Re-Excision Surgery Coming Up...

emamei

I have already had a lumpectomy and axillary node dissection back in October and I've just finished 8 rounds of chemo, 4 AC and 4 Taxol.

I am having re-excision surgery on April 27th to further clear the margins. I was originally diagnosed with Stage 2, Grade 3 IDC and I'm TNBC.

My surgeon revisited my original pathology report with me this week. What was not explained to me many months ago is that there was a chance that any remaining rogue invasive cancer cells could survive chemo? This scared the crap out of me.

I emailed my surgeon's RN, Jan, this week with some questions. Here is what went back and forth via email:

Hi Jan.

Could you find out for me, or direct me to someone who can, tell me the answer to this...

How many women (with early breast cancer like me) who have had lumpectomies with axillary node dissection, then chemotherapy followed by re-excision surgeries still have cancer showing up in their pathology?

To which she replied:

"Maria, I don't know statistically because it really depends on the persons original pathology. As far as I know it is not uncommon given your original pathology that there may be some residual cancer in the breast post chemo. The re-excision at the positive margins will remove that. Often it's DCIS that is found as it doesn't respond to chemo and is not life threatening. The important thing is that if there is any invasive cancer still there that we get it out on this next surgery. Then you be all clear of cancer in your breast."

I then emailed again and asked:

"If it's not DCIS can I do more chemo to better my chances?"

To which she answered:

"You won't need chemo because you've already had it and if there's any cancer left it will be removed surgically. And the Radiation will help protect you from it coming back in your breast. The only time you'd be offered more chemo is if it recurs somewhere down the road (heaven forbid)."

This has only left me with more questions and concerns. If the upcoming pathology comes back positive for invasive cancer cells what does that mean for the rest of my body?

You see, my invasive breast cancer has already been identified in the first surgical pathology as LVI - lymphovascular infiltration identified. All of the surgeries, chemo and radiation are and will be focusing on the point of origin, my left breast. What is concerning me is if invasive cancer cells are still found in the breast tissue post-chemo, what chances are there that there are rogue cells elsewhere in my body?

Given the fact that if this cancer recurs, it tends to recur in the lungs, bones, liver and brain, how do we (me, my medical team etc.) know?

Prior to my first surgery back in October, I was sent in for thorough chest x-rays and a thorough abdominal ultra sound, both to check for any sign of cancer metastasis.

Given what I'm being told this week, I feel it would be medically prudent to have a CT Scan or MRI to check me from head to toe.

I know there are a lot of "ifs" here, and I'm trying very hard to not focus on the "ifs", but I feel I need these answers in order to cope. I know that I have to wait and see what the next pathology looks like.

I'm terrified. I want to live. My surgeon and I discussed doing a mastectomy instead but she said that would only make a 2% difference for me as far as the chances of recurrence is concerned. She explained that being TNBC - IF recurrence is to happen, there is only approx. a 10% chance it would come back in the breast, but an 80% chance it would come back elsewhere in my body.

I know that if the pathology comes back clear, the next 3 years will be crucial and I know I will be followed and checked quarterly by my oncologist.

I don't want to be frozen with fear. I want to be able to think positively, but I'm struggling. I keep thinking of my three young daughters, ages 10, 8 and 7. I want to see them grow up. I have goals and want to plan my life post-cancer. I'm trying not to think too far ahead, but it's hard.

Has anyone else had re-excision surgery, post chemo, and still had cancer cells in their pathology?

disneyfan2008

clueless
what is re-excision surgery?


I can kind of figure it out..but never heard of it>

Gabe N Abby Mom

Take a deep breath, in
Take a deep breath, in slowly, out slowly. Then, no matter what the pathology or docs say, definitely "plan your life post-cancer." Don't allow the fear to steal your joy!

You are at the tipping point where faith and belief have to take over. Faith that you have made the right decisions along your journey, and belief that your doctors are being thorough.

I have gone/am going through much the same thing. I'm triple neg and IBC, each is considered aggressive on it's own, so you add them together and it gets pretty damn scary. My chemo was TAC all together and 6 rounds, then a bilateral, then rads. The surgical pathology said there were spots of cancer found throughout the breast, 12 of 14 nodes were positive, clean margins.

I also asked for more/different chemo and got basically the same response you did. I took that to ultimately mean the docs are doing everything they can, and I'm doing everything I can, so all the rest is what it is and will be what it will be. There are some things I can't change, some things I can't control...but I can decide how I approach each day. I can take time today to appreciate each person in my family, to say I love you. I can plan for a future with my husband and children. I can take the time to laugh and feel joy each and every day.

As for an MRI, did you ask your doc for one? If so, it can't hurt to ask again and state your case. The worst thing is that he'll say no or 'insurance won't cover it'. And then for follow up visits and the how do you know if it's mets question...my onc gave me a list of symptoms (cough that won't go away, unusual headaches, new aches/pains that don't go away, unusual back ache, etc.) and said if they persist for 6 weeks he wants to know about them. I have decided that I'll be sending an email if any of those issues persist for 4 weeks. But be sure to talk with your onc about the how do you know if it's mets question, your onc may have a different plan for you.

You said "All of the surgeries, chemo and radiation are and will be focusing on the point of origin, my left breast." I feel compelled to point out that only surgery and radiation are targeted treatments, yes they do focus on the point of origin. Chemo however, is not a targeted therapy. It is a systemic treatment, meaning that it will attack cells, healthy and not healthy, throughout your body (that's why it has so many SE's). So any little cancer cells that were trying to find a home somewhere else in your body have been attacked and treated.

I hope this helps, and I hope you are able to find peace. I'll be thinking of you on the 27th, and praying for clean margins.

