Episode 18: Post-op

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Readers, I'm sure you've noticed that it's been a while since we've seen Jane. You may have asked me about her. In fact, the worldwide attention to her absence has been staggering.

We apologize for the break. Stuff was going on.

The good news is, Jane got through her surgery just fine! Dr. Smith removed her breast tumor and also did a sentinel lymph node biopsy. (See Episode 13 for more details about that procedure.) The tumor and the nodes were then sent down to the Pathology Department for analysis.

Speaking of the Pathology Department, have you guys noticed how common pathologists are on TV shows these days? It's getting to where you can't throw a microscope at a TV without hitting one! And a lot of them are very good-looking. Perhaps even excessively good-looking.

Not that I'm jealous, but where are the TV shows about hot doctor-cartoonists??

Anyway, between getting their microderm abrasions, what pathologists do is examine tissue. Extremely thin slices of the tumor and lymph nodes taken from Jane were placed under a microscope. Carefully, so as not to ruin their manicures, the pathologists looked at those slices. There were a few specific questions they were trying to answer.

One of those questions was: did Dr. Smith remove the whole tumor, or was a little left behind?

Surgeons, when they remove a tumor from a patient, generally try to excise (that's fancy for "remove") it with a rim of normal tissue around it. That way they can feel reasonably confident that they got the whole thing out. That rim of normal tissue is called the margin.

The bigger the margin, the more confident the surgeon will be that no cancer was left behind. When I first heard about this, that made no sense to me. After all, I thought, a margin was a margin. Whether it's one millimeter thick or two inches thick, as long as it's there, the tumor is fully removed.

It turns out I was wrong. Tumors aren't round spheres. They're funny-looking, oddly-shaped things, with tentacles that can stick out in all directions. Those tentacles can be microscopic, so that the surgeon can't see them when they're in the operating room. Even the beautiful pathologists can miss them. So to be as confident as possible that the whole tumor has been removed, even with its tentacles, surgeons aim to get a thick (or at least somewhat thick) margin.

The catch is, the margin is made of normal tissue. That tissue had some sort of job in the body. Removing it isn't exactly good for the patient. So surgeons are always trying to balance between the need to take a decent margin with the desire to remove as little normal tissue as possible. It's a tough balance.

Which margin is best??

Which margin is best??

Fortunately, the pathologists reported that Dr. Smith had removed Jane's tumor with a margin that, at it's closest point, was about 4 millimeters. That's a very respectable margin. Dr. Smith (and Jane) were both pleased.