August PET Scan Results

I apologize for not writing a post sooner. Up until a week ago Monday, not much has been going on. All of my blood panels have been looking normal, well, for me anyway, with the typical rise and fall of my white and red blood counts and my ANC.

On July 10th after I went in for my regular monthly appointment with my oncologist I was feeling so good and energetic that I went home and worked out for the first time in ages. Now it is a month later and I am still working out and other than some intense fatigue last week, I have been feeling well and like I have completely recovered from the radiation treatments.

On July 31st, I had my PET Scan to see if the radiation treatments effectively treated the lesion on my rib in my back. I had the scan a month later than usual to give my body time to heal from radiation. I saw my medical oncologist on Monday this week for my regular appointment and to get the results of my PET Scan. The results are not the worst news, but not the best news either, but something in between, so I will do my best to explain what the results are and what they mean. {oddly enough, the doctor that read my scan and wrote the report is the wife of my medical oncologist}

As far as the lesion on my rib in my back is concerned, the report said that “there is increased sclerosis of the left eighth posterior rib with decreased FDG {fluorodeoxyglucose} uptake, SUV 2.0, previous SUV 4.2. Findings suggest favorable treatment response, with reported interval radiation therapy.” So, the lesion is still there, but its activity is less than half of what it was in the March PET scan. Increased sclerosis is a sclerotic lesion that is an unusual hardening or thickening of your bone. They can affect any bone and be benign or malignant. In general, they’re slow-growing.

I have never had any mention of my lungs until now. I have a “new ground-glass opacity in the posterior lower left lobe that measures 3.0 x 1.9cm and is adjacent to the left eighth rib metastasis. Given the interval development and radiation therapy, this is favored to reflect radiation pneumonitis/fibrosis.” Pneumonitis/fibrosis refers to the signs and symptoms of soft tissue injury resulting from radiation therapy. All soft tissues within the radiation field can be affected, including skin, connective tissue, muscles, nerves, and blood vessels. At this time, it is believed that this is just scarring from the radiation therapy, but my doctor will keep an eye on it. The activity SUV of this spot is 2.6, which is within the range of where my body runs, so hopefully, it will stay that way.

Now for one of the more serious findings from my PET scan. “Subtle new FDG avid lesions in the T8 spinous process, SUV is 2.1 and left S2 segment, SUV is 2.2; worrisome for new osseous metastases.” S2 is located at the level of the posterior superior iliac spine. S2 covers the back of the thighs. What does osseous metastasis mean? Bone metastasis occurs when cancer cells spread from their original site to a bone. Nearly all types of cancer can spread (metastasize) to the bones. But some types of cancer are particularly likely to spread to bone, including breast and prostate cancer. The good news with this finding is that the SUV in both areas is below where my body runs, so just as with the spot on my lung, they will keep a close eye on both sites and see if the activity increases.

The last finding in the report is “Increased FDG uptake within a left supraclavicular lymph node measuring 8 x 15mm. SUV 2.9, previously 2.2.” FDG uptake reflects the tissue glucose metabolism and is usually high in high-grade tumors and relatively low in low-grade tumors. Supraclavicular lymph nodes are lymph nodes found above the clavicle, which is where I had the first two small masses in my neck in February 2022. My understanding was that after my first month on iBrance, both tumors were dead and gone leaving a little bit of scar tissue behind, which I can’t even feel anymore. So this is another area that will be watched closely in the coming months.

I know that this was a lot of information and it certainly was not what I expected to see when my oncologist handed the report to me. We talked about possible changes in my treatment and that there are other drugs that he could put me on should my next PET scan show any increase in activity in the areas that we are watching. He would change my medication because an increase would indicate that iBrance and Faslodex are no longer working. He reminded me that eventually my body will adjust to the current medications and that we will have to make changes. For now I am continuing forward with iBrance and Faslodex until my next PET scan which will be in November.

I wish I had more positive news from this last scan but as I have said many times in the last 4 years, cancer is tricky and in my case it is aggressive, so my doctors and I have to be just as aggressive with my treatment. My oncologist says that cancer is very humbling, and that is so true. Cancer doesn’t care if you are rich or poor, the picture of health or sickly, young or old. If you ever feel a bump that wasn’t there before, you have pain that will not go away, you are constantly tired even with a lot of rest and good sleep or you just don’t feel right; please go see your doctor and find out what is going on. Your body talks to you, you just have to learn to listen.

