Scan Results

This is going to be a short one, because really there isn't that much to say.  I had all of those scans done about a week ago.  Amanda, Dr. T's nurse called late last Monday night to tell me . . . . .

ALL SCANS ARE NORMAL!!!!!!!!!!!

 

 

 

 

 

 

We now assume that all the cancer is gone and the chemo and radiation are preventative to get rid of any floaters out there.  Praise God, praise medicine, praise my husband, praise my son; I needed this boost of positive information to keep going. 

 



A Day of Tests

My Friday started out bright and early.  Really bright and early for me these days is anything before 10:00am.  I'm still pretty stiff from surgery that getting up and moving takes a while.  The tissue expanders feel really heavy so after laying down for 8 hours, I feel like I've had an elephant  sitting on my chest all night.  My range of motion is improving, but it takes a while to get limber. 

Sam and I had to go to chemo class.  We got a tour of the clinic and treatment rooms and then had to watch a video of the side effects of chemo.  The video was long and boring.  I get why they do it, but with this cancer stuff people seem to repeat and repeat and repeat information.  Sam was pretty impressed with the infusion room.  There is wi-fi, tv, coffee, tea, snacks and massage chairs.  He silently tapped me on the shoulder and asked if he could come to chemo with me every time.  They really do like you to feel at home. 

(image: Google images)

 

I had to wait after the class to get a few labs drawn for the clinical trial and Sam had to get off to work.  I was on my own for the day.  There was really no sense in having Sam wait in waiting rooms all day.  After a quick blood draw I was on my way across the street to the hospital. 

 

I was signed up for a PET scan, CT scan, EKG, and echo.  I headed to the PET scan first.  I really don't feel like I was given enough information about this scan.  It was nice to see a familiar face though.  The gentleman that checked me in was the same person who admitted me on the day of surgery and the rad tech who assisted on my injection prior to surgery was the same person .  Susie the rad tech took me back to get changed into some killer PJ pants.   

(image: be jealous)

 

Ok, ignore my post partum body, but who wouldn't want to document this.  I was taken back to a holding room where Susie started an IV.  Luckily we could leave this IV in all day for my other tests as well.  Susie then brought in the radioactive injection.  She was dressed in hazmat gear, carrying a lead lined box, and a syringe inside a tungsten cover.  Crap--what are they injecting into my vein.  

 

Then I had to sit . . . for 50 minutes.  Yes, you read that correctly, 5-0 minutes.  All that was in my holding room was trashy magazines.  Not bad you think, no? Oh no, these were from June of 2012.  Nearly 1 year ago.  But, the time passed quickly and before  I knew it Susie was back to get me and take to me to the scanner. 

 

The scan itself only lasted about 20 minutes.  The tube was small enough for my claustrophobia, but big enough I didn't have a complete freak out moment.  I made it through test number 1.  Susie, then took me down the hall for my head CT. I was quickly taken back.  I didn't realize how quickly a CT is done.  Not even 5 minutes and the first part was done.  The tech then came in and put the contrast through my IV.  She warned me it would make me hot all over and then make me feel like I was going to pee my pants.  I thought, oh sure, we'll see.  We were having a conversation because we had to wait about 10 minutes for the contrast to absorb in.  All of a sudden, I felt this overwhelming hot feeling and a sudden urge that I had just wet my pants.  Don't worry, I didn't pee myself.  The sensation went away as quickly as it had come on and the tech started the scan again.  About 5 minutes later and I was done with test number 2.

 

Then on to the heart hospital for the remainder of my tests.  The heart hospital is attached, but is a much newer building.  Most was endowed by the Pohlad family who I'm quickly learning is the Trump of Minneapolis.  I was quite early for this appointment so I had to wait quite a while.  Finding humor in the situation, there was a lady in the waiting room sleeping.  Apparently she was very tired. 

 

 

This is the humorous part--her shirt said "No Sleep Til BKLN".  Hey lady, you're only in Minneapolis; WAKE UP!! 

 

I called back for my echo shortly after this photo--and laughing to myself.  The echo was really neat.  I got to see the blood flow and the valves working as the heart pumped.  The EKG lady came right into the room to finish things up.  I think it took her longer to put the leads on than it took to do the test. 

