Biopsies and Surgery
With the decision to forego chemo behind me, we set our sights on the next step - surgery. However, before we could schedule surgery, we had to address an issue at hand.
ANOTHER BREAST BIOPSY
To back up a bit, the week before going to the Hollings Cancer Center at the Medical University of South Carolina (MUSC) for the first visit to get a second opinion on 4/13/23, I had an MRI in Columbia of the breast and lymph nodes (in the armpit area). It showed the lymph nodes were clear, but there was an additional suspicious spot in the breast that the ultrasound had not detected. Uggh. Another biopsy was done, and the needle insertion created a hematoma within hours.
That next day, as we drove to MUSC for the second opinion appointments, we got the call saying the pathology report said it was benign! Tod and I celebrated this news as we rode.
LYMPH NODE BIOPSY
Once we got to the appointments at MUSC, Dr. Abbott (the surgeon) said her team could not see the MRI imagery sent from Columbia of my armpit lymph nodes clearly, so they wanted to do their own imagery of the armpit area. Disappointed, I headed to the MUSC mammography/radiology floor that afternoon for another ultrasound.
My heart sank when the radiologist said I had “swollen” lymph nodes. What? I was told they were clear just the week before in Columbia! What a rollercoaster of emotions.
I told Dr. Abbott how discouraged I was with this news after getting a “clear” result the week before. She comforted me by saying the “swelling” could be from the hematoma I developed from the biopsy of the fibroid adenoma the day before. That made sense, and I believed from that point on that cancer had not spread to my lymph nodes.
Because the lymph nodes were “swollen,” the MUSC team wanted to dive deeper with a biopsy of one of the lymph nodes nearest the tumor.
I asked Dr. Abbott if we could wait to do the biopsy until the lymph nodes settled down, hoping that if another ultrasound showed no “swelling,” perhaps I would not need another biopsy. I really didn’t want another biopsy. All these needle insertions – if they go into a cancerous area – can disperse cancer cells to circulate and encourage metastasis.
She agreed to wait several weeks. So back we went back to Charleston a few weeks later for repeat ultrasound. While it revealed about half of the lymph nodes had gone back to normal size (Yay!), not all of them had reduced size - which meant I faced another biopsy. However, the fact that half had settled down confirmed to me that the inflammation was from the hematoma and there was no spread of cancer.
The needle biopsy could not be done the same day as the ultrasound, so we scheduled a third trip to MUSC. Then we waited for the third time to hear the results of a biopsy. With each of these procedures, there were continual tests of our faith. These interim times of waiting for test results have been just one of the many mentally and emotionally exhausting pieces of this journey.
METASTATIC CONCERNS
Waiting for this biopsy result was weighty. If the pathology report came back positive, that would change my diagnosis from Stage 2 to Stage 3 cancer, which obviously would have much more serious implications being in the lymphatic system.
Most days, my faith was strong as I clung to the scriptures. If I only needed a mustard seed of faith to believe that the lymph nodes were clear, I contended with God that I had that. While I was exercising my “mustard seed of faith,” sometimes fear and worry crept in. Typically, it would happen as I read things or someone would say something that invoked fear and anxiety. I kept going to the growing list of Scripture Statements and Prayers to stand on God’s Word instead of my feelings.
During the first month of my journey, two separate friends spoke the same words to me: “It is Finished.” I journaled these words and believed that because I got the same words just days apart from two different people, that it could be a message from God to encourage me. I chose to believe that “It is Finished” meant this cancer would not have a reoccurrence. It was finished. It helped build my faith as I prayed for complete healing.
As I would talk to God about the lymph nodes and the biopsy result we were waiting for, I heard the word “clear.” It comforted me to think that if I was hearing from God, that there would be no spreading of the cancer to other areas. “Nothing to see here!” I would claim over my armpit as I talked with God on daily walks in the woods.
What a relief it was the next week when the result of the lymph node biopsy came back as benign!
SURGERY-INDUCED METASTASIS
Taking those three weeks to let the “swollen” lymph nodes settle down before doing the biopsy gave me time to research surgery options and risks. I was surprised to learn that surgery can induce metastasis. This was a new concept to me.
This article and other information I gathered gave me such a great understanding and tips for pre-and post-operation to reduce the risk of metastasis.