Hugs,

Linda

emamei

disneyfan2008 said:

clueless
what is re-excision surgery?


I can kind of figure it out..but never heard of it>

Clueless...
Re-excision surgery is performed when the margins are not 100% clear, or in my case the cancer cells were too close to the margin for my surgeon, so she will be performing minor surgery on the original tumor site and cutting away a few millimeters of tissue to clear the margin.

emamei

Gabe N Abby Mom said:

Take a deep breath, in
Take a deep breath, in slowly, out slowly. Then, no matter what the pathology or docs say, definitely "plan your life post-cancer." Don't allow the fear to steal your joy!

You are at the tipping point where faith and belief have to take over. Faith that you have made the right decisions along your journey, and belief that your doctors are being thorough.

I have gone/am going through much the same thing. I'm triple neg and IBC, each is considered aggressive on it's own, so you add them together and it gets pretty damn scary. My chemo was TAC all together and 6 rounds, then a bilateral, then rads. The surgical pathology said there were spots of cancer found throughout the breast, 12 of 14 nodes were positive, clean margins.

I also asked for more/different chemo and got basically the same response you did. I took that to ultimately mean the docs are doing everything they can, and I'm doing everything I can, so all the rest is what it is and will be what it will be. There are some things I can't change, some things I can't control...but I can decide how I approach each day. I can take time today to appreciate each person in my family, to say I love you. I can plan for a future with my husband and children. I can take the time to laugh and feel joy each and every day.

As for an MRI, did you ask your doc for one? If so, it can't hurt to ask again and state your case. The worst thing is that he'll say no or 'insurance won't cover it'. And then for follow up visits and the how do you know if it's mets question...my onc gave me a list of symptoms (cough that won't go away, unusual headaches, new aches/pains that don't go away, unusual back ache, etc.) and said if they persist for 6 weeks he wants to know about them. I have decided that I'll be sending an email if any of those issues persist for 4 weeks. But be sure to talk with your onc about the how do you know if it's mets question, your onc may have a different plan for you.

You said "All of the surgeries, chemo and radiation are and will be focusing on the point of origin, my left breast." I feel compelled to point out that only surgery and radiation are targeted treatments, yes they do focus on the point of origin. Chemo however, is not a targeted therapy. It is a systemic treatment, meaning that it will attack cells, healthy and not healthy, throughout your body (that's why it has so many SE's). So any little cancer cells that were trying to find a home somewhere else in your body have been attacked and treated.

I hope this helps, and I hope you are able to find peace. I'll be thinking of you on the 27th, and praying for clean margins.

Hugs,

Linda

Taking a deep breath...
Thanks so much Linda.

laughs_a_lot

ok
Time for more prayers.

BioAdoptMom

I had a re-excision as well,
I had a re-excision as well, but mine was about a month ago. I don't start chemo for another 2 to 4 weeks. My surgeon explained that it was fairly common to need to go back in and also that the rads oncologist would not treat anyone who didn't have clear margins. They cannot depend upon chemo to kill the cancer cells. It's probably similar to someone who has a larger tumor is prescribed chemo first, then surgery. She (or he) still has surgery to remove whatever cancer is left. My surgeon also told us told us that having unclear margins does not change the prognosis!

Nancy

emamei

BioAdoptMom said:

I had a re-excision as well,
I had a re-excision as well, but mine was about a month ago. I don't start chemo for another 2 to 4 weeks. My surgeon explained that it was fairly common to need to go back in and also that the rads oncologist would not treat anyone who didn't have clear margins. They cannot depend upon chemo to kill the cancer cells. It's probably similar to someone who has a larger tumor is prescribed chemo first, then surgery. She (or he) still has surgery to remove whatever cancer is left. My surgeon also told us told us that having unclear margins does not change the prognosis!

Nancy

I had a re....
I think what is concerning me the most is the fact I had my chemo already and my re-excision surgery is on the 27th and I was not aware there was a possibility that there could still be cancer cells present post-chemo.

disneyfan2008

emamei said:

Clueless...
Re-excision surgery is performed when the margins are not 100% clear, or in my case the cancer cells were too close to the margin for my surgeon, so she will be performing minor surgery on the original tumor site and cutting away a few millimeters of tissue to clear the margin.

@emanmei
thanks for explanation

alexlib_mom

cancer cells post chemo
Not to scare you, but I had a mastectomy after chemo (which came after lumpectomy and re-excision) and to everyone's surprise (doctors, me, my husband), there was an entirely new tumor in the same breast after the chemo (far away from original cancer, etc). Because no one had been watching for it before and didn't realize it was there, they can't tell me if it shrunk during chemo or grew, but it was a completely separate tumor (IDC). I also had lots of DCIS. Now, chemo doesn't take care of DCIS, so I expected that. It was the IDC I didn't expect.

I had four rounds of T/C. So this is to tell you that you can still have cancer cells post chemo, which doesn't seem fair after what you've been through! I also have young children and know the angst you're going through. Good luck figuring it out.

DebbyM

BioAdoptMom said:

I had a re-excision as well,
I had a re-excision as well, but mine was about a month ago. I don't start chemo for another 2 to 4 weeks. My surgeon explained that it was fairly common to need to go back in and also that the rads oncologist would not treat anyone who didn't have clear margins. They cannot depend upon chemo to kill the cancer cells. It's probably similar to someone who has a larger tumor is prescribed chemo first, then surgery. She (or he) still has surgery to remove whatever cancer is left. My surgeon also told us told us that having unclear margins does not change the prognosis!

Nancy

Sending prayers and hugs to
Sending prayers and hugs to you.


Debby