 

I was finally done.  6 hours later.  I was so tired, but Sam and I had a date that night so I hurried to get Camden and head home. 

 

 

Clinical Trials

My oncologist called late last week to talk about a current Phase III clinical trial.  This trial is for a specific subset of breast cancer patients.  When I received my biopsy results, as well as the surgery pathology, it was determined I was HER2 negative.  HER2 is a protein that attaches to the cancer cell and becomes part of the fuel for the cancer.  This is considered to be a very aggressive type of cancer as this type typically grows very quickly because of the protein. 

In all actuality my cancer is not a true HER2 negative, but rather a HER2 low.  There isn't enough of the protein to consider it positive.  The clinical trial the office called about is investigating whether or not HER2 low patients would benefit from the standard of care given to HER2 positive patients.  There have been studies in England and Europe that have proven HER2 low patients to benefit from receiving the medicine Herceptin as part of their protocol.  It cuts the recurrence rates in half. 

It is a 50% chance I will be randomized into the group who receives the medicine.  If not I will be in the control group for the study.  The study will follow my treatment for 10 years.  If the study reaches a Phase IV and eventually FDA approved then I would be one of the first people to receive this new protocol. 

I have signed my consents to be a part of the study and now wait for randomization.  I hope I get the Herceptin, but if not I know that I will be furthering the knowledge of breast cancer.  And specifically breast cancer for women under 30.  There aren't a lot of statistics or studies done on my group of women, but in my opinion we are the ones who need it.  We have too many years to live and more research should be done on how to minimize recurrence and metastasizing cancers.  This is just one way I will give back to the women who will follow me on this never ending bumpy path.   

What Are We Waiting For

In order to make sure we know EXACTLY what we are dealing with I need to have a few scans before I can start treatment.  Dr. T suggested I have a PET scan, head MRI, and EKG before I begin my chemo.  I also have to go to chemo class. 

The PET scan is a scan to show the function of my organs.  This is a full body scan, to my knowledge, and will pick up on any additional tumors in my body.  They use a contrast dye to illuminate anything out of the ordinary.  This scan terrifies me.  Not so much the scan, but what the results might show.  I don't want there to be any other cancer in my body. 

(image: drugline.org)

 

(image: http://mediumtimes.blogspot.com/2010/11/scan-results.html)

The brain MRI was suggested, but because the tissue expanders have metal in them and an MRI is magnetic I get to do a CT scan instead.  This is great.  Much bigger tube and no Jason hockey mask covering my claustrophobic face.  This is to make sure the cancer isn't in my brain.  Again, scary. 

(image: http://happyhippierose.com/2012/02/10/how-a-ct-scan-near-bout-killed-me-seriously/)

 

Last I have to get an EKG or ECG (same thing).  This is just a fast little test to show that my heart is healthy because the AC chemo can cause heart failure in patients who may have an underlying heart condition.  

 

Sam and I will also attend a chemo class together.  I'm not really sure what to expect here.  It's given by one of the oncology nurses and I guess she just talks about what will happen during treatment and what I need to do before and after to insure that I feel the best I can.  

 

I should be calling the wig shop or writing thank you notes, but instead I sit here blogging and feeling a bit sorry for myself.  Today is my first day alone alone.  I guess I'm just in one of those valleys that people talk about when they mention peaks and valleys.  I'll get out of it and tomorrow will be a better day.   



MRI--Claustrophobia's Worst Nightmare

As part of the additional screening to see what the cancer is doing, Dr. DJ ordered a breast MRI.  She would be looking at both breasts to make sure there was no sign of additional cancer and no cancer on the left side.  This would also give her a better picture of where exactly the tumor was sitting or touching.

Cue my overwhelming fear of small spaces.  I have had an MRI before in high school for my shoulder.  Even on Valium I proceeded to pound on the inside of the tube and yell, "GET ME OUT OF HERE!!!"  Klassy, Nicole, real Klassy (yep with a K). 

