I was supposed to see the breast surgeon today, followed by an ultrasound, but the surgeon was running late. So I got the ultrasound before seeing the surgeon. This turned out to be a good thing.
The surgeon ordered an ultrasound of my left axilla (underarm) even though I've already had a breast mammogram, breast ultrasound, and MRI that supposedly covered the lymph nodes. Today's test was very targeted. Unfortunately it showed one enlarged node. The report says this:
In the left axilla at 1:00, 12 cm from the nipple, there is an abnormal-appearing lymph node measuring 1.2 x 0.5 cm (long by short axis) with an eccentrically thickened cortex measuring 0.4 cm.
This website defines a normal lymph node as: A normal sized lymph node is less than 10 mm with a thin cortex of less than 3 mm. In comparison, my lymph node is 12 mm long and 4 mm thick.
Four doctors had examined my lymph nodes before and didn't feel any enlarged ones. The first ultrasound and MRI also didn't show anything suspicious, although the surgeon today explained that lymph nodes can hide and not be visible in tests. She also said that she felt the enlarged node. I've always been suspicious that my lymph nodes were not involved, so today's finding is not a surprise. There's a possibility that the node is benign. But my gut feeling is it's positive. If so, my cancer stage will be IIB instead of IIA with a worse prognosis. Oh well.
Anyway, for the study I'm joining, they need a baseline and will have to do an ultrasound-guided lymph node needle biopsy (not a sentinel node biopsy) before I can start chemo. I'm waiting to see if they can squeeze me in tomorrow or Wednesday. The study coordinator wants to move my chemo to Friday, but I want to wait till Monday because I will have to restart my fasting. More on my fasting later.
At the appointment with the doctor, I learned a few new things. One is that if the chemo shrinks my tumor significantly, I might be eligible for a lumpectomy instead of a mastectomy. But if I get a lumpectomy, I will need radiation which comes with its own side effects. I will see the surgeon again after my last chemo.
Another thing I learned had to do with sentinel node biopsies and lumpectomies. The dye and/or radioactive tracer they inject to find the lymph nodes is extremely painful. There is a study where they use LYMPHOSEEK, and it's supposed to be a lot less painful. I might be able to join the study.
For lumpectomies, if they don't get a clear margin (no sign of cancer in the excised breast tissue), they will have to do a second lumpectomy, and this occurs at least 20% of the time. I thought the surgeon said LYMPHOSEEK will also improve the chance of getting a clear margin, but perhaps I misunderstood. I don't see lumpectomies described on the LYMPHOSEEK page. However, I saw this site that mentions MarginProbe that reduces the risk of a second lumpectomy by 61%. It also says that second lumpectomies happen 25-50% of the time. That sounds extremely high. I will have to ask the doctor about it.
Another thing I was concerned about was the risk of getting breast cancer in my other breast if I don't get a prophylactic mastectomy of my healthy breast. What I had heard was the risk was 1% per year, and it was cumulative. So in 20 years, I would have a 20% chance of getting cancer in my other breast. But the surgeon said that info was from earlier studies, and she thinks the risk is 3-4% in 10 years. What's more concerning is that there's a higher risk of recurrence in the breast that does have cancer. Nevertheless 3-4% sounds too high. However, mastectomies come with their own complications and can affect quality of life. But so does worrying about whether you'll get cancer again.
I had asked the oncologist before whether I should be concerned about delays in my chemo treatment. I also asked the surgeon's nurse today. Both say that breast cancer is slow-growing compared to other cancers (perhaps with the exception of inflammatory breast cancer), and another week's delay won't make much difference.
I'm glad I switched to Stanford though. They're more thorough than PAMF, and their doctors are more specialized. They're not just general oncologists for all types of cancers and general surgeons for all types of surgery but breast oncologists and breast surgeons. They even have separate buildings for their Women's Cancer Center that offers advanced treatments for breast and gynecologic cancers.
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