breast cancer treatment

ohilly

I have just been diagnosed with intraductal invasive breast cancer. I am going to a large teaching hospital (Rush Presbyterian St. Luke's in chicago). I just met with my doctors today for the first time, but so far have been told that the tumor is very small (1 cm) and that it's early stage breast cancer. I have two questions: 1.) I don't want a resident to operate on me: the resident can assist in the surgery, but I don't want the resident to remove the tumor, only the surgeon. Is it other people's experience that a teaching hospital would go along with this request? 2.) I was originally diagnosed at another hospital and then I took all my slides, etc. to this large teaching hospital. Now my doctors are telling me first they have to have their radiology people review all the slides and tests and determine if more tests are necessary (they indicated probably more tests will be necessary). from my understanding, these are more mammography and tests on my breast, not other parts of my body to see if the cancer traveled. The surgery to remove the tumor will not be scheduled until completion of all these tests. So my question is: is it normal procedure to delay scheduling the surgery until all these tests are performed. I would appreciate a reply back. Ohilly

3cbrca

I'm sorry that you're now part of our club but welcome. I used to live in Chicago - Rush has a great reputation for its Breast Cancer program - and Dr. Melody Cobleigh is an oncologist actively involved with research and the latest treatments.

I have been lucky enough to live in cities where there are excellent programs and now only go to academic medical centers for all my care. My breast surgeon is the only one that has operated on me but to be sure, for your own peace of mind you have the right (and nobody will be offended) to request (insist) that the your surgeon be the one do the surgery. It's not an unusual request. I have done that for other surgeries.

In my experience (I've had two different types of cancer)it is usual to do all these tests - they don't want to miss anything. You can take comfort in the fact that they are doing them. It will determine the biology of the tumor, tumor grade (how fast it grows) and the extent of the cancer. Those issues figure into whether they will recommend a lumpectomy or mastectomy and may determine whether they do a single sentinal node or an axillary node dissection. Although it sounds like your cancer is really early stage, it may be that they recommend that you have chemo and more frequently these days, chemo is done before surgery.

I know its hard to wait but you want them to know as much about your tumor as possible before operating. We all know what your going through! A bit a shock and probably anxious to get the tumor out as soon as possible.

This is a great website for asking questons. There are wonderful caring women here so keep us posted as to your progress.
She

KathiM

I agree with She. I had all of my surgery done at a teaching hospital (UC Irvine Medical Center). For my 'other' cancer, colon, I had fought tooth and nail with my insurance to allow me to go to this particular surgeon, and I made it VERY clear that, although I thought it was GREAT that there were others learning, I had but one chance at this low bowel resection without ending up with a colostomy, and I wanted my surgeon to do the proceedure. He agreed. He did have residents assisting, and they were the ones that followed up most days when I was in the hospital, so I welcomed them being involved. With my breast cancer, it was at the same place, and I said the same...this happened to be the head of the Surgical Oncology department. He had residents assisting, but, again, did the proceedure himself. Just ask. They are usually pretty accomodating.

As far as changing treating hospitals. They will be ultimately responsible for your health, so they want to make sure their diagnosis and treatment is theirs. I had a friend that switched, and it turned out the new hospital was able to treat her without the surgery recommended by the other hospital. She is NED still. Not that this is going to happen, it's fairly rare, but you can see their point...

All that said, this transition shouldn't take long. If it does, start asking questions....even though you do have a bit of wiggle room, the sooner things can get started, the sooner you will be thru. My breast cancer was as yours is, with a twist that once the sentinel nodes were tested during surgery, they were involved, and they plus the next set of 5 were removed during surgery. I am almost 2 years NED as I write this.

Welcome to our group!

Hugs, Kathi

survivor51

I highly recommend that you have further testing. An MRI picked up several details for me. I was given some options of a lumpectomy or mastetomy. We new of 1 tumor but there were some other areas that looked "shady". I had decided to have the one breast removed. Then when the mri came back showing some "shady" places on the other one. I was told it definitely didn't look like cancer. I spoke to some people that had reconstruction surgery and one had only one breast removed. She was a judge and said that hind sight would decide both because it is easier to make them match. Also, there were several pple where it came back in the other one. So I decided to have a bilateral one. When the results came back, it was in the other one but had not gone into the nodes. Luckily I am having to recover only once. Each person has to make their own decission. Read several postings and on Tuesday, join the chatroom. Ask for suggestions. Remember, these are "just" doctors and you are the paying customer. Don't worry about hurting anyone feelings, they are professionals. This is your body, your life. Hope this helps and feel free to email me. Angela

seof

I agree with what the other 2 ladies before me have said. I feel like more information will lead to a better decision on treatment, even if it means a brief delay. Cancer is a scary diagnosis. I remember feeling like it just needed to be out of my body, YESTERDAY! but there usually is enough time to be thourough and take time to make a wise decisions.