Recent Appointments

Soon after my last blog post, I went on vacation with my husband to celebrate our 19th anniversary, relax, and try to make more progress in my recovery from radiation. We had a wonderful trip, but it was unseasonably hot, so the heat affected me much more than usual because I was nowhere near 100% during our trip. So, when we arrived home, I wasn’t any further along in my recovery than before we left.

Martha Brae River in Jamaica

Two days after we returned from our trip, I had an appointment with my medical oncologist for my regular 30-day blood panels and injections. I was happy that my blood panels showed that my white and red blood cell counts had improved slightly and that my ANC was in the normal range for the first time in a while, recording at 1.7. My numbers did not match how I was feeling, but it showed me that I was making progress.

We discussed my next PET scan and when I should have it. Because I could have extra tissue where the tumor was located on my back, the tissue could look like the tumor is still there if we scan too early. I also had very intense radiation, so he did not want to expose me to more radiation so soon. So, we are delaying my scan by one month, meaning I will have it in early August vs. early July. It’s hard enough to wait every four months for my regular scan, but adding in a month makes it even more difficult, so I do my best to stay busy and not think about it.

Because of the timing of my trip, I went to my appointment a week late, so we discussed where I was in the month with my meds and what made sense as far as getting me back on track. Because my blood panels looked good, well, at least for me, they were good; my doctor decided I could wait and come in another six weeks. So my next appointment won’t be until July 10th. As usual, he reminded me that I could call at any time and come in to see him if I was having any issues.

My next appointment during the same week that we returned from our trip was a few days after seeing my medical oncologist when I saw my radiation oncologist. She looked at my back to see if I had any indications of skin irritation and at the location of my treatments for the same. My skin looked normal and clear, so that was good to hear. She couldn’t help but joke about the tan line on my back, saying everything looked great, especially my tan line.

I told her I still had some irritation in my esophagus when I drank liquids but that the pain from eating solid food was gone. She explained that my esophagus would take a while longer to heal and to take pain meds if needed, but I was definitely toward the end of feeling the discomfort. She asked when my next PET scan would be so we could see the results from the radiation treatments, and I let her know that it would not be until early August. I told her I would call her office once my PET scan is scheduled, which should be when I see my medical oncologist on July 10th. And with that, my appointment was over, and the only reason I would go back to see her would be if I needed radiation treatments again.

I am expecting things to be pretty quiet while I continue to recover and wait for my next appointment in July. I am feeling better as the weeks go by, and time has been flying by, which also helps quite a bit. I can’t believe it has already been seven weeks since I finished radiation. I was told that it could take up to six to eight weeks to recover, so I am near the end of that time frame now and feeling better with each passing day.

Once I am through my recovery, I hope to post more often and go back to not only updating about how I am doing but also passing on valuable information to everyone interested and especially to both cancer patients and their caregivers. I have found many articles that have helped me get through my challenges with stage 3c breast cancer in 2019 and, more recently, in 2022, stage 4 metastatic breast cancer. As always, thank you for being here, and take care!

CT Guided Biopsy

A few days ago, I had a CT Guided Biopsy of my 8th rib on the left side, on my back. Everything went well; I am in a little bit of pain, but nothing that Tylenol can’t help. The doctor instructed me to rest for the rest of the day on Thursday, remove my bandage on Friday, and resume my normal activities.

After finishing my paperwork in the hospital registration office, I went to the lab to have my blood drawn for a few panels; among a few other things, they had to check my kidney function before doing the CT, and after that, I went to radiology to wait to be taken to the pre-op area.

Once my nurse was done prepping me for my procedure, my anesthesiologist came to get me and take me to the CT room. He explained that he would only give me enough medication to make me relaxed and a little sleepy but not entirely out. He said that if I did get sleepy not fight it and let myself fall asleep. I did fall asleep for some of the procedure, but I don’t think it was for very long because the process only took about 30 minutes.

