I met with my surgeon today. I can see why everyone loves him. He is extremely good with people, which probably isn’t the norm for surgeons. Or at least, that’s what I learned from Grey’s Anatomy on TV. ?

The surgeon explained the risks and benefits of the surgery, which was pretty straight forward since I have done so much reading and research in the past week. I know that the tumour has to be removed via process called a lumpectomy. From there, they have to make sure that there is healthy tissue all around the removed tumour, which is what they call negative margins. This is determined by sending the tumour off to a lab, where they look at it under a microscope to make sure that there are no cancerous cells around the removed tumour. At the same time, they will analyze the tumour to find out if it is estrogen or progesterone positive, HER2 positive, a combination of the three, all three (triple positive), or none of the above (triple negative).

Of the tumour types, I am most worried about a triple negative breast cancer. That type of cancer does not respond to targeted therapies like trastuzamab or estrogen blockers. The only things it responds to is chemo and radiation. And if the chemo is not effective, what do you do? HER2 is a fast growing and aggressive type of tumour, but there is a drug called trastuzumab (Herceptin) that beats the crap out of it. However, you also need chemo almost 100% of the time if you have that type of tumour. I get the feeling that a HER2 positive tumour used to be especially dangerous, but isn’t quite bad these days as long as it’s caught early enough.

The surgeon plans to remove the tumour and perform a sentinel node biopsy. In this case, the word biopsy is a bit misleading. Usually, when a biopsy is performed, a sample of tissue is taken. In a sentinel node biopsy, large amounts of radioactive dye is injected into the breast. At that point, your body needs to figure out how to drain the extra fluid out, which is where lymph nodes come into play. The idea is that the first lymph nodes that take on the radioactive dye are the same ones that drain fluid from breast tissue. So, they identify those lymph nodes and remove them to analyze them for cancer.

The reason surgeons do this now is because someone figured out that there is no need to perform an axiliary node dissection to remove all lymph nodes. If the sentinel nodes are healthy, there is no reason to believe the cancer would have spread anywhere else. As a result, the other lymph nodes can be left alone. That spares people the complications of an axiliary node dissection which is 30-40%. Some of the complications are numbness in the arm, lymphedema (swelling in the arm), or weakness. Yuck.