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Avatar universal

Risk of metastasis and no one available to finish the surgery! What can I do?

Hello,
My girlfriend was recently diagnosed with invasive duct breast CA 8mm.  Suggested lumpectomy with rads. Had surgery plus sentinel nodes. 2 nodes taken, 1 clean, but 4mm CA found in remaining single node, otherwise all other margins clean. Surgeon gone away for 2 weeks. Returns in 3 days for consult with us and is going away another 2 weeks. We don't want to wait more time for this to potentially spread. Another surgeon in this major center will not take the case in this surgeon's absence. The wait time is mentally killing me because, being a doc, I know how this can metastasize.  Any advice how to speed  up this hopelessly slow crawling process?  PS: no frozen section was done at the time of surgery to see involvement right away.  Could have explored other nodes at that time instead of waiting 2 weeks for only a consult and then perhaps another 2 weeks til surgeon returns again.  Plus we are headed for July 4 weekend.  HELP!  Patient may opt now for bilat mastectomy as well. Everyday of waiting time is torture. Please advise.
Thank you.
6 Responses
1686908 tn?1307197390
Hi there, when was she diagnosed and when was surgery?  ok so it has spread to 1 node, they should have looked into more nodes at the time.  At least the tumors are small what stage are they? I would get a copy of the reports from the hospital and see what stage they are, maybe even in the time waiting for the surgeon consult and oncologist and see what the options are for starting treatment.  The wait is the absolute worst.  I remember crying all the 2 weeks waiting, and my mother had the lumpectomy and went back to the recheck and was told masectomy and 1 week later we were in surgery again.  It's hard.  At least you can do something while the doctor is away, talk to an oncologist and get a copy of the results so you know what stage the cancer is in so you can plan for any treatments after the next surgery if she wants to go with surgery instead of treatments.  If it were me I would go for the mastectomy.
Avatar universal
Hi Tina,

Thanks for your response. Diagnosis was May 24.  Surgery/lumpectomy was June 15 with sentinel node biopsy at that time. We met with PA in absence of surgeon and told us it was stage 2 (would be stage 1 if not in sentinel node).  PA also said it is not common to spread in other nodes....but they have been wrong before when they said it was a very non aggressive cancer and would only have less than 5% chance of going to the nodes.  It is moderately differentiated...orig. only 8mm in size in breast.  HER2+ (*****) found this at PA consult; estrogen receptor + (a good thing).  This is where I stand.  The issue is not the surgeon but the surgeon's schedule.  The surgeon is actually highly skilled and very prominent. Don't know when the next step can be done due to the schedule and was told chemo is now necessary.  Now, what should come first....chemo or more surgery (mastectomy)....further lymph node exploration is most likely going to be done.  Problem: if you do surgery you must delay chem treatment for a long while. Maybe it is better to do chemo first and then choose mastectomy vs radiation of the affected breast. As it is....she already had lumpectomy so the cancer in the breast is gone and so is the affected sentinel node. Thank GOD.  The protocol is to do chemo and then radiation. So can't she still have the chemo now and decide on radiation vs mastectomy later?  What do you think?  What is the order of this? What if the surgeon leaves again and can not perform the node surgery and does not refer to another surgeon in his absence?  Why should we wait a total of one month for the further node biopsy with HER2+ biopsy?  I am mentally drained and exhausted.  And I'm a male and not the patient!  I feel for all of you women out there....and want to kill this dreadful disease.  The death of cancer is 100 years overdue!
Avatar universal
I'm SO sorry to hear about your girlfriend's diagnosis and that getting treatment scheduled is so frustrating to you both. I tried to find some information on the wait time and did find that a four week wait isn't unheard of. If I'm following your scheduling information correctly, it seems that she could possibly have her surgery the week of the 17th. If that's correct, that might not be too bad, although I know the wait is torture. I don't know what you can do to get the present surgeon to change his/her schedule unless you could get some "professional courtesy" doctor to doctor.  During your consult I would definitely express your concern with the additional two week wait and see if he/she would consider referral to another surgeon. Again, because you're a doctor, another surgeon may take her case on if her personal physician asks for this. I'm assuming there are many highly qualified surgeons in your medical center and in the New York area, so even though you prefer this surgeon, to ease your mind this may have to be a possibility. If this is out of the question, for sure you can make sure she's scheduled at the consult for the first possible opening on his return.For sure, I would also get set up with an oncologist during your consult so you can discuss your question of chemo before surgery. I don't know if that's possible in her case, but if it is, it would ease your mind somewhat about metastisis. I'm
a retired nurse who came here after I was diagnosed with LCIS in '09 and I certainly don't profess to know everything about breast cancer treatment. I just try to provide information that I do know, web sites for reputable medical centers to get additional information and support to the people who come here. I do feel it's encouraging that her cancer was found at a small size and that what was known to be cancerous was removed. I also think she's lucky to have you to advocate for her as so many women don't have that.
I hope you find some sort of resolution in the very near future so you can proceed to the next step with your girlfriend. I wish her all the very best in her fight against this horrid
disease. Try to stay positive on the outcome, as I really feel this is so important when
facing serious illness. I'm sure you've seen in your practice, too, that attitude has so much to do with recovery.
Please keep us updated on this same thread if you wish. I'm sorry I couldn't be more helpful, but there may be others here with additional ideas. I'll be thinking of you and wishing you both all the best,
nc
739091 tn?1300669627
Two cents....

HER2+ means that this is an aggressive type cancer. I'd opt for searching out a micro-surgeon (3 teams are excellent and come to mind). I'd be considering muscle sparing tissue transfers such as DIEP, SGAP etc...
Here is a post I did for someone a while back which gives a lot of information. This surgery, done by the best offers soft breasts which later will tolerate radiation where implants/expanders will not. It never hurts to go to the best. Best wishes.

http://www.medhelp.org/posts/Breast-Cancer/Trans-flap-vs-implants/show/1308880?personal_page_id=384050
1686908 tn?1307197390
I can't really tell you what to do but I will tell you what I would do.  The HER2+ is like Sue said very aggressive.  My mother's cancer was not in the lymph nodes and they still took the entire breast, the biopsy came back (she had biopsy and lumpectomy) and the dr said it's too aggressive, we need to remove the breast.  See what happens many times the order of treatment is the difference between life and death.  Stage 2 aggressive HER2+ usually does require a masectomy and since it had started to spread to the nodes probably stage IIa.  The difference in treatment is if you do the surgery and hit the remaining particles with chemo and radiation it kills them and chances of recovery are better whereas if you do chemo and radiation and you are hitting the cancer and it's growing other ways to spread.  
Avatar universal
Hello again.  Today we meet with the surgeon who is back for only a couple of days and then is supposedly away again for 2 more weeks.  Totally frustrated.  I have organized over a page of questions to pose and see what the responses are.  I will not accept an answer indicating it is ok to wait another 2 weeks for lymph node exploration.  It is too long and too stressing to wait this long and also, I feel, too dangerous.  I don't like chasing horses out of the barn.  I prefer to aggressively contain them.  I hope I will not be told "don't worry, another 2 weeks in no big deal".  It IS a VERY big deal....to me it can be life and death.  What happened to the urgency and common sense approach to serious disease?  I am hoping they will defer to another surgeon if this one is absent for that amount of time.  If not, I need to make some fast moves but don't know how long it will take to get records.  If it takes the same amount of time it almost does not make sense.  Very frustrated and stressed out!  
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