When I walked into the CT room, they had me lay on my stomach on the CT table. I was shocked to find out that the lesion is actually on my 8th rib on the left side of my back, not in the front, and it is very close to my spine, so that has me a bit concerned. The rib that I fractured some 18 years ago, that I was thinking was what was showing up in my scans, was a few ribs down from where the lesion is located, so it has nothing to do with the lesion at all. So with that said, I don’t know what to expect when I meet with my oncologist next Tuesday to get my biopsy results.

I have had many people ask me what I think of all of this, how I am feeling, and what my gut is telling me. I can’t help but see the similarities to the first time I went through cancer three years ago. With every appointment, things get worse and worse, more scans, more biopsies, etc. As before, I want to know what type of cancer I have to fight against, and I want to get started on whatever treatment plan my doctors and I agree on as soon as possible so I can get this over with and move on.

I am feeling OK so far. Even if the lesion on my rib is positive for cancer, it appears to be localized like the tumors in my neck, so it is not as aggressive as it was in 2019, and because of that, I have been feeling much better physically this time around so far. Mentally I am up and down; the stress is unreal because this is the moment as a cancer survivor that I have been fearful of, having to deal with recurrence.

Lastly, what is my gut telling me? I will be shocked if the lesion on my rib is negative for cancer. After reading the PET scan report and looking up a few medical terms that I had not seen before, I immediately thought that it would be a bad result once the biopsy results came in. I, of course, hope that I am wrong, and in a few days, I will know for sure.

Oncologist Appointment & PET Scan Results

I met with my oncologist this past Tuesday to discuss the results of my PET Scan. I was shocked to hear that I have two tumors in my neck, not just one. I found them early, so they are small, 0.9 x 0.5 cm and 0.5 x 0.5 cm. So small, under 1 cm, that they usually wouldn’t have done a biopsy on them, but I had already gone to my surgeon to have the initial ultrasound and biopsy done and had received the results already. I am happy that I took that initiative and went to see my surgeon as soon as I found the tumors so that I found out sooner rather than later that my cancer had returned.

The spot on my rib is still causing concern; it has been determined that it is a lesion that was not on my previous PET Scan in 4/2019. So with the fact that it was not on the last PET Scan and the combination of findings from the recent PET Scan, they are concerned that it is a solitary bone metastasis. My oncologist ended up ordering a biopsy of my rib after our discussion. So next Thursday, I am going to the hospital to have a biopsy of the lesion done. I will have both a local drug and anesthesia for the procedure. The procedure will take about an hour, and I will be in recovery for about 2 hours as they want to keep a close eye on me for bleeding and excessive pain. Unfortunately, I have to go through this biopsy to know if the lesion is cancer or not because it could change my treatment plan if it is positive for cancer, and I then have two different locations on my body with cancer.

Because I am having the biopsy done this coming week, I cannot continue planning with my radiation oncologist at this time. It is good that she now has the images she needed to determine my scope of treatment and if it is possible to treat the tumors in my neck, but the biopsy results could change everything. The lesion on my rib is on my 8th rib, right under my left breast, so as far as I know, it is located in the previous scope of treatment done in 2019/2020.

So my oncologist and I discussed what would happen if I couldn’t have radiation treatment. As far as my neck is concerned, he doesn’t want me to have to undergo surgery, but it is a possibility that I may have to go that route. When it comes to my rib, he didn’t want to speculate on it much. I asked him if it is common for there to be one tumor in one location when it comes to bone cancer, and he said it is unusual but not impossible.

Yesterday my husband remembered that I had pain in my rib several months ago. While we were discussing it, I remembered that I mentioned it to my surgeon when I saw him for a follow-up appointment in September. I pointed to the location of the pain and told him that I felt a bump there as well. When he felt the spot that was hurting me, he said, “that is your rib,” and I told him that I didn’t realize it was my rib because I had never been able to feel my rib so easily when I weighed much more than I do now. He asked if I remembered bumping into something or hurting it somehow, and I couldn’t recall doing anything like that. So I felt it yesterday, and when I pressed on it, it still hurt, and the bump was slightly more significant. So now that I remember that conversation with my surgeon, I am very anxious to get the biopsy done and meet with my oncologist to discuss the results and what will happen next.

