Well, I said I would be willing to change plans after taking into consideration what the surgeon had to say. And yeah, plans have changed.
I spent about an hour and a half with her. She was open to double mastectomy ... um... but not right now.
It's a little complicated. I'll explain. And this explains why she cancelled today's surgery (or handed it off, I don't know) and moved my appointment from Friday to today.
I smoke. Not a lot, but enough. Where this causes a problem is in the blood supply to the skin that will cover the area. I've got one count against me because of the size, a second count because of my age, and the third is the smoking, which constricts blood vessels, so there's a danger of the skin actually dying, and then we're talking necrosis and grafts and a royal mess.
If I quit smoking right now, after about (I forget how many) weeks, (in a minute you'll understand why the time span doesn't matter anyway) my odds of no problems after the mastectomy go way up. So, ok. Cold turkey tonight.
The problem is that I don't have that much time. We have to move on this fast.
I had noticed that every time someone scanned or prodded this thing, the size estimate went up. I kinda figured that was because everyone was looking at or estimating something different. Well, no. It IS getting bigger. Fast. It's now at 2.1 cm by 2.2 cm by 2.2 cm. On the 16th it was 1.5 ish.
I saw the lab results from the biopsy today. Most stuff looks pretty good, but there's one bad number, and that makes all the difference. Not in prognosis - that still seems pretty good - but it means we don't have time to waste.
Biopsy lab results:
Grade 2 (of 0 to 4), in the absence of a lymph node biopsy, but the nodes "look good".
It is estrogen sensitive, 60%. That's good for treatment effectiveness.
Slight progesterone , at 1%.
Her2/neu is negative, which is very good news.
Ki-67 is 40%, which is very bad.
Ki-67 is an indicator as to the aggressiveness, rate of growth.
Under 10% is almost like the tumor is resting. 10-20% is borderline.
Over 20% is high, fast and aggressive.
I'm at 40%. That means that 40% of the cells are currently in the process of dividing. Do you know what exponential growth is?
So, there's no time to wait for anything other than pre-surgical testing.
She wants to do a lumpectomy and sentinel node biopsy ASAP.
I had told her about my negative feels about lumpectomies, so I asked her to "go wide and deep, way beyond what looks like the margins, as much as you can take without creating secondary problems. Remember, appearance is not a consideration." She laughed, and agreed. Go wide and deep.
And then, after we have the malignancy in control (after radiation and chemo, and how much of what kinds depends on what they find), after I've healed from all that, THEN we can do the double mastectomy if I still want it. (And I'm pretty sure I will.)
I swear I heard her say the lumpectomy will not require a hospital stay. In and out in one day. Interesting.
Now I quit smoking, and wait for calls scheduling all the pre-surgical testing.
Garbage collection is tomorrow, luckily, so I can clear out all the ashtrays and whatever tonight. (One ashtray on the front porch, one on the back patio, one in the van. I don't smoke in the house.) That's a quick cut. And I have all the milk, eggs, and bread I'll need for a long while, so I won't have to go to the deli and be tempted.
You know, I'm still not worried about the tumor. The quitting smoking, yes, but not the tumor. I'm surprisingly relaxed. Or at least I am now. I might not be so relaxed after four days cold turkey. Hmmmm. Rocky, any hints to make it easier?