Surgical Follow-Up News

We are back home from Boston once again. Robin had a scheduled follow-up with the plastic surgeon Thursday afternoon. We were also able to meet with the surgical oncologist (who performed the mastectomy) and review the final pathology results, which answered many of our questions.

Most importantly, the lymph nodes were confirmed negative. No cancer was found in the right breast. There were three total tumors in the left breast: 3cm, 1.6cm, and 0.8cm. Robin's three tumors were "invasive" or "infiltrating" ductal carcinoma, or cancer that has already broken through the milk duct. She also had many areas of DCIS throughout the left breast. DCIS, or ductal carcinoma in situ, is early stage 0 cancer that is confined to the individual milk ducts. These are areas that over time can become "invasive" tumors. Considering all of this, it looks like we are dealing with stage IIa breast cancer.

Before the surgery, the surgical oncologist said that she would need remove breast tissue as close as possible to the skin on the front of the breast because the tumor seemed to be close. After she did this in surgery, she was concerned that she had to get so close that some of the skin may not have enough blood supply and would possibly die. This would cause problems and make the reconstruction more complicated. The plastic surgeon was also concerned that the blood flow would not be adequate after he completed his part of the surgery, although he was cautiously optimistic. Everyone agreed that aggressive removal of all possible tumor was the priority over cosmetic concerns. The pathology indicated that the tumor did indeed extend all the way to the edge of the removed tissue. The surgical oncologist was very confident that she had "hugged" the skin during the procedure so closely that there would be no breast tissue left behind. The good news now is that the cancer was fully removed AND the skin did not die in this area. The plastic surgeon said this was no longer a concern, everything looked excellent and Robin was healing very well.

The bad news for Robin was that the drains were not quite ready to be removed. The drainage has not yet decreased enough. Hopefully they are ready by Monday morning, when we are scheduled to see a plastic surgeon in Syracuse that has agreed to help us. 

The general criteria for receiving radiation is having lymph node involvement (Robin has none), size of largest tumor over 3-5cm (Robin is 3cm), and having little to no clear margins around the removed tumor. Not having a clear margin is the issue that may indicate radiation for her. Robin's was not necessarily clear but the surgical oncologist was convinced that this is because they was no more tissue beyond that could possibly be taken out. In fact, she said that she plans to reach out to the radiation oncologist and explain how thorough she was in surgery. She wants to make sure they take that into account when reviewing the case and advising on the need for radiation. Her opinion is that radiation will not be necessary.

Next Thursday we find our way back to Boston to meet with the medical oncologist. This is where we will review all of the information and determine the next phase of treatment, including chemotherapy and the possibility of radiation. 

This is finally starting to feel like a much more manageable situation for us. It went from one tumor to three tumors to six tumors, then maybe one large 7cm mass to the very scary possibility of stage IV metastatic disease in her spine to what we know today. I guess it's better to go in that direction than the opposite. The high points of the stress and anxiety of not knowing are hopefully behind us now. We went from being legitimately concerned for her life and leaving her family, especially our three boys, to now dealing with uncomfortable drains and the upcoming hair loss. Now that she knows this is something she can fight and win, she is ready to give it her all. Robin is the most amazing person I know. She is an unbelievable wife, mother and friend and I know that she will also become an awesome breast cancer survivor.