Dr. L… was chosen following my ‘two witness rule.’ In even considering a step essential to my recovery, I employed a biblical principle: “…at the mouth of two or at the mouth of three witnesses shall the matter be established.” (Deut. 19:15) I had heard from several friends, etc. that Dr. L… was the soul of kindness and one of the best surgeons around the area.
They were right. She was, indeed, the warmest, most caring doctor I’ve ever met at a first appointment. She graciously listened to our questions and gave her answers in great detail. It shocked me to discover that 2.5 hours had just flown by and we were just finishing our questions!
After examining me, she said that the tumor was not a hard little knot like most are – it’s actually rather squishy. That makes it a little more of a challenge of knowing where the tumor’s edges are and how much of a margin to cut away. But she’s very skilled and will employ a device that makes detection more assured. An ultrasound will tell where the core of the tumor is and a wire will be inserted that will act like a pointer to it.
The margin will be about 1 mm all around the tumor. Once the tumor (and margin) is incised, it will be sent to a pathology lab. In a few days, we’ll get a report that will tell us either one of three things:
1) that the cancer cells came all the way out to the edge of the margin – in which case, she’ll need to go into the same area and scrape more away
2) that the cancer cells were just at the edge of the tumor itself but well away from the outer margin – a good sign!
3) That the cancer cells were mostly contained within the tumor itself – the best sign. (The type of cancer it is - DCIS or infiltrating ductal cancer – means that some of the cancer cells had escaped out of the tumor and infiltrated the space around it.)
The sentinel lymph nodes will be tested for cancer. Most people have one; some people have two. They are just under the armpit. The function of lymph nodes – and we have many! - is to carry ‘junk’ out of your system. They help keep your system clean of impurities. Impurities (called ‘free radicals’ and/or oxidants) can be the result of ‘stuff’ that’s entered your body externally or what it has produced internally. Lymph nodes act like strainers – sieves.
In the case of the breast, the impurities are carried along the pathways called mammary ducts – like rivers – and are carried to the sentinel lymph nodes. These nodes are called ‘sentinels’ because they are the primary nodes; they act as ‘doorways’ to all the other nodes. Cancer cells are larger than normal cells and if they clog the nodes (which act like strainers), that’s when a person gets cancer in the lymph nodes. (We all have cancer cells in our bodies; I guess this happens when a flood of cancer cells try to get through the lymph node.) If no cancer is found in sentinel nodes, then it is not possible that any cancer is found in any of the other nodes.
Sentinel node(s) are stripped from a person during the surgery. They are tested right then and there by a pathologist for signs of cancer. If there are no signs, then the patient is good. If there are signs, then the surgeon strips the next two layers of nodes – just to be sure all cancerous nodes are removed. As a person has many, many nodes in the body, the responsibility to clean and purify the body is assumed by the other nodes; their load is increased but this hasn’t been found to be a problem.
Although a test is done real-time to determine of a node is cancerous or not, the node is sent to the lab and further tests are done. It is possible to be negative real-time but turn up positive a couple days down the road. If this happens, the surgeon goes back in and removes the second and third layer of nodes.
As far as (conventional) treatment is concerned, if the sentinel lymph node(s) are cancer-free, the treatment is radiation and, I think, hormone therapy. If the sentinels are cancerous, it means the whole ball of wax: chemo, radiation and hormone therapy.
If the lump is removed and the margins are clear and the lymph nodes are free from cancer, conventional medicine is (approx) 70% sure that there are no cancerous cells ‘in the rivers’ and they think this way because the cancer in the lump was well-contained and there was no cancer in the lymph nodes. However, there’s always that chance that there were cancer cells enroute to the lymph nodes. That’s why they prescribe radiation treatment.
Keep in mind that radiating the whole breast to kill any possible cancer cells in the ducts is a little like aiming a machine gun and spraying the entire perimeter - you can’t tell where the enemy is at all so you shoot up the whole place. Yes, you are shooting blindly but you do it long enough and steadily enough so that you are quite sure that all and any cancerous cells that are eft after the surgery have been destroyed. That’s why radiation takes about 4-5 weeks to accomplish. There are two other methods of radiation but they attack only the affected spot and are considered somewhat still in the experimental stage.
Radiation, according to Dr. L…, reduces your risk of recurrence from 70% to 95%. However, for the stray cancer cell that does survive and gets through into the system, it most likely means either a recurrence of breast cancer or brain cancer, uterine cancer, or cancer in the bones. If it recurs in the same breast as the first lumpectomy, there is no other option but to remove the entire breast. (This is because of radiation but I don’t know the reason why.) If the stray travels to the lungs or liver and causes cancer, you are then untreatable and considered terminal.
Not surprisingly, Dr. L… did not know anything about possible Immunology methods of dealing with cancer in the aftermath (or before hand) of surgery. Not her field of expertise. (I had found an article on Resan – a vaccine that purportedly kills the cancer cells without all the side effects of chemo or radiation. I believe it is used in Europe but my doctor had never heard of it.)
In the case of discussing alternative treatment, she had nothing positive to say. In a very compassionate way, she reflected the viewpoint of conventional medicine: Alternative ‘medicine’ is undocumented, unproven and for those reasons, inadvisable. Should a patient choose to do that, it’s OK as long as the conventional methods are followed. In other words, do it their way and they don’t really care much what else you do because they don’t have any faith – scientific proof – in any thing else.
Rex indicated that he leaned towards radiation therapy while I favored natural healing. The doctor gave (me) an extended dissertation on the ‘why nots’ of Alternative medicine.
I was not happy with Rex for doing so because he had never said that in any of our previous conversations and that was not the place to do so! (I let him know how I felt about that after we left the office – I felt ganged up on. I didn’t blast at him because I know where he’s coming from. Because he’s an engineer, he’d like to be as sure as possible about the outcome. Engineers hardly take the first step in any project unless they can see clearly the entire path and the end of the journey! This whole process must be extra difficult for Rex – so many feelings and emotions to deal with! So many uncertainties! Besides, I know that in his heart, he doesn’t want to lose me…. He apologized sincerely and said that perhaps the way he phrased and presented it was inappropriate. We went on about our business without hard feelings from this point.)
We learned that after the lumpectomy, the breast is given between 2 – 4 weeks to heal and then radiation begins. (You might ask: What if a stray cancer cell gets through during that time? Good question! It’s also one we didn’t think to ask!) The other forms of therapy – chemo and hormone – I’ll discuss at a later date.
We were at the end of our visit. It came time to determine the date for the surgery. I had previously determined earlier today what the date for my surgery would be: March 17th, St. Patty’s day. Fitting, eh? Well, I wasn’t going to choose March 14th – our anniversary or March 15th – the Ides of March! And the doctor only did surgery on Tues, Wed, & Fri.
When she heard of my decision, she was delighted – a little relieved? – that I was going through with the surgery. Earlier we’d discussed if waiting two weeks would make a difference in the growth of the tumor, etc. In her opinion, it would make little difference. I decided to use the two weeks so that my breast can be fully healed from the biopsy, thus making her surgery easier and to use natural health products to boost my immune system as much as I possibly can.
I pray that the surgeon’s aim will be sure.
I pray that the doctor gets a good, cancer-free margin around the tumor.
I pray that there is no cancer in the sentinel lymph nodes.
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