On Deck: Oncologist


Date: March 24th, 2011

Time: 8:AM

Status: 10-day Survivor

Info:  Our visit with Dr. Norton (surgeon) went very well yesterday. She [Dr. Norton] is amazed at how upbeat and how great Bonnie looks, feels and her overall positive attitude after only a week of recovery. Each of you reading this share a piece of that responsibility and I thank all of you for positively connecting with her when you do. The doctor went over the pathology report regarding the clean tissue and those areas; both breast and lymph nodes affected by cancerous tumors. The lymph nodes detected (and removed) are both extremely small with one on each side. Bonnie joked with her yesterday explaining that she’s a girl of balance – again the sense of humor Bonnie demonstrated yesterday showed Dr. Norton just how balanced Bonnie really is.

So we learned a new term yesterday: MICROMETASTIS or as Dr. Norton refers to it; “MICROMETS.” I think knowing the definition first will help before I continue:

Micrometastasis is a small collection of cancer cells that have been shed from the original tumor and spread to another part of the body. They cannot be seen with any imaging tests such as mammogram, MRI, ultrasound, PET, or CT scans. These migrant cancer cells may group together and form a second tumor, which is so small that it can only be seen under a microscope. During a sentinel lymph node biopsy, the lymph nodes that are removed will be tested for micrometastasis. If a lymph node is found to contain micrometastasis, it is said to be positive, and this information affects your diagnosis, staging, and treatment plan. The key words in the definition above are [at least to me] “cannot be seen with any imaging tests”.

We were fortunate in our decision to execute the radical bi-lateral mastectomy. Had we not, these affected lymph node areas may not have been found.

As you know, everything in our lives is classified by some sort of standard. The standard used for classifying a tumor as a micromet is done by the size of the tumor. The lymph node in Bonnie’s right side is measured between 0.2mm – 2.0mm. So small Dr. Norton could not definitively show us on a ruler just how small that one is. The left side sentinel node measured in at 2.1mm with no evidence of extranodal spread. In just those few words there is GOOD news along with the BAD. No extranodal spread. Okay.

Dr. Norton went onto explain what she does with these numbers. Using a “prediction tool” provided by Sloan-Kettering Cancer Center, the numbers are plugged into a nomogram to assess the likelihood the breast cancer has spread to the sentinel lymph nodes. More good news. Ready? The probability for her right side spreading to additional lymph nodes is 5%. The probability of her left side spreading to additional lymph nodes is 16%. The left side percentage is greater due to the pathological size of the tumor found in that breast which was 3.5cm, coupled with the number of positive sentinel lymph nodes (1) and negative sentinel lymph nodes (1).

It’s important to remember these cancerous lymph nodes have been removed. The sticky part now is since they are lymph node related – where else have they traveled? Our primary concern(s) in this vein are of course her ovaries. We are still on guard in protecting against lymphedema. For those of you not aware of that definition – allow me:

Lymphedema is a debilitating condition in which excess fluids (lymph) collect in tissues causing swelling (edema). In women, it is most prevalent in the upper limbs after breast cancer surgery and lymph node dissection, occurring in the arm on the side of the body in which the surgery is performed.

Dr. Norton showed Bonnie how to “walk the wall” using her fingers and the correct way to conduct these exercises. It’s always something, but we’re doing our best to ensure she’s not diagnosed with this. In fact, a few hours after leaving Santa Rosa yesterday I scheduled each of us to attend the Lymphedema Prevention & Care class (a two-part series) for next April. These classes will teach us on ways to speed the healing and reduce the risks related to cancer surgery along with understanding the lymphatic system and drainage pathways, the risk factors in developing lymphedema, skin care, simple exercises, self-measurement and self-lymphatic drainage techniques, recognizing the symptoms, warning signs of cellulitis, and learn about nutrition and natural approaches that can support the lymphatic system.

This afternoon we meet with Dr. Stanton; her oncologist. We enjoyed our first introductory session with him and we’re hoping to learn what chemotherapy regimen he has in store for us. As always, details to follow.

Was that enough for today? All in all – a good meeting with Dr. Norton. She was happy to learn via email we’ve scheduled our Lymphedema class. Her email response went onto say:  “Great! Thank you very much and thank you for taking such good care of her! 🙂 You guys will like the class. The teacher is excellent and my patients say nothing but great things about it. Very useful info she’ll need years to come.”

I’m sure you have questions – believe me when I tell you – that’s the constant state of things with Bonnie and I. The great thing is her mental mood. Dr. Norton stated she was so excited to see how “ready” for surgery Bonnie was last week and how “upbeat” she was yesterday. Her mental attitude will take her the distance so keep those positive phone calls, emails and blog responses coming!!

Her co-workers are coming over to have lunch with her this afternoon. How great is that? Hope they don’t bring a ton of work with them that’s probably been piling on her desk … that’s a cheap shot I know, but …

Keep her close you guys.

Love,

Paul

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7 thoughts on “On Deck: Oncologist

  1. Good news abounds — yay. My pathology was very similar, with micromets but no organized tumors. It becomes a numbers game at this point, and I’m sure her oncologist will spell it out for you. So glad the recovery is so positive, and you’re smart to be on guard for lymphedema. Walking the wall is great, and you also want to cut out as much sodium as possible, elevate the arms when resting, and drink a lot of water.

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