfort especially in the late afternoons and evenings after I had been up all day. He explained about scar tissue and such, and told me it would resolve. He was right, it is almost gone and almost all of the tenderness is gone. Hang in there