MINDF*CK

I saw my oncologist today for routine follow-up and she said she would like me to consult with a radiation oncologist to discuss some findings on my final pathology report. Apparently, the final report indicates the breast tissue removed during my mastectomy showed evidence of possible lymphovascular invasion (LVI) ... my tumor had characteristics of cells trying to escape through the small blood vessels in the breast tissue.

My breast surgeon was very reassuring about this when I saw him a couple weeks ago, stating that he got clear margins and my sentinel node tested negative. Under the normal protocols, he said I shouldn't be a candidate for radiation because the two tumors I had side by side were less than 5 cm and I didn't have lymphnode involvement (although only the one sentinel node was taken). Usually, you need more than 4 positive lymphnodes to warrant radiation therapy. Nevertheless, he still urged me to discuss the LVI in the pathology report with my medical oncologist to be sure.

My onc today said that's it's true I don't fall within the normal guidelines for radiation, but they just don't know enough to say what to do for LVI ... in fact, there is no protocol ... but I'm "young," yadda, yadda, yadda. She said I could still have LVI without ever having positive lymphnodes. So obviously, if I want to do EVERYTHING to be aggressive, I guess I should entertain radiation ... even though I had a mastectomy, I did chemo, I am doing biologic therapy (Herceptin), and I am doing hormonal therapy (Tamoxifen).

But if I have LVI, how is radiation (regional therapy to the breast area) going to help microscopic cancer cells that may have already escaped through the blood vessels to distant areas outside the breast (like to the lungs, liver, bones, or the brain)?? Isn't this what chemo, Herceptin, and Tamoxifen (systemic therapy methods) are for?? Isn't radiation only intended to stop cancer cells in their tracks if there are any left behind in the breast? I just wonder what the percentage benefit would actually be if most of my breast tissue is already gone. Risk vs. benefit ... how did my life come down to this?

Maybe I'm just in denial, being naive, vain, reckless ... fill in the blanks ... but my honest feelings (today) are that I don't want to mess with my present recon. (Radiation will likely damage/tighten the remaining muscle and tissue in my breast, thereby possibly impeding a good result for implants.) One of the upsides to me about opting for the mastectomy ... if you can believe there IS an upside ... is that I was going to be able to avoid radiation -- something the oncology protocols would have MANDATED if I had only had a lumpectomy.

I just got the good news that my exchange surgery for implants is scheduled for Thanksgiving time and I was feeling soooo good about that. Now I feel like the rug is being pulled from under me again. This whole emotional rollercoaster is really too much at times. It all feels like such a crap shoot because of this beast's unpredictable nature. Breast cancer is predictably unpredictable. I just wish someone could look in their crystal ball and tell me what's the right thing to do, promising me I will never, ever have to worry about cancer again. I'm so tired of this ... really, really tired.

(Now here come the tears.) (:-(