Save the date. Well, maybe you shouldn't, but I will.

 

Boob lamps. Love or hate.

I finally have a surgery date.

Of course, there are like 30 more appointments before then. Pre-op, covid testing, a day where they inject radiation into my breasts to trace it to the lymph nodes during surgery so we can see if there is any spread. It's all very strange, but also there will be a short window during which I will have radioactive breasts WITH TITANIUM IN THEM. 

So June 9.

I go in early in the morning. Mostly I wanted an early surgery so I wasn't plagued by caffeine headaches. Addiction is real.

The day of surgery, once I'm under, my surgeon will take her radiation gadget and find the lymph node that's hot (from the radiation injected the day before), and remove that. Because I have cancer in both breasts, we have to do that on each side. These are called sentinels: they are lymph nodes in the armpits where we would expect the cancer to spread to first if it were going to escape the breast.

She'll get those tested right then and there for spread. It's pretty accurate, so that guides what happens next.*

The not-best-case scenario:

If she finds cancer cells in the lymph nodes, she does a full axillary lymph-node dissection (ALND). This is not ideal for lots of reasons. I mean, first off, the obvious thing is that there's spread. But the recovery is a bit more, the risks are a bit more, and the chance of lymphedema shoots up to 30% (from <3% if I just have the single node taken out). This is a painful conditions where the limbs swell like crazy from lymphatic fluid accumulating. If caught early, they can treat it with...more surgery. This involves reconnecting lymphatic channels which sounds insane and invasive and like it will f me up so let's hope against hope we don't have to do that.

If there is spread, that means radiation, as well.

Best case scenario:

If there is nothing there, we just progress like nothing happened. We expect (and hope for) this.

About chemo (aka the worst-case scenario):

Once the tumors have been removed, they will be sent to pathology for an oncotype (onco meaning cancer, and type meaning, um, type). Well, one goes and the other...just hangs around, I guess. This test takes 7-10 days. They sequence 21 genes on the tumor (remember the tumor is my own DNA just freaking out, so we want to know which genes are the culprits). From this sequence, they generate an Oncoscore (which I imagine has a TM next to it). That score tells us how likely the cancer is to come back. Of course nothing is foolproof, but this is based on lots of data from other not-Krises.

If the score is low, then there's no suggestion that I will benefit from chemo.

If the score is intermediate, then we have a conversation about whether I will benefit from chemo.

If the score is high, then I freak out and need some xanax. Oh and chemo.

Because I'm young, the threshold for "high" is lower because they want to be more aggressive about making sure it doesn't return. Which I'm all for, but I'm also all for the concept of not having chemo.

Steps

So here's what happens. June 9 I go in for surgery. More on that in another post.

The surgeon sends the tissue out for the Oncopanel. I recover.

If that comes back as indicating I need chemo, that happens next. If not, then we move on.

If I need radiation, that happens after chemo (if needed). That would be 4-6 weeks of radiation 5 days/week. If we get there, I'll talk more about that in a different post, but suffice to say that the options are interesting. We don't expect that will be the case.

Recovery

The doctors say I'll be fully recovered in 6 weeks. They have been saying this throughout. I'm just going to say that I think their "recovered" and MY "recovered" are different. It'll probably be a while before I'm doing this again:

I have a kickass physical therapist I'm working with who specializes in aerial who will get me in the air again as soon as I am ready. She's already got me doing exercises to prepare me for surgery. Our initial guesses are 3-ish months if all goes perfectly...but that is a complete guess.

More on choices next time as I get comfortable enough to put it out there.

*I mentioned the accuracy of that lymph-node test. There's a failure rate of about 5% where it misses cancer that is found in later histology. If that happens, I go back in for a second surgery, but again, we don't expect this.