The synovial sarcoma surgery was on a 22 year old female who originally presented to her primary care physician with a complaint of pain behind her right knee. When her doctor palpated the popliteal fossa (are behind the knee) he felt a suspicious lump. She received some imaging studies and it was determined that the suspicious mass needed to be biopsied. She was referred to the surgery oncology team and they performed a fine need aspiration and confirmed the diagnosis of sarcoma. She began a course of 8 weeks of focused radiation to shrink the large mass. She just finished the radiation therapy 1 week ago and the mass had shrunk. Yesterday we removed the mass.
It was a difficult surgery as the tumor was tangled in vessels and nerves. It was tedious to remove the tumor while trying to preserve the nerves that had been enveloped in the tumor. A potential complication of this kind of surgery is nerve damage that leave the patient with paralysis of her foot and or leg. There was no way to preserve every nerve but we were to keep all the major branches. After the surgery and again today we were able to confirm that here motor and sensory abilities were spared in the surgery. We did have to cut a few small branches of some nerves but it appears that by sparing the major branches she was able to maintain normal function. You never know for sure how much function will be maintained or lost during the surgery so we were pleased with the initial results. We were able to remove all of the tumor so this procedure is considered a surgical cure. However this cancer does have a high rate of reoccurrence and given that she is so young there is a high likelihood that the cancer will come back. If or when it comes back it usually is much worse the second time and often fatal.
Tomorrow I will be in on 4 mastectomy cases. Today we had breast clinic all day. I saw about 25 + patients who were suspected to have breast cancer or in various stages of treatment for their breast cancer. I had to be the bearer of bad news to 5 different patients today and tell them that they had cancer or that their cancer had returned. This is a difficult task and there is lots of tears and questions as the patients life is derailed. It is a surreal experience to be sharing in that experience (in a detached way) with the patient and their family. I also had the opportunity to tell several patients that they did not have cancer and I was able to celebrate with them as gave them the good news. It is strange to leave one patient sobbing and scared for their life to go to another patient who is so elated by good news that all they can do is cry for joy and hug you.
The good thing about this rotation is that by the end of it I will have performed enough breast exams and felt enough breast tumors that I should have no problem identifying abnormalities in my future patients. This is where you get literal hands on experience that is so much more valuable than reading about it in a book. This is where most students perfect their breast exam skills. Even after one day of clinic I already feel much more adept at performing breast exams. I hope this is not considered petting.
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