Megan my awesome CCC scheduled everything for me and she told me if I ever needed anything to call.  Since I do a very similar job to hers I didn't want to be "that patient", but I couldn't help myself.  I called Megan and left her a very awkwardly insane sane message. 

"Hi Megan, it's Nicole.  So, I was thinking of this MRI you are having me do.  About that, I'm really claustrophobic so I was wondering if you could maybe prescribed me something for my anxiety.  Or better yet, I know MRIs are for soft tissue, which is what my breasts are made of, but do you think Dr. DJ could get the same information from a CT scan since the tube is bigger.  Or could you ask Dr. DJ if this is *really* necessary?  Let me know what you think."

Yep completely sane. 

Megan called me back and assured me that this was the best diagnostic tool for me and I would be ok.  She would prescribed me Valium in case I needed it and it was waiting for me right outside the door of where we met with genetics. 

On my way to work I text my PA L to remind her I would be late.  I also told her if she heard any screaming coming from the imaging center that it was me and to please come save me.  No joke, again completely sane. 

I showed up to my appointment nervous as all heck.  I was texting one of my nestie besties (from thenest.com my group of ladies).  She is amazing.  We have been through getting pregnant and child birth and breastfeeding together.  We met roughly about a year ago and have been texting way too much since then.  Any way . . .  I was texting her about how nervous I was when my stupidity hit me.  I gave birth to a child, naturally . . . by choice.  I got this.  I can get into this stupid MRI tube and make it through this.  

Right then the tech came and got me.  We went through everything together and I signed my life away.  With my Valium in my purse I convinced myself I could get through this.   I walked into the exam room and didn't look at the tube.  The tech started my IV for contrast (so those cancer cells would show up better) and got me positioned. 

 (Image from Google Images)

This is kind of what things looked like.  I entered the machine head first.  Once my head was in the massage table head holder (technical term) I closed my eyes and used my natural child birthing techniques while listening to the Dave Ryan in the Morning Show.  Before I knew it, I was pulled out of the machine. 

I did it, without Valium.  With this mindset I felt like I could get through anything. 

The Details

So here is the nitty gritty science of what we have going on. 

My tumor--although I don't like to "own" this--is a invasive ductile carcinoma.  This means the tumor started inside the milk ducts of my right breast and started to invade the outlying breast tissue.  (image: http://www.breastcancer.org/symptoms/types/idc)

Normal breast with invasive ductal carcinoma (IDC) in an enlarged cross-section of the duct Breast profile:
A Ducts
B Lobules
C Dilated section of duct to hold milk
D Nipple
E fat
F pectoralis major muscle
G Chest wall/rib cage
Enlargement
A Normal duct cell
B Ductal cancer cells breaking through the basement membrane.
C Basement membrane

The tumor is a grade II on the Nottingham scale--which as I understand means the cells are just slightly mutated.  This is NOT the stage of my cancer.  As of right now the doctors have not given a stage.  I presume this will come after the surgical pathology. 

The biopsy of the lymph tissue came back negative which is great news.  During surgery Dr. DJ will take a lymph node for pathology to determine more. 

My cancer is estrogen and progesterone postive.  This means the "food" the cancer is using to grow is my hormones.  This is actually a good thing.  This way we know where and how the cancer is growing and there is medicine to stop the hormones so the cancer doesn't have food to eat. 

My tumor is 1.7x1.3x1.5 cm.  Relatively this is a very small tumor even though it feels about the size of a bouncy ball in my chest.  (Another reminder to feel your boobs often ladies and men).

I did also have an MRI scan of both breasts to get a better picture of where the cancer was inhabiting.  I will describe more of the experience in another post.  Dr. DJ told me in the MRI they found another lump of about 7mm.  My ducts were also lined with illuminated cells.  They can't prove or disprove there is cancer here unless they were to do a biopsy, but if either area came back cancerous the right breast would be unconservable. 

At this point I don't know if I will need any additional treatment; whether it be radtiation, chemo, or medicine to help attack my cancer.  We will find out this information after my breast tissue is sent to pathology and checked out under the microscope. 

For more information on pathology reports: http://ww5.komen.org/BreastCancer/ContentsofaPathologyReport.html

As more develops I will update the status of the cancer living inside of me.