Re-Excision Surgery Coming Up...

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?