I would also encourage you to be firm in your desire to have the surgeon of your choice to work on your body. After all, you are the one who will be living with the results.

Best whishes, seof

Skybuf

I too agree with what the ladies are saying, any and all testing is usually a good thing for YOU. I had invasive ca and turns out it was in the nodes and I ended up with a mastectomy. Thank God for the scans/XRay machines, radiation machines, and all things that Help us heal......:)
Gods bless you

phoenixrising

Hi Ohilly, welcome and sorry to hear you've had to join us. The lovely ladies here will help you with just about everything. There's not much that can happen that hasn't already happened to someone here.

I think these wise women have given sound advice and I couldn't add much more to it.

I travelled 500 miles for my surgery as my trust and faith laid in the bigger hospitals in a major city. I was explicit with my surgeon that only she operate and she took it quite nicely.
I told her if it didn't matter who operated on me I could have stayed home and had it done. It too was a teaching hospital. By the way, I've been complimented on my scar....can you believe that?? I've been quite assertive on what I will and will not let them do. They seem to understand and take it well.

Good luck with your decision.
jan

cabbott

If I were you, I would go ahead and ask just to make sure. What my surgeon told me was that insurance companies insist that HE do the operation. I had Coventry at the time, but later switched to Blue Cross/Blue Shield PPO. He was with Johns Hopkins, also a teaching hospital. When I went to the operating room, he was definately the surgeon in charge. I allowed as many students as he wanted to be in the room and boy were they there in force. But they were all very polite and quietly standing around the edges of the room. The residents and students were allowed to help guide me to the room, arrange me on the table, help with minor procedures, but only the surgeon was allowed to operate. When it came to the path report, another important procedure, both a resident and a fully certified breast specialist pathologist had to sign off. When I went to the same hospital, a student oncologist overseen by a senior oncologist saw me day to day, but only after the senior breast oncology specialist had approved everything and noted that nothing would ever be done that he didn't sign off on. That way, he indirectly saw many more of us than the hours in the day would have allowed him to see directly. In short, I have been the recipient of excellent care at a teaching hospital. My senior doctors have seen to it that I received the state of the art treatment and the students who have had contact with me have all been winners. Ask your surgeon. If you have insurance, the rules are likely to be the same.

mgm42

ohilly - I'm being treated at Northwestern Memorial's Lynn Sage Comprehensive Breast Center - just down the street from your hospital. Yes, residents are involved in every phase of your treatment, but I've found that when it comes to the actual "work," the doctors do the real work and th residents assist. As for their radiation people reading your test results and them doing their own tests, I think that's SOP. They trust their equipment, whereas, I don't thnk they fully trust "outsiders" equipment. I was diagnosed with Invasive Ductal Carcinoma. My tumor was 1.7 cm. I had a lumpectomy. No node involvement and clear margins. My tissue sample is now being tested in California where they are doing a Oncotype test. I will learn shortly if I need chemo or not. If not, then on to radiation. I travel 165 round trip for my treatments, but I wouldn't have it any other way. Good luck to you. You and I are rather close in terms of treatment as well as geography. Please see me profile and email through this network if you'd like to compare notes. I'd love to hear from you. mgm42

ohilly

mgm42 said:

ohilly - I'm being treated at Northwestern Memorial's Lynn Sage Comprehensive Breast Center - just down the street from your hospital. Yes, residents are involved in every phase of your treatment, but I've found that when it comes to the actual "work," the doctors do the real work and th residents assist. As for their radiation people reading your test results and them doing their own tests, I think that's SOP. They trust their equipment, whereas, I don't thnk they fully trust "outsiders" equipment. I was diagnosed with Invasive Ductal Carcinoma. My tumor was 1.7 cm. I had a lumpectomy. No node involvement and clear margins. My tissue sample is now being tested in California where they are doing a Oncotype test. I will learn shortly if I need chemo or not. If not, then on to radiation. I travel 165 round trip for my treatments, but I wouldn't have it any other way. Good luck to you. You and I are rather close in terms of treatment as well as geography. Please see me profile and email through this network if you'd like to compare notes. I'd love to hear from you. mgm42

This message is for mgm42 - I would like to talk with you since our experiences sound quite similar. I don't really know how to use this website very well or look at your profile, but I would really like to talk with you. Let me give you my email address (ohilly@hotmail.com) and please email me. Ohilly