Last week I had an MRI to assess the tumor and lymph nodes post-chemo/pre-surgery. I spoke with my surgeon this morning, and the results are GOOD!
She said comparing my initial MRI with this one is "actually quite shocking" and that "the tumor shrunk up beautifully." On the initial MRI, the mass measured 3.2 x 2.6 x 2.6cm and now it is described as a "non mass enhancement" that measures 1.9 x 0.9 x 2.0cm. I like those numbers!
The best part is that the initial MRI also showed a swollen lymph node 2.7 x 2.0 x 1.7cm which was biopsied and found cancerous, plus two other small lymph nodes that appeared abnormal. These lymph nodes are no longer visible on the MRI, which means the chemo did exactly what we hoped it would!
We'll move ahead with a lumpectomy and sentinel node dissection on May 10th, and the hope based on this MRI is that the lymph nodes they remove will not have any microscopic cancer cells left. If they do, more lymph nodes will be removed, but the MRI gives me hope that I won't need any further surgery. Celebrating small victories!
This part of my story is a big one, friends! On April 5, 2019 I received my LAST round of chemo and got to ring the bell in the cancer center. I thought ringing the bell was kind of cheesy and silly... until I did it. And all the nurses cheered. And I got a little choked up and teary eyed. This didn't mark the end of my treatment, but any means. Surgery and radiation would continue into July and hormone therapy for the next 5+ years. But finishing this big, scary milestone of treatment which had affected by entire body systematically feels pretty. darn. awesome.
Chris was able to take the day off and come with me, which I was VERY grateful for as it was the longest day of treatment thus far. It was the first time I had a big gap between seeing the oncologist and starting chemo, so we celebrated the milestone by walking to a local bagel shop for lunch. Thankfully, my veins were cooperative for the IV (8 rounds of chemo with no port!! A big deal!) However, I had a reaction to the Taxol chemo which slowed things down. Many people have allergic reactions to Taxol, and I had a minor one with the 2nd round exhibiting as back pain. Since then, each time they taper my dosage, starting very low and increasing the dosage after 5 minutes, then again, then again. Yesterday, the nurse misread my chart and gave me the full dose right off the back. After just a couple minutes, I had sudden chest tightness, shortness of breath, and overheating with flushing. It was terrifying! I thought I might be having a heart attack or something crazy.
They immediately stopped the infusion and rushed to check all my vitals. So many nurses all of a sudden! To be safe, they gave me a half hour to calm down, and then started the infusion again, tapering it slowly like they should have initially. Thankfully, the rest of the treatment was uneventful. But it extended my 3 hour infusion to 4 (after the 3 hours of waiting between my oncology appointment and the infusion.) Long. day. With a broken TV in my infusion room. So glad to be done with all that.
So what's next?
Over the next few weeks I would have another breast MRI to reassess the size of the remaining tumor (which physical exams suggest is substantially reduced) and to assess the lymph node involvement (I had one previously confirmed by biopsy and two additional abnormal spots on MRI). Aside from shrinking the tumor, the primary goal with chemo has been to get the cancer out of the lymph nodes so I need less nodes removed. There's no way to know for sure until surgery if any are still cancer positive, but the MRI may give a hint.
I also scheduled pre-surgery bloodwork, an EKG to check my heart health, and SAVI seed placement. The SAVI seed is a tiny radioactive marker to be placed with ultrasound guided injection about a week before surgery. This helps the surgeon locate the tumor and potentially involved lymph nodes using a wand outside the body so she can make the incisions in the best possible places and easily find remove the correct tissue. (Yay science! What an awesome invention.) The tumor and lymph node were also marked with metal clips during my biospies, for the surgeon to see once surgery begins.
My surgery was scheduled for Friday, May 10 with a lumpectomy and sentinel lymph node dissection. Once I'm asleep, they will make the incisions and then inject a blue dye and radioactive tracer into the tumor to follow the lymphatic pathways. Using these tracers, the surgeon will remove the first 3 lymph nodes connecting the breast tissue to the rest of my lymph nodes. By removing these, we cut off the pathway for any cancer to travel from that breast to the rest of my body. If the previously biopsied lymph node is not one of these 3, she will remove that also. They will be immediately sent to pathology while the surgeon continues with my lumpectomy, removing the tumor and surrounding tissue to ensure "clean margins" (i.e. no more cancer!) If pathology finds any remaining active cancer cells in the removed lymph nodes, the surgeon will proceed with an axillary node dissection, meaning she'll remove all the lymph nodes from my armpit, ensuring that there is no possibility of remaining cancer cells that could spread. I'm super grateful that pathology can do this assessment on the spot, as it makes it far less likely they would need to go back in for a second surgery to remove more tissue.
