Need someone to talk to

Hi Caramaya, 

Is there any way that you could get a second opinion from another surgeon? I don't want to add to your stress, but it does sound like one of those cases where it might help. It's your body and your health after all. Are the any other breast cancer doctors you could ask to speak to (maybe through your Macmillan nurse if you have one) on a day your surgeon isn't around so that it's more diplomatic? Failing that you could ask a second opinion elsewhere. At my hospital there are several surgeons who meet as a team with the other staff involved in a patient's care, and they are usually quite happy to let you speak to someone else in the team when they aren't there. My surgeon works in 2 NHS hospitals which are the same trust as well as sometimes a private hospital (as most do).and my oncologist is also working at 2 hospitals.

It's routine to run a heart scan before chemo, and it does sound like you wouldn't cope with it. I'm guessing that he wants to minimise your time in surgery because of you health, but it's standard practice to check the nodes. Did they scan them? Usually if they are apparently clear (20% of those which look clear aren't) then they remove the sentinel nodes. If there are more involved or the nodes already are positive then they will do a clearance, My nodes looked clear but one wasn't so I'm now having that operation in a couple of weeks which will take another 2 1/2 hours approx.

I'm guessing it's an ER + cancer, but is it also HER+, and what size is it?

Everyone told me that the waiting for test results and treatment to start is the worst part, and it really is!

Margaret xxx

Hi Caramaya,

There are at least a couple of tests I'm aware of that can be performed to see if the cancer is present in the lymph nodes - ultrasound and needle biopsy. I'm uncertain at what point in the tumour's growth they would be picked up by either test but it seems the biopsy would be relatively straightforward for indicating if the disease had spread to a lymph node(s) most local to the tumour.  So it might be worth asking if a lymph node needle biopsy is possible to see if there's any obvious spread?

That said, it may be they've already biopsied the tumor, found it's a grade 1 (slow growing, slow spreading) and therefore doesn't need chemotherapy? Without more information about the tumour's specifics it's purely guesswork on my part, I'm afraid. That, coupled with your existing medical conditions, makes it very difficult to advise what the best way forward would be. However, I imagine the type of surgery has been decided on balance with your medical conditions. After all, the longer the surgery, the greater the risk, no matter how slight that is and that, in turn, must be balanced against the type and size of tumour, where it's situated and so on. Similarly, the surgeon would have consulted with his colleagues as part of a multi-disciplinary team and won't be making these decisions in a vacuum.

Before you seek a second opinion, potentially delaying your treatment, it may be worth speaking to the consultant or the breast care nurse again (a different one, if the ones you've spoken to seem off) to establish exactly what grade the cancer is and the process and formula used to reach the treatment decision they have.

I think it's safe to say the treatment team will be acting in your best interests and the decision they've reached will be based on relatively rigorous scientific logic. Having a greater understanding of how and why they've reached the conclusions they have may help ease your mind somewhat.

I hope this helps in some small way.

Dom.

Hi have you phoned the Macmillan nurses they are very good and will listen and answer all your questions