The previous post covers the lymph system, but I think I am getting closer to understanding why they keep wanting to remove parts of me. When it still feels like this is a pretty small tumor. 


Micrometastases are areas of cancer spread (metastases) that are too small to see. If there are individual cells, or even small areas of growing cells elsewhere in the body, no scan is detailed enough to show them.

For a few types of cancer, blood tests can detect certain proteins released by the cancer cells. These may give a sign that there are metastases too small to show up on a scan. But for most cancers, there is no blood test that can say whether a cancer has spread or not.

For most cancers the doctor can only say whether it is likely or not that a patient has micrometastases. This 'best guess' may be based on the following factors.

  • Previous experience of many other patients treated in the same way. Doctors naturally collect and publish this information to help each other.
  • Whether cancer cells are found in the blood vessels in the tumour removed during surgery. If they are found then cancer cells are more likely to have reached the bloodstream and spread to somewhere else in the body.
  • The grade of the cancer - the higher the grade, the more aggressive the cancer and the more likely that cells have spread.
  • Whether lymph nodes removed during an operation contained cancer cells (for example in breast cancer or bowel cancer). If the lymph nodes contained cancer cells this shows that cancer cells have broken away from the original cancer. But there is no way of knowing whether they have spread to any other areas of the body.

This information is important. If the doctor thinks it is likely that there are micrometastases, they may offer further treatment such as chemotherapyradiotherapybiological therapy or hormone therapy. Treatment after surgery is called 'adjuvant treatment'. The aim is to kill the areas of cancer cells before they grow big enough to be seen on a scan.

Some doctors call this 'belt and braces' treatment. In other words, the treatment is to try to make sure the cancer does not come back. But no one can know for sure if all the cancer cells have been destroyed when someone has finished treatment. It is this uncertainty that can make cancer difficult to cope with for many people, even if they seem to have been successfully treated.

This is copied directly from: 

Clearer now?

It is to me at least. It's all about working out if the surgical solution will be enough. I suppose the worst case will be that after surgery they decide they still want to do the chemo/rad, but there is a good chance the surgeries will be enough. 

The only other thing I'm not clear on is that I believe the section of tumor taken during the cone biopsy already indicated that my tumor has passed through a blood vessel. Maybe there were no cells in the blood? I'm not sure - and I suspect seeing the report wouldn't help me. But the fact that they are still giving me the surgery must mean it wasn't too bad. 

FYI: The first place cancer in the blood gets too is the heart and lungs, as all blood goes directly back to the heart and into the lungs to be re-oxygenated once it leaves cells. So the micrometastases will most likely appear in the first place they can find somewhere to catch onto. That's why the chest CAT scan is the first test they do.  

On a more personal note:

I'm pretty calm about the surgery tomorrow. I'm as ready as I can be, the only big problem is that it is so early! We will have to leave the house about 6.30, and there are a few things I have to do in advance, so I will be up around 5. At least I can watch the superbowl! May need to learn some of the rules though.

I've gone shopping and bought some proper granny style nighties, as otherwise I will end up in hospital gowns all the time. I don't fully feel like I have all the information I would like though. But I'll bring a few questions written down with me, and get some answers. It surprisingly hard to speak to the actual surgeon, and I still get a feeling they are not properly talking to each other about various test results. I'll make sure I know what I want to tomorrow, and will update when I get home.