We're praying that I don't need more than a handful of lymph nodes removed, as taking them all increases my risk of swelling and/or numbness in that arm and for future injuries, even simple cuts, in that arm or hand to become infected. But whatever we need to do to get rid of the cancer, we'll do. If we are able to go for the more conservative surgery, I'll come home the same day. If I need the full axillary node dissection, I will have a drain installed and will need to stay at the hospital overnight.
About 4 weeks after surgery, I will begin radiation. This could last 3-6 weeks, and I won't know until after surgery. The more lymph nodes involved, the more radiation I will receive.
I'm about halfway through my active treatment, and ready to move onto this next phase. Especially since surgery is what will be curative. So even though treatment won't be over yet, I will technically be CANCER FREE! Soon!
Once I settled on Penn Medicine for my treatment... it was time for more testing. Throughout November, I had a whole body bone scan, CT scan of the chest, pelvis, and abdomen, and a breast MRI. For someone who has never had a serious illness or injury, this was a lot. Not to mention that I continued to teach a full load of college courses, edit a literary magazine, and co-direct a dance company at the same time.
The bone scan process was actually pretty cool. Even though I've always been a creative person leaning toward writing and the arts, some aspects of science have always fascinated me. Maybe it's because my older sister studied biology. I have vivid memories from childhood when a crow was leaving its prey in our bird bath to soak and my sister took the opportunity to point out to me the specific body parts of the poor, dead bird: the stomach, the intestines, the heart. Having never personally experienced so much as an x-ray, seeing a live scan of my entire skeleton on the screen beside me was, admittedly, awesome.
The bone scan began with a nuclear injection. A nurse took me to a room with a radioactive warning, asked me a series of check in questions, and gave me a quick, painless shot. Then, I waited. For four hours. Rather than driving home, my husband came with me and we sat in the lounge down the hall watching episodes of Grey's Anatomy on my iPad. Once the radioactive material had adequate time to spread, I went in for the scan. I laid on my back on the table and the tech lowered a large, flat, square panel with the camera over my head. The sensors kept the camera an appropriate distance from my body as it passed very slowly from my head to my feet. This process took about an hour.
Sounds boring, I know, but once the camera passed my face I was able to turn my head and watch on the monitor as the machine scanned my body, outlining every bone.
The next week, I went in for my CT scans--not my favorite test. Sitting in the waiting room, I had to drink two large containers of mochaccino to prepare for the scan. No amount of mocha flavoring can hide the thick, chalky consistency of the pre-scan beverage.
The actual scan was easy enough. They started an IV for contrast, and I laid on my back again while a donut shaped camera passed over me, scanning my chest, abdomen, and pelvis.
And the next day, one final test--a breast MRI. My least favorite. The MRI machines are located in the basement of a brick building, down the freight elevator and through the concrete hallways. After check-in and changing into my ever-so-stylish hospital gown, a nurse led me to a room that could accommodate a variety of patients and put me in the blood draw chair to start my IV.
Have I mentioned that I've hated needles all my life? When I was five, apparently I ran down the hallway from the pediatrician because I didn't want a shot. So suddenly needing IVs left and right seemed less than ideal. And this IV? Hurt. The nurse inserted the IV in the crook of my elbow (why, why would anyone choose the crook of your elbow?) and even though she told me I could move my arm freely, it hurt least to keep it out straight.
In the MRI room, she pulled over a step stool for me to climb up onto the machine. For a breast MRI, you lay on your belly so that your breasts hang down freely for imaging. As you can imagine, this is not terribly comfortable.
I stepped up and knelt on the padded platform, then lowered myself into position with my breasts dangling through the two holes. A plastic divider dug into my breastbone. My face rested in a horseshoe shaped cushion like at a massage parlor, but there was no masseuse coming. My arms were raised over my head, Superman-style, at which point the nurse hooked my IV up to contrast dye, tugging and pulling in the process. More hurting.
With giant headphones over my ears, they moved me into the machine and the MRI began. If you've never had an MRI, go to YouTube and search for MRI sounds. They're obnoxious and loud and anxiety inducing. The headphones played music, and they even let me select the Pandora station, but the machine drowned out the calming Sarah McLachlan music I selected. I tried to just keep breathing, but you also have to lie very still for an MRI, and this meant breathing through my belly, not my chest, in order to keep my breasts as still as possible. After awhile, I realized I was holding tension everywhere.
Before I could spiral into panic, the sounds paused and the tech spoke in my headphones:
Ok, Katherine, we're going to insert the contrast dye now. You're almost done.
As the dye went in, I actually felt the cold sensation in my arm, then my neck, and moving slowly down my body. They say sometimes you feel like you peed yourself. It's true. Only cold.
45 minutes later, I'd made it. The testing was over. Another milestone completed.
The best part? All tests showed no signs of metastatic disease, meaning the cancer is localized and has not spread beyond my breast and underarm lymph nodes. With this confirmed, it's full speed ahead to chemo, surgery, and radiation.
Breast cancer survivor.