I elected to have lumpectomy surgery instead of mastectomy. Everyone must make a choice they feel good about, and I felt better with a lumpectomy for two reasons. First, I had learned that you can remove the breast completely and still have a reoccurrence on the chest wall. So, to me, if there was still a risk of getting cancer on the chest wall, it was not worth having the entire breast removed.
Secondly, surgically, a lumpectomy was less trauma to the body than a mastectomy. Reading about how the body responds to surgery trauma was enlightening in relation to cancer. When an incision is made, the immune response of the body says, “Hey, here’s a big wound over here! All hands on deck!” The white blood cells and “natural killer cells” attend to the wounded area. Meanwhile, as the tumor is disturbed, Circulating Tumor Cells (CTC’s) are released into the bloodstream, and they are left defenseless because the body’s immune response is focused on the surgery site.
I deduced in my mind it made sense to minimize the trauma to my body, and a mastectomy would be more traumatic than a lumpectomy. With Dr. Abbott’s confidence to get clear margins, I felt that was the route that made most sense for me.
We scheduled lumpectomy surgery AND sentinel node dissection. The sentinel nodes are the 1-3 lymph nodes nearest to the tumor which “stand guard” at the gate before the other lymph nodes in the armpit area. They are believed to be the ones to which cancer would migrate first. The needle biopsy just determines if there is cancer in that section of the lymph node, an indicator of cancer activity or lack thereof. However, it is possible there is cancer in another part of that same lymph node, so common procedure is to remove one to three lymph nodes completely and do a pathology report.
I had mixed feelings about removing the sentinel node(s). It would cause more trauma to my body, increasing the immune response and the chances of CTC’s going unchecked. Additionally, there are potential complications, including lymphedema. And finally, I believed I was clear of disease in the node, so it seemed pointless to remove it in my mind and bring additional trauma and complications.
My childhood friend, Shari Trotter, and her husband Doug joined us in Charleston for the surgery. We enjoyed a nice meal out the night before.
I prayed for the Lord to show me if I should have a sentinel node removed, and I never heard anything definitive. Tod thought I should have it removed, so I decided to go ahead with the removal. I also agreed to have the benign fibroid removed.
The surgery was on Friday, July 7, 2023. It was my first surgery, so the effects of anesthesia were new to me. What a strange, awful feeling of being so groggy and foggy until it lifted the next afternoon. I was restricted in movement a bit at first, but not for long. Thankfully, Kristen (our youngest daughter) and Thomas (our grandson) came to stay and assist for the weekend.
PATHOLOGY RESULTS
We waited for the tumor and lymph node pathology reports. It was two long weeks before we heard the good news that Dr. Abbott removed the tumor with clear margins and the sentinel node was clear! We celebrated and thanked God for this report, as it was a confirmation that cancer had not spread to the most likely place.
This is the My Chart communication indicating the clear margins and benign sentinel node.
I did have some complications as a result of the lumpectomy and sentinel node removal. More on that later!
HIDDEN TREASURES
As I mentioned before, there are hidden treasures on the journey. Nobody wants to walk this path or any other hardship. Yet, I am grateful for the things I have experienced and learned. I realized HOPE was a hidden treasure - which is why I named the website Adele Hopes. It is critical to believe there are better days ahead, especially on the days when things are not looking up. It is critical to have encouragement. His Word, stories of people healing from cancer, and the words of friends and family all provide a lift. When I get discouraged, I pray for the Lord to do or show me something encouraging to give me hope. He has not disappointed.
I have hope for this life on earth, as well as eternal life. I believe I will see the goodness of the Lord in the land of the living! Psalm 27:13.
Cancer gets a lot of attention. But what I’m going through is nothing compared to what others are going through. Many people around me have had hardships and sickness that are much more intense and some for many years. I pray for these hidden treasures for all who are suffering.
But those who hope in the Lord
will renew their strength.
They will soar on wings like eagles;
they will run and not grow weary,
they will walk and not be faint.
Why, my soul, are you downcast?
Why so disturbed within me?
Put your hope in God,
for I will yet praise him,
my Savior and my God.
May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit.
We have this hope as an anchor for the soul, firm and secure. It enters the inner sanctuary behind the curtain, where our forerunner, Jesus, has entered on our behalf.
Hebrews 6:19-20a
HOPE. A PRICELESS TREASURE.