Cancer Journey Update: Round #4 Down, But the Road Ahead Is Still Long

Yesterday marked the completion of chemotherapy round #4—a day that started bright and early at 7am with blood work, a check-in with my oncologist, and finally, infusion time. Afterward, I met with my breast surgeon, Dr. Keto, to discuss the next phase: surgery and what comes after.

It’s a lot to take in.

Dr. Keto recommended removing all the skin below my nipple to ensure every last bit of cancer is gone. This means I’ll be flat on my left side for at least six months. If I choose to pursue reconstruction, that surgery would happen at the University of Michigan. Right now, I’m still on the fence about that decision.

If I opt for surgery on just the left side, the procedure will last about 3–5 hours. However, if I decide to remove the implant on the right side as well, the surgery time will double. I haven’t made a final decision yet—there are pros and cons to both, and it’s not a choice I’m taking lightly.

I did ask about the possibility of a lumpectomy, but unfortunately, that’s not a viable option. Dr. Keto explained that she couldn’t guarantee complete removal of the cancer. There’s also a high risk of damaging the existing implant or the tissue behind it that protects my rib cage. If the cancer were to return, it would most likely come back as stage 4 and be even harder to treat.

So, a more aggressive surgery is the safest path forward—even though it’s not the one I hoped for.

As for chemo, my last full round of chemo is scheduled for July 8th—which feels like a light at the end of a very long tunnel. But that light dimmed a little yesterday when I learned that I’ll need to continue HER2-targeted infusions every three weeks for a full year. Each session will take about two hours.

This was news I wasn’t expecting, and honestly, it was pretty disheartening. I had hoped that 2026 would be my fresh start—no more cancer, no more treatments, maybe even no more port. But now, it looks like this journey will extend further than I had imagined.

During surgery, Dr. Keto will attempt a Sentinel Lymph Node Biopsy (SLNB), which involves injecting dye near the nipple to identify which lymph nodes cancer would reach first if it spread. This test usually removes 1–4 lymph nodes and has a low risk of lymphedema (less than 2%).

Sentinel Node Biopsy

However, because I’ve already had a mastectomy, there’s a chance this test could fail. If that happens, the next step is an Axillary Lymph Node Dissection (ALND)—a more invasive procedure where 10–30+ lymph nodes are removed from under the arm and muscle. This surgery carries a 20–30% risk of lymphedema, which is a chronic swelling caused by lymph fluid buildup due to a compromised lymphatic system. It often requires ongoing management and weeks of physical therapy to regain strength and mobility.

Axillary Lymph Node Dissection
What is Lymphedema?

Lymphedema is a condition that causes swelling, most commonly in the arm or leg, due to a build-up of lymph fluid. It happens when the lymphatic system — which helps fight infection and drain excess fluid from tissues — becomes damaged or blocked.

In breast cancer patients, lymphedema can develop after surgery (especially lymph node removal) or radiation therapy. When lymph nodes are removed, the body may have a harder time circulating lymph fluid in that area, which causes swelling and discomfort.

Symptoms of Lymphedema:

  • Swelling in the arm, hand, breast, or chest area

  • A feeling of heaviness or tightness

  • Reduced range of motion

  • Aching or discomfort

  • Hardening or thickening of the skin (fibrosis)

  • Recurrent infections in the affected area

Treatment for Lymphedema:

While there’s currently no cure for lymphedema, it can be managed effectively with the right care and therapies. Treatment aims to reduce swelling, improve lymph flow, and maintain limb function.

Here are common approaches:

1. Manual Lymphatic Drainage (MLD):

A specialized type of gentle massage that encourages lymph fluid to flow around blocked areas and drain properly. It’s often performed by a trained lymphedema therapist.

2. Compression Therapy:

Wearing compression sleeves or garments helps prevent fluid build-up by applying consistent pressure. These are often custom-fitted.

3. Exercise and Movement:

Gentle, regular movement — especially range-of-motion and strength exercises — encourages lymph flow and reduces stiffness. A physical therapist can guide you through a personalized program.

4. Skin Care:

Keeping the skin clean and moisturized helps prevent infections like cellulitis, which can make lymphedema worse.

5. Pneumatic Compression Devices:

These are at-home machines with sleeves that inflate and deflate to promote fluid movement. They’re often used in more moderate to severe cases.

6. Surgery (in some cases):

For chronic or severe lymphedema, there are surgical options like lymph node transfer or lymphaticovenular anastomosis. These are typically considered after all conservative treatments have been tried.

Lymphedema Support

If you are at risk or already dealing with lymphedema, connecting with a certified lymphedema therapist (CLT) can be extremely helpful. They can evaluate your condition and develop a treatment plan tailored to your needs.

So, needless to say, I’m feeling pretty defeated right now.

I’ve tried to stay hopeful and focused, but this journey is long, hard, and full of unexpected turns. I was so looking forward to having this chapter closed—or at least mostly behind me—by the end of the year. Instead, it feels like I’m still deep in the middle of it.

But I’m reminding myself: I’ve made it this far. One round at a time. One decision at a time. One day at a time.

If you’ve been following my journey—thank you. Your support, prayers, and kind words help more than I can say. I’m not done yet, but I’m still fighting.

Also, if you’d like to follow my journey, join my private Facebook Group.

—Dani

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