Surgical Pathology Report

Pathology reports by their very appearance indicate supreme intelligence, which advances well beyond my comprehension.  I envision someone in a white lab coat wearing spectacles and a pocket protector, mumbling under his or her breath while slicing the “specimen.”  This person looks at the slices and makes a “gross” judgment based on what he or she can see from the naked eye, then adds this to the report.

From there the slices are transferred and evaluated under a microscope by another lab coat, confirming a diagnosis and noting any remaining “viable” (live) cancer cells.  The final report is written then signed off by another MD.  For this type of report, you want a pathologist who is very precise.  And precise it is.

The report is four pages long.  The first two pages provide the result of the microscopic analysis, and the last two pages contain the gross description.  It was helpful understanding which part meant what, and learning that what really matters is on page 2 – the Final diagnosis.  I read the entire report and tried to make sense of it.  The Physician Assistant explained it to me on Friday before I went into the hospital for the infection, but I wanted to also hear it from Dr. Rourke.

This was my post-op visit.  She had not taken any time off without being on-call 24/7 for the past two years, so this was an unusual week.  She apologized several times for not being there when I was admitted to the hospital, but of course I was fine with it.  In a way it was good she was out, because I got to know Dr. Gordley and see now that even though he didn’t do the surgery, he was still willing to cover for her and see me daily.  They make a great team.  I was not expecting her to tell me why she was out (we assumed vacation). However, she told us her mother-in-law is dying of cancer, and this was their trip to say “good-bye.”  I didn’t prod further, but assured her we would be praying for her family during these final days of her life.  By the expressions on her face, I am sure this is a difficult time for their family as she was very close to her mother-in law.

On to the report.  She said she never had anyone ask her about some of the detail I inquired after reading.  She was impressed.  She was also very impressed with the results.  It brought a huge smile to her face.  In fact, she was overjoyed and gave me a genuine, heartfelt hug before we parted ways.  So here it is, as best I can explain it, if you care to read all the medical mumbo-jumbo.  I’ll start with the two specifics for which I asked you to pray.

Answered Prayers.   The best news was discovered while I was in surgery, and confirmed in the report.  Dr. Rourke sent four sections of the skin to be tested where we thought there might be cancer invasion.  They were at 1 o’clock, 2 o’clock, 3 o’clock and 4 o’clock (you can envision this on your own).  All skin was benign with no tumor present.  I love this statement from the report: nipple and skin free of tumor.  Invasion of the skin creates many more complications, so this is such a blessing!  This relieved the ongoing fears of inflammatory breast cancer (although we are still waiting for the radiation specialists to make that final call).  If they had found cancer in the skin, the surgeon would have had to remove a bigger section, and this would have also meant involving the plastic surgeon to close me up.

The section removed had a 1+ cm margin on all sides where there was no cancer present, which is excellent.  This means she got it all!    No more surgery would be required to remove further cancerous cells!

Remember two prayers I requested just before surgery?  God answered both with a resounding “YES.”  She closed me up without assistance, and she got it all. Praise the Lord!  Again I say thank you for your continued prayers. “Keep on asking, and you will receive what you ask for” (Matthew 7:7 NLT).

The Final Report.  The Overall Grade is II (on a I-III scale).  This indicates the aggressive growth nature.  It was mid-grade, again better than a III.  The section (breast) she removed showed evidence of invasive ductal carcinoma, an estimated 9 cm tumor at its greatest dimension, containing an approximate viability of 10%.  This confirms the ultrasound measurement of a 9 cm tumor just before starting chemo.  It is extremely rare, if ever, to have no viability on the report.  To have 10% viability from a 9 cm tumor is much better than expected.  This means there were some remaining live cancer cells, but the chemo (and of course prayer) did an excellent job reducing the size to a near-nothing effect.

She also removed two clusters of lymph nodes.  The first cluster contained 16 nodes and the second, a little further up in the right axilla, contained two.  Neither of the two nodes from the second cluster contained any cancer.  Two of the 16 lymph nodes exhibiting micrometastases demonstrate extensive therapy-related change.  What this means is, there was still a residual amount of live cancer cells left in 2 out of 16 nodes, but the chemo did a significant job of reducing it in the lymph nodes.  (Micrometastases means the tumor cells are between 0.2 mm – 2.0 mm).  Size of largest deposit: 1.56 mm. That is very, very tiny.  NO nodes contained macrometastases (>2 mm).  This is again excellent news!  When I was diagnosed, I had macrometastases in several lymph nodes.

Some women have surgery and then chemo.  In my treatment regime, I had chemo then surgery.  In this case, I can see the results of the chemo.  So while it was a long wait until surgery I was grateful to see the outcome.  I shared with Dr. Rourke that a lot of people were praying for her as her hands were operating on me, and for me as well. I could see the emotion she was trying to withhold as she was leaving the room.  We have overcome a major hurdle in my battle against cancer.

The nurse removed one of my drain tubes and completed papers to return to work next week. As we left, my step was springier and I was standing taller than when we arrived.

Thanks for visiting, Cheryl!
We miss you already.

Up next:  We took our friend Cheryl to the airport after a fun time of fellowship in a Thai restaurant we discovered by accident.  Unfortunately our plans were interrupted by my unexpected hospital stay, but it was still very special to see her for a few days and enjoy her cooking and company.  Now we are looking forward to the next visitor(s) who will come to stay in our guest room.  We aren’t sure who that is yet but we look forward to it!

Physical Therapy.  One or two visits should be all I need.  The stitches try to pull my arm and shoulder down, and Dr. Rourke said I need to stretch to full extension.  The physical therapist will provide me with exercises, a special sleeve, and show me how to prevent lymphedema with massages (you can read more about lymphedema on this webmd page: http://www.webmd.com/breast-cancer/guide/side-effects-lymphedema).

I still have to undergo radiation therapy as well.  This treatment will start about a month after my body has time to heal.  I understand radiation will make the area so undesirable no cancerous cell would want to inhabit that place.  (Interesting word “want,” as cancer does not have a brain, but you get the drift.)  So basically it prevents recurrence.  A small price to pay in the long scheme of things.

À la prochaine (Until next time) …