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 cancer treatment gets going, it's really pretty uneventful. Routine kicks in. A "new normal" in some ways. You adjust your mind and your body to what it needs, and you just keep moving forward. My fifth and sixth chemo infusions were just that: uneventful. I switched to a new drug (Taxol) which has less side effects, mostly notably no nausea or digestive discomfort. (Hooray!)
The only real side effect I experienced after these infusions was some muscle and bone pain for about 36 hours. It's uncomfortable, to be sure. The pain in my shins and my lower back felt like they're radiating from the inside out, and it comes in waves. One minute I could be sitting comfortably on the couch, and the next I'm wincing in pain. By the time anyone would notice the look on my face, the pain passes. Overall, this side effect = much more manageable than the previous AC chemo. Beggars can't be choosers.
My last chemo was scheduled for April 5, followed by a meeting with the surgeon to schedule my lumpectomy for sometime in early to mid-May. The hope was this: that the tumor is shrinking; that I'll only need the sentinel lymph nodes removed from under my left arm; that minimal radiation will follow in June and July; that by my birthday, this will all be behind me.
Breast cancer survivor.