Surgery

Treatment Update: Surgery

There are many stages in cancer treatments. I have written in an early posting that I have four distinct therapies in my plan. I have completed the chemo or what is referred to adjunct therapy, which treats the whole body. Next I will experience the localized therapy: surgery and radiation.

Back in November we (the doctors and I) made the decision to do chemo first to shrink the tumor and follow that with the possibility of a lumpectomy if the chemo was successful. Well, as most of you know, the tumor did dissolve and diagnostic tests indicate that there is no “suspicious activity” in the breast area. So for several months, I had been expecting the surgeon to suggest a lumpectomy. But that was not the case. The surgeon failed to mark the tumor before the chemo treatment and in addition did not perform sentinel node biopsy that would have indicated if the cancer had moved to lymph nodes. These two procedures became very important in the present stage of treatment.

Without the tumor markers, the surgeon stated that he did not know where the tumor was so he suggested a type of mastectomy. I can’t express in words the disappointed I felt. I was also concerned about the removal of lymph nodes, a process that can cause lymphodema a very limiting condition of the arm. One of the things that brought me hope from the beginning was the “fact” that the cancer had not spread to lymph nodes and that I was responding well to the chemo treatments. The surgeon crashed that hope in a few short minutes.

Back at home after the doctor’s appointment, I went to my computer and with the aid of Google, I perused several nationally recognized cancer centers. I found that today it is routine to do the marking and the sentinel node biopsy before starting the chemo. I was very disappointed in myself and the doctor for not knowing this. I was especially disappointed in the doctor and decided to fire him and hire a new physician.

I have learned that ANY medical treatment requires us, the patients, to take responsibility, research and understand the possible treatments and their side effects. The Wellness Community (see links on the right) is a center for cancer patients and their caretakers. The mission of TWC is to assist cancer patients to take charge of their treatments and offer educational support and wellness activities, such as yoga, expressive arts, etc.

So through the encouragement of the support groups at TWC, I located and hired a new doctor. This doctor gave me three options; one of which was a lumpectomy with sentinel node mapping/biopsy. In other words, he will remove only the area where the tumor was located and the three sentinel nodes. You may be asking, “How can he know where the tumor was located?” Good question.

The answer is actually very interesting. Breast cancer cells settle and grow in micro calcifications found in the breast. The mammogram that indicated the tumor mass also showed that the tumor was surrounded by these micro calcifications. These micro calcifications are the “landmarks” of where the tumor was located. The morning of the surgery, technicians will locate these micro calcifications and mark the area with wires. (Not exactly sure how this will work but will write about it next week after the surgery.) The surgeon will then remove the tissue inside the wire markings.

Before the “wire mapping,” I will be injected with a blue dye that will locate for the surgeon the sentinel lymph nodes, which were the first in line to the tumor. If the cancer had spread to the nodes, it would be indicated here. He will remove the tissue in the area where the tumor was located and the three sentinel nodes.

After surgery all of this tissue will be sent to pathology for examination. If no cancer cells are found there, I am finished with surgery. If cancer cells are found, then more surgery is required. None of the diagnostics indicate cancer cells. There could still be some microscopic cells but we don’t think so. So I am expecting the surgery to be successful on Wednesday with no more surgery needed. All tests indicate that this is a very high probability.

Now, this is all easy to write about. I can intellectualize by doing the science research and keeping it all in technical terms. However, on the emotional level it is a different process. Through this whole process of cancer treatment I have dissociated from my body. I feel like I am on the outside looking in. Many women have shared with me their long episodes of weeping, feelings of fear, etc. I have not felt this. Not because the tears are not there, nor the fear; it is because I have dissociated from my feelings. I know this because I have done this before in my life.

My way out of dissociation is through meditation, poetry and art making. I felt a window to the emotions opening one day in a poetry workshop at the Wellness Center. I started a poem from my soul. I could feel the emotion very deeply. I did not finish the poem.

I have an art piece that I am “working” on. Well, not exactly working. It is only in my mind. When I lived in Binghamton, I was part of the Rude and Bold Women art show. Some of us participated in a process of “breasting.” During this process, we made castings of our breasts and hung them from a clothesline across the gym where the art exhibit took place. It was awesome. I still have my “breasting.” I decided last fall that it would be an excellent venue for expressing my feelings about the cancer.

I have thought about some ideas and one day I even started the process. I placed the white breasting on a large white cold press paper. I then placed pink rose petals in a curved line from the area where the tumor was located, crossing to the other breast and then moving upward onto the paper. It looked quite awesome. It was very simple but very beautiful. I then took it all apart and placed both the breasting and the petals back in the boxes!

So far, in the process of cancer treatment, it was been easy to stay in dissociation. Even during chemo infusions, when I look at the IV bags and tubing, I can see it as a movie or a “House” episode! Somehow, I think the surgery, especially the removal of most of my breast and the resulting disfigurement, will be the trigger to the emotions. This process will be the most permanent and symbolic.

To tell the truth, I do not know now I will feel. The whole idea of breast cancer in connection with my body, is just that “an idea.” It is all in my head and has not, as of yet, moved from my head down into my body and soul.