I know this might not be common, but it seems that my body will cause me random pain, and then I find a tumor one to two weeks later. It has happened to me three times in a row, so I can say without a doubt that I will never, ever ignore any pain I might have in the future, especially if it is around my bones. My experiences are listed below; I don’t believe that this is a coincidence anymore.

Pain in my lower neck, to shoulder, to the shoulder blade = breast cancer

Pain from my outer ear, up the side of my head, to the top of my head = breast cancer in the lymph nodes in my neck

Pain in the 8th rib under my breast = most likely more cancer, not sure of the type due to location

I will update again next Thursday, depending on how much pain I am in, or Friday about my biopsy. Thank you for being here!

Radiation Oncologist Appointment

A few days ago, I had an appointment with my radiation oncologist. I hadn’t seen her in over two years, so it was nice to see her, but I wish it had been under different circumstances. After we caught up on where we had been, I was finally able to show her the pictures from our vow renewal ceremony, so that was nice, and what we had been doing; we discussed my cancer.

Unfortunately, since the CT of my neck came back clear, she has to wait for the results from my PET scan. She needs to see the exact size and location of the tumor to figure out if she can treat me or not. If there is even the slightest part of the tumor in my previous treatment area, she can’t put me through radiation. I didn’t know that you couldn’t radiate the same area more than once, so we must have clear images to compare from 2019/2020 to today. My PET scan is tomorrow, Friday, and I am going back to my oncologist next Tuesday for the results.

So after my initial appointment, my doctor asked if I could come back in an hour to do some plotting with the tech. I didn’t need to be anywhere, so I said I could come back, no problem. When I came back, they took me to the CT room, measured a few coordinates, and went ahead and marked me with stickers in case I could have radiation soon. When I laid down on the table, my doctor came over and felt where the tumor was, and she said, ” it seems like it is very superficial; that might be why the CT scan didn’t see it.” I hadn’t thought of that being the reason for the clear CT, but it makes sense.

Next, they had me put both arms over my head, which is the position I will have to be in for the radiation treatments. It has been almost three years since my first surgery in April 2019, and it still hurts to have my arms up over my head for any length of time. I have gained a lot of mobility back since that first surgery but not 100%. Because of the pain I am in when in that position, they will make molds for me to rest my arms in so the pain and pressure will be decreased, making me more comfortable. When I put my arms up, my doctor felt the tumor again and said it had dropped slightly in location, taking it closer to the area where I had radiation before; this is not good if I want radiation to be the primary treatment to get rid of the tumor.

So, now we are waiting for my PET scan and the results. What will happen if I can’t have radiation? I am guessing that I will have to have surgery to remove the tumor, but after that, I am not sure. I will be asking my oncologist about that when I see him on Tuesday next week.

Scan Results & My Treatment Plan

So I guess if there can be any good news that goes along with having cancer again, that would be the good news I received today.

There is a spot on one of my ribs in the nuclear medicine bone scan. I am confident that it is from when I fractured my rib ages ago. We need to be sure that it is from my fracture and not more cancer, so I have a PET scan scheduled for next Friday. Something odd is that the CT of my neck came back clear, yet that is where the tumor is located; the CT couldn’t find the tumor that I can feel, crazy! My other CT came back clear, so the cancer is isolated to my neck. I will have to go through radiation, so I have an appointment with my radiation oncologist next Tuesday. She will determine how much radiation I need and if I will need surgery after radiation.

After radiation, I will be put on a new inhibitor because the one I have been on for the last two years didn’t work other than possibly keeping the new cancer from spreading. I will also be going through chemotherapy again, but this time, it will be in pill form, not by infusion, and for at least two years. But the good news is that I will not lose my hair while on the chemotherapy drug.

As far as my diagnosis, I have the same cancer I had before, invasive ductal carcinoma, breast cancer stage 3c. Because the tumor is nearby where the cancer was in 2019/2020, in the lymph nodes in my neck, and it has not spread to my organs, it is still considered breast cancer. Oddly enough, the tumor is on the same side of my body this time as well.

All in all, I am very relieved! I will update you after my next appointment.

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