Tag Archive | results

Good news!

I saw the breast surgeon (Dr. Engel) today, and there was good news. The latest breast MRI came back completely clear of cancer. My oncology team had a meeting this morning to talk about my case and they were all quite impressed with how well the cancer responded to treatment. Needless to say, I’m extremely excited!

Unfortunately, it doesn’t change the surgery I have planned. I still need a modified radical mastectomy. Because of the size of the initial tumor, Dr. Engel will remove all of the right breast tissue and most of the axillary lymph nodes. Since I had a biopsy that verified the cancer had spread to the axillary lymph nodes, he’ll take most of them out just to be safe. I just have to decide if I want to do reconstruction on the breast or not. I’m having a hard time making a decision on that. I will meet with the plastic surgeon to get some more details and maybe that will help.

Once surgery is done, the pathologist will look through the tissue for any evidence of the cancer. If I’m really lucky, and there’s no pathological evidence of the cancer, I won’t even have to do radiation! That would be pretty awesome, but I’m not counting on it. Just having it not show up on the MRI improves my long-term outlook, and makes me quite happy today.

Tests to clear up the previous tests

One more round of tests before the chemo starts. I needed an abdominal CT scan with contrast and a vaginal ultrasound to check on the abnormalities the PET scan found. I would also need a baseline MUGA test.

ba56The CT scan required a 6-hour fast, so I got up at 5:45 for a quick breakfast, and went back to bed. There was no way I’d make it to noon without some food in my stomach, and I really didn’t want to start my day that early. Turns out the fasting was to allow the barium contrast in my gastrointestinal tract to show up most strongly. I had to drink 900 mL of barium sulfate in about a half an hour. I got berry flavor, which wasn’t actually too bad. The worst was the slightly thick texture of the drink which made me gag occasionally, but I managed to get it all down. Once I finished the barium, it was time to get into the CT scanner – just another table that slides through a tube. I also needed IV iodine to add contrast to the blood vessels. Since I have a PowerPort, they actually got to use my port for the first time – yeah! Nurse said I had good blood return, so the port was working well. 153The iodine injection caused the weirdest sensations. It made the inside of my ears feel hot, and made me feel like I was peeing, although I wasn’t. It only lasted a minute or two, but it was quite odd. The CT scan was quiet, but I did have to hold my breath a couple of times. The nice thing was there was a counter on the machine that told me how many seconds longer I would have to hold my breath, so I wasn’t wondering how much longer every time.

Elements added: Barium and Iodine

The ultrasound to look at my ovaries was the easiest test yet, since there were no injections needed. I just had to drink a lot of water before getting there so I had a full bladder for the first half of the test. I did get to empty the bladder before the tech did the intravaginal part of the test. Once again, I got talking to the tech, and she showed me the ovaries and where the developing eggs were on the ovaries.

The final test of the week was a MUGA scan (or Multi-Gated Acquisition scan). Because my tumor is HER2 positive, Dr. Li is adding Herceptin to my drug regimen. One of the less common (2-4% chance) side effects in heart failure, which would definitely count as a bad thing. So, as a precaution, everyone on Herceptin has periodic tests of their heart to make sure it’s fine. There’s a lot of natural variation in heart efficiency, though, so you need a baseline test to compare with future tests.

A MUGA scan uses radionucleotides, specifically tc43technetium, attached to your red blood cells to get a picture of how efficiently your ventricles contract. Technetium will attach to different cells in your body, depending on what loading medication they give you. I got the loading medication (a sn50tin-based solution), and then sat in a waiting room while it moved throughout my bloodstream. After about 20 minutes, I got the technetium injection, and then moved to the machine to measure my heart function. There, I laid under a set of white plates for eight minutes and was done. Since I had been talking quite a bit with the tech (are you sensing a theme here?), he called me over and showed me the pictures the machine took. It was pretty awesome seeing the blood move through the heart, and the walls of the heart moving. The scan is set up to compare the ratio of the left ventricle at minimum and maximum contraction. Once again, I was radioactive for the day, and a bit longer than the PET scan since the technetium has a half-life of six hours.

Elements added: Technetium and Tin

CT results showed the mass on my kidney was a cyst (yeah – not renal cancer!) and there’s a cyst on the ovaries. Ultrasound was inconclusive – there’s a mass on an ovary, but it wasn’t clear with it is exactly (probably the cyst seen on the CT). MUGA showed good heart functions to start with. All set to start chemo now!

Meeting the oncologists

I finally got to meet the radiation oncologist, Dr. Figura, and the medical oncologist who is in charge of chemo, Dr. Li. My entire medical team had met that morning to talk about the results from all my tests and come up with a treatment plan. I will be getting chemo first in order to shrink the tumor to a size that is more easily operable, surgery, and then radiation treatment.

We met with Dr. Figura first, even though I’ll be under his care last. He talked a bit about how radiation therapy works. in my case, I’ll be getting 28-33 doses, five times a week until it’s done. The best thing was being able to see my PET scan. I love the digital imaging that doctor’s have access to these days. The PET imaged slices of my body, and you could see all the different parts – my favorite was the parts of the skull and the cross-section of my shoulder.

Dr. Li went over the results of my previous tests. The breast MRI showed no abnormalities in the left breast, and no chest wall or skin involvement on the right. Unequivocal good news! The PET scan, since it was a whole body scan, found a few abnormalities. Good news first – no involvement in the lungs, liver, or bones (the common places breast cancer spreads). They did find a dark spot on one of my kidneys. Since it’s dark, we know it’s not the breast cancer. It’s probably just a cyst, but it could theoretically be renal cancer, so I need a CT scan with contrast to check. Also, the ovaries showed some abnormalities, but it was unclear what’s going on (not enough intra-abdominal fat to resolve the image). So, I need an ultrasound to check that out. Also, I need a baseline MUGA test to check my heart functions. Off to schedule more tests!