The Surgical Consult

We met with a well respected and highly recommened general surgeon the day after I got my diagnosis.  He was very professional and to the point.  He went through the pathology report in detail.  He even made hand written notes for me to take home.

The type of cancer was invasive ductal carcinoma.  Invasive meaning that the cancer was no longer just in the ducts.  It was now in the breast tissue and at least one lymph node as well.  It was also in more than one area of my breast meaning that I was not a candidate for a lumpectomy.  A mastectomy was recommended. 

Now since the cancer was in one lymph node, he wanted to be sure that it was not in any more.  After a thorough exam of all the lymph nodes, he told us he could feel at least one other, but he also suspected more due to the nature of cancer itself.  Because of this he recommended an axillary lymph node dissection along with the mastectomy. 

In the auxiliary lymph node dissection he would remove two of the three levels of the lymph nodes in my axilla or arm pit.  I was not a candidate for the less invasive sentinel node dissection because I  had one known lymph node positive and at least one more suspected as well.  This procedure (the axillary node dissection) increases the chance of lymph edema or the retention of the lymph fluid in the limb where my lymph nodes would be removed.  Yikes!  He casually mentioned that this was about a 15% chance.

Genetic testing for the BRAC-1 or BRAC-2 genes were highly recommended since I was so young. These genes are the known genes that are passed on from generation to generation that can increase your chance of getting breast and some other types of cancer.   He did also say there may be other 
genes associated with breast cancer but as of yet they have not been discovered. 

 If the testing came back positive, he would recommend a double mastectomy and removal of my ovaries as well.  The removal of the ovaries would be recommended because it also increases your chance of ovarian cancer.Because of my young age, genetics is a huge question as to the cause of my cancer.

He also recommended that I have a bilateral MRI of the breasts to look for any signs of cancer in the right breast as well as look for further involvement of lymph nodes in the affected left side.

One other thing that he was able to tell from the pathology report was if there were hormone receptor sites on the cancer cells themselves.  This is a good thing to test positive for because then you can treat with hormone therapy.  In my case I was negative for progesterone receptors and only weakly
positive for estrogen receptors.

At this time the doctor wanted to know if I would like to set a date for surgery or wait until the genetic testing was finished.  I opted to wait.  I was not sure that I wanted to have surgery done at all, and I certainly wanted to keep my ovaries!  Of course I didn't say this to him at this time.  I would wait to drop the bomb at a later date.