Spring in Kingston is cool this year, so the flowers and trees are late blooming, and the blooms are lasting longer than usual. The cheerful daffodils and brightly coloured early tulips are still fresh. And the hellebores! OH! Such joy! The sun rises earlier each day, and the birds don't seem to have noticed that spring is late and chilly (at least if their bird song is any indication.)
Some things are (relatively) certain, even if the timing is not always predictable.
My surgical scars are healing well. But the pathology report on the tumours, which I only received last week, had some surprizes which have taken me awhile to process.
The good news:
There were clean margins around both tumours. The larger tumour shrank considerably after the chemo treatment, and while the breast MRI back in March suggested the smaller tumour had shrunk proportionately even more, this did not turn out to be the case. It was 10 mm on MRI in September, 2 mm on MRI in March, and 13 mm on pathology examination (these measurements cannot be strictly compared and the pathology measurement is always the most accurate.) The larger tumour was given a grade of "stage 2" based on size and the way the cells looked under microscope, while the smaller tumour was a DCIS or "stage 0."
The disconcerting news:
a) the cancer is not "garden variety" invasive ductal breast cancer, as I had assumed, but has features that occur only in about 5% of breast cancers. Not so much is known about it; its features were only differentiated about 30 years ago. It does spread more quickly to the lymph system, but the research literature suggests that outcomes are similar to "regular" invasive ductal breast cancer (though "outcomes" to cancer researchers mean different things from study to study, let alone to people who have cancer!) One of the research papers I read, with Chinese authors, described this cancer as "special and rare" (I think there may have been an endearing translation glitch). I'm not sure "special and rare" is great when it comes to cancer. The surgeon confirmed that not as much is known about it, and therefore, it is more difficult to make predictions.
b) the surgeon removed what he thought were two sentinel lymph nodes (the lymph nodes first in line that drain from the breast), which turned out to be six in total (two in one clump and four in another. Apparently it is common for there to be more than one node in a surgical clump.) One of the six lymph nodes contained a "micro-metastasis" of 1 mm. The surgeon explained that if it were 2 mm or larger, the recommended procedure would be to go back to surgery and remove some of auxiliary lymph nodes (the second in line draining from the breast).
In my first post-surgery meeting with Dr. Walker, two weeks ago, he said he was disinclined to go back for more lymph nodes, because the metastasis was so small (and has been removed), but he would consult with his oncology colleagues. Today, when I met with him again, he told me that his colleagues didn't have strong opinions either way and thought the decision should be mine - whatever I was most comfortable with.
To my ears, that sounds like there is no clear choice, no "right thing" to do. The surgeon acknowledged that it is not easy when patients are put in this situation and have to make a decision like this.
The downside of removing more lymph nodes is permanent lymphedema (swelling in the arm) which is very uncomfortable and can be outright painful. The surgeon stated that he doesn't like doing auxiliary lymph node dissections but if I wanted it done, he would do it. He said he would do the surgery but I was the one who would have to live with the (possible) consequence of lymphedema. He also made it clear that he didn't think there would be any impact on recurrence - which suggests to me that I could have the auxiliary lymph nodes removed and end up with lymphedema AND a recurrence of the cancer! (worst case scenario!)
So these last two weeks have shattered my illusion of certainty that I would have treatment, everything would be fine, and I would pick up and carry on. It has reminded me that while some things are certain (e.g., the days getting longer in April), many other things are not (e.g., the nature and the timing of our deaths). Of course, we all know this, but the reminder for me seems to be getting stronger, more pointed.
I'm coming to the realization that further surgery may provide an illusion of a guarantee that the cancer is gone, but it may only shore up an illusion of certainty. In the end, no one knows if the cancer will come back or how long I will live. And when it comes right down to it, I want to live a fulfilling life with the most joy, presence, kindness, and compassion as I can muster, no matter how short or long it is. (Though I definitely want to stick around at least until Claire is an adult!)
There are some things I can do reduce the risk of recurrence of the cancer. As my Kinesiology colleagues know, regular exercise seems like the answer to just about everything. And there are some supplements that seem worth taking (i.e., coriolus mushrooms and green tea). I'm disinclined to take up a keto diet, with very low carbohydrate intake (the theory is that cancer cells starve because they can only use glucose and can't use the metabolites from a high fat, high protein diet). I would miss fruit, carrots, beets, legumes, etc., —and avocados don't fit very well for eating locally, which is important to me. I have already given up alcohol (a carcinogen) - though I haven't quite figured out how to cope if Doug Ford wins the provincial election again (maybe I'll move to Nova Scotia.)
After talking with Dr. Walker this morning, I am leaning towards not having the additional surgery. But I asked to have the weekend to think about it. Maybe I'll wake up tomorrow morning with a different leaning. In that case, Dr. Walker said it would be early June before the surgery could be scheduled.
If I stick with my current leaning, I'll start radiation treatments in about 2 weeks (to be confirmed with the radiation oncologist), for 16 treatments (daily, from Monday to Friday). Stay tuned!
Wishing you much delight, in whatever brings you joy.
