Pathology

Those 8 abnormal cells found in the sentinel lymph node went under more scrutiny by the scientists for a few days after my surgery as did the rest of the extracted tissue.  Dr. Keleher called to fill me in on the results:

- left breast was cancer free as predicted
- right breast showed evidence of a large (7cm by 9cm) tumor that was virtually dead except for a .8mm spec found within the aureole complex of the nipple.  Surrounding skin and muscle were clear. 
- sentinel lymph node also showed a few specs even smaller.  These are visually similar to 'salt' as described by Dr. Keleher.  The pathologist has to report them if they are in the range of .2-2mm.  My largest was .35 - just at the bottom of the range.
- second lymph node showed no signs of cancer.
(that's the abridged version of the 4 page report!!!)

What's all this mean?  Dr. Keleher is confident she has gotten all the cancer.  Because of a few factors, she's asked me if I she could present my case to the Tumor Board.  This is a group of medical professionals that meet to review cases, discuss results and recommend actions.  The factors she's referring to are specifically my age and the original size of the tumor.  The actions to discuss?  To radiate or not to radiate to prevent reoccurence.  Of course, I agree.  To get the educated opinion of so many professionals at once is a bonus!

Dr. Keleher and I finally connect a few days after the Tumor Board met.  After presenting and discussing my case, the group was inconclusive.  There was no evidence my life would be effected in a positive way if I chose to do radiation.  In fact, the risks could out weight the benefits.  Among the group were several radiologists and even they didn't recommend radiation.  My cynical side insisted they would opt for their discipline if not for monetary reasons... Dr. K assured me ethically they wouldn't and it seems she was right.  Still, she didn't commit to a yeah or nah and left the decision up to me - as it always was.  She recommended I see a radiologist that wasn't at the Tumor Board and have them review my situation and see what they say one on one.  If I were to opt for the treatment, what would it be, that kind of thing.

Two of my other doctors were there - Sepulveda and Rubin.  I saw Dr. S on Friday.  His answer was clear when I posed the question of what he felt about the Tumor Board discussion - 'If it were my wife or daughter, I wouldn't do it!'  Right there - straight and to the point.  It was good to hear honest plain english.  I'll visit Dr. Rubin today and see what he has to say too.

Once I have all my opinions from all my 'trusted' advisors, I'll do my own research about risks vs. benefits of radiation and make my decision.  This has all been quite an education.