I don't have cancer or indeed anything wrong with me but everyone at work is looking at me as if I'm wriddled with it. I told a few people so there wouldn't be questions asked when I'm not around. I'm wondering if everyone knows now or are they just hot and those expressions are their it's to hot in here faces. Everyone has been really nice, supportive and helpful but I am a little tired of sympathy.
A's surgery being scheduled for the 22nd, a week later than we were originally told. This sucks mainly because it delays the staging of the axilla. This isn't the putting on of a Greek tragedy.
Cancer is described it terms of grade and stage which determine prognosis. Grade is how aggressive the cancer cells look when examined under a microscope. How angry they look. How likely the cells are to come away from the body of the primary tumor and spread in the lymphatics to distant sites. A's tumor is grade 2 (out of 5) which is not very aggressive which is good. But we don't know the stage. We don't know if the cancerous cells have moved down the road (lymphatics) to the armpit (axilla). If they have they will be waiting in the lymph nodes. We want to know the lymph nodes are clear. Ms C thinks they are, Mr S thinks they are. I'm really hopeful that they are and I haven't been able to find any swollen lymph nodes in A's axilla. They ultrasounded A's axilla and took a needle biopsy of a tiny little lymph node and the sample came back as too small to test. In truth we just won't know until after she has had the surgery.
About a week after surgery they will have two pieces of news for us.
- Firstly they will have been able to examine the whole of the tumor by slicing it into thousands of slices and examining every one under a microscope. This takes at least a week. They will hopefully be able to confirm that the grade determined by the earlier small biopsies is correct and representative of the whole population of cancer cells in the tumor. They will tell us the real grade. Normally this is the same as the biopsy grade.
- Secondly they will also be able to tell us if the sentinel node has or does not have cancer cells in it. The sentinel node is the first node to filter the lymph from a region that contains a cancer. It is determined by injecting, at the time of surgery, methylin blue dye into the fatty breast tissue around the tumor. The dye moves with the tissue fluid in the lymphatic drainage network and will collect in the lymph nodes (glands). The first lymph node in the drainage chain will be the one that goes a very obvious blue colour the others will be their normal creamy yellow colour. It will be in the axilla, so the surgeon will make a small incision in the armpit to go looking for it. If the sentinal node is positive for cancer cells then they will count what proportion of the other nodes that were sampled are also positive.
If A has positive nodes then she will have chemotherapy, a complete mastectomy, surgery and radiothereapy to the axilla to remove or destroy all the cancer in the lymph nodes. Axillery clearance and radiotherapy often causes permanent swelling of the left arm. She will also have her whole body scanned to look for distant metastasis. A bone scan to look for spread to the skeleton. A head, chest and abdomen CT to look for spread to the brain, lungs and liver. In short I really don't want the nodes to be positive. I want those nodes to be negative more than I have ever wanted anything in my life. Nothing but the news that they are clear can console me. When I close my eyes I can see the microscope view of the cells ugly, blue, pink and purple with the pathologist's stain creeping towards the nodes. The waiting is unbearable. But it must be borne and there will be other waits too.
If they are positive though all hope is not lost. A is young, strong and healthy and I'm still confident she'd be ok. Her youth and health mean that she can take very aggressive forms of treatment. These forms of treatment can be summed up as poison and radiation that you hope the cancer can stand less well then the host. It's these treatments and their physical and psychological effects on A that I am fearful of. I'm still not entertaining the prospect of loosing her.
A's strength is incredible and its more her supporting me than the other way round. I hope that as time goes on I will be more useful to her and I will make sure she goes through none of it on her own.
