News from Kim

Hello all,

Another update on my stage IV breast cancer journey. Monday I received mixed results from last week's scans. A couple of chest lymph nodes actually decreased in size, while a nodule in my left lung increased slightly. My tumor marker (CA 27-29) remains somewhat stable at 32 (1 up from 31 2-1/2 months ago, yet still within the normal range of 0-38.) Dr. Green deemed the results not conclusive enough to move on to the next level of treatment. Not significant enough growth to discontinue the use of my current med. Once we put a drug behind us, there is no going back to it. And the more drugs we put behind us, the less there are in front. Once you've used up all available treatment options, well ... clearly it's not good.

However, Dr. Green was very concerned about the marble-sized lump I discovered a couple of months ago on my back left rib. We looked at it on the chest CT scan and yep, there it was, between my skin and ribs. Not on the ribs. There was no mention of it in the radiologist's report (x-ray and CT scan) -- quite disconcerting to me, especially since I had mentioned the finding to both the x-ray technician and the CT technician. I had also specifically requested that the CT scan tech place a note on my chart/films so that the radiologist reading the scan would be aware of the new issue and could take a closer look (to which she replied "Oh they look at everything.") I said that regardless, I would appreciate it if she would put a note or mention it to the radiologist, since it was new and I was concerned about it. Evidently, either she didn't do as I requested (bad enough,) OR, the radiologist didn't pay attention to the note. In any event, the radiologist failed to notice the nodule. There was no mention of it in the CT scan report. Thankfully, it was palpable enough and slightly tender so that I found it myself and reported it to Dr. Green.

Dr. Green felt the lump and was definitely concerned. She recommended an ultrasound with a possible fine needle aspiration (fna) biopsy. She said that if the lump was found to be more cancer, then she would definitely change my medication from Aromasin (daily by mouth) to Faslodex (an injection, not sure how often,) and it was scheduled for 3 days ahead, which brings us to today.

Today I went for an ultrasound of the nodules on my left flank area (a much more medical term than left back rib area!) First the ultrasound tech simply scanned the area while I laid on my stomach. The bad news was that she actually found 3 nodules instead of 1! One large one, one medium, and a third that she said was small and "indistinct." She left to show the radiologist the ultrasound results, and returned to inform me that yes, a biopsy was definitely indicated in this case since the nodules appeared to be solid. Okay. Danny wasn't allowed in the ultrasound room with me, but when the tech left to prepare for the biopsy, I texted him and my sister to keep them up on the latest news, and also so I wouldn't just lay there and cry. My last needle biopsy was not pleasant, but this time I wouldn't be watching the screen like last time. I told myself I would never do that again, as it was really traumatic to watch while feeling it too. The radiologist came in and explained what was going to be done. I asked her what other conditions the nodules could be if they weren't cancer. She said that if they were closer to the skin, they could be neuromas, but they weren't close the skin. She said that her list of things it could be besides cancer was short, but there was a slim chance that it was something else (but she couldn't name anything.) I said "What, some new disease that you can put your name on for discovering it?" which got everyone in the room to laugh. Back to the business at hand ... first she numbed the area with lidocaine, an anesthetic that is injected into the tissue. THAT hurt! Then came the needle to actually perform the biopsy, which wasn't so bad but for a few brief, painful moments. Unfortunately she did not get enough tissue during the initial FNA and had to do it again! Ugggghhhh! It was nothing nice! After that, Danny was allowed into the room, where we waited for the pathologist to return with some "preliminary" results from the cytology lab. Not surprisingly, based on my earlier conversation with the radiologist, the tissue was confirmed to be malignant -- what she called "metastatic deposits" in the muscle. Very disappointing, to say the least! They will run all the usual pathology on the tissue, including ER, PR, and HER2 testing. I will see Dr. Green next week, when we'll discuss my next treatment options. I suppose that will ultimately depend on what the pathology report says.

I am glad they will be running more of my tumors through the pathology process. An estimated 20% of HER2 negative tumors will convert to HER2 positive at some point in the metastatic disease process. Not sure if convert is the right word to use, but what I'm saying is that since my cancer was HER2 negative before, there's a 20% chance it may be positive now ... Which, in my opinion, may be helpful in that there would actually be more treatment options for me than strictly the estrogen-related ones. More options sounds good to me!

Well, that is all for now. Another setback, but again we are waiting for more test results before we'll know what's next.

Thanks for reading, and for the prayers.
Kim