"Your path shows no tumor whatsoever. The pathologists put through additional sections beyond the usual and still found nothing."
We're overjoyed.
Here's how we got to this point.
When Kathy was first diagnosed with breast cancer, titanium clips were inserted at the margins of the tumor to help localize the area as the tumor changed.
After 4 doses of cytoxan/adriamycin and 5 doses of taxol, the tumor disappeared - an MRI showed no evidence of disease.
Per my blog last week, Kathy and her breast surgeon made a decision to move forward with a lumpectomy. Here are the details from the surgeon's clinical note
"Impression: Carcinoma of the left breast, s/p neoadjuvant chemotherapy with a complete response based upon clinical examination and recent breast MRI.
Options for management were discussed which includes an attempt at breast conserving surgery. This would be a wire localized left partial mastectomy using two wires to bracket the cancer at presentation. If adequate margins are attainable, she would then receive adjuvant radiation therapy followed by hormonal therapy. Alternatively, mastectomy with and without reconstruction was discussed.
Ms Halamka and I have decided to proceed with an attempt at breast conserving surgery. The procedure was discussed in detail, including the wire localization. The pre-, peri-, and post operative care was discussed. Consent form was signed. This has been scheduled for 5/11/12."
On May 11, I drove Kathy to BIDMC at 6am and we checked into surgery at 7am. She was taken to interventional radiology for placement of wires aligned to the titanium clips to guide hemisection of the breast. Here's the procedure note:
"Using standard aseptic technique and 4 cc of 1% lidocaine for local anesthesia two needles and subsequently two wires were advanced into the patient's breast. Satisfactory positioning of the wire was confirmed on orthogonal views with the percutaneous clips at the respective wire stiffeners."
Kathy tolerated the procedure well, and was bought to the Operating Room at 9:30am. She was given Monitored Anesthesia Care (MAC) - breathing on her own but deeply relaxed via doses of Propofol, Versed and Fentanyl. Her surgeon cut out the tissue between the wires and sent that to Pathology. She then cut a wider margin and sent that to Pathology. Here's the procedure details from our OR system
Procedure Detail: WIRE LOCALIZED LEFT BREAST PARTIAL MASTECTOMY WITH 2 BRACKET WIRES
Incision Time: 09:39 Cosmetic? N
Close Time: 10:49
Specimens Taken? Y
Specimens:
149845-1 Mammo.
LEFT LOWER INNER QUADRANT PARTIAL MASTECTOMY
Anatomical ID: Left
Markers: SHORT STITCH-SUPERIOR;LONG STITCH-LATERAL
Disposition: Fresh
Comments: Specimen out @1000.
149845-2 Permanent
RADIAL RE EXCISION LEFT BREAST
Anatomical ID: Left
Markers: SHORT STITCH-SUPERIOR;LONG STITCH-LATERAL
Disposition: Fresh
Comments: Specimen out @1022.
She was taken to the recovery room at 11:00am and I met her there. She did very well and had no post operative pain.
Over the past week, she's done well, with no swelling, redness, or pain at the incision site. She's had a small amount of clear drainage but no signs of infection.
So, she's done with chemotherapy and surgery. Her Pathology report was perfect, showing no evidence of cancer. Tomorrow we'll meet with her care team to prepare for the next step - radiation oncology.
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