An “excellent response to treatment”

I got some very good news at the consultation I had with the oncologist on Monday in advance of today’s chemo session. The MRI scan I had on 3 November – to review any effect that the chemotherapy drug I’d had two sessions of at that point was having on the breast cancer – shows there has been “an excellent response to treatment”.

The chemo is continuing to do its job, so much so that the “primary lesion is no longer clearly identifiable”, the much bigger suspect area that extended from the nipple back towards the chest wall “is now no longer distinguishable”, and there is no longer any sign of the cancerous lymph node there had been in the right axillary or armpit. This doesn’t mean the cancer is “gone “- you wouldn’t expect that anyway in cancers that are oestrogen positive like mine – and it doesn’t mean I need any less surgery than I was told I’d need initially. However, it’s good news in that it has positive implications in terms of my prognosis.

Regardless of the effect of the chemo on the tumour, for various reasons I was always going to have a mastectomy and also, it seems, lymph node clearance. The main aim of chemo was always to lower the risk of the cancer coming back in the future by killing off any cancer cells that had broken away from the main tumour and were on their way to a new site somewhere in the body but that that couldn’t be detected. Breast cancer cells spread through the lymphatic or blood system. As the oncologist explained at the start of the treatment, although I might be paraphrasing here, “We’re good at finding [breast cancer cells that have broken away] once they’ve got to where they’re going but not so good at finding them when they’re on their way there”. The fact that the chemo is working so well on something we can see (ie the tumour) implies it’ll be having much the same effect on any stray cells that may be out there but can’t be seen.

Importantly, the MRI scan report makes it clear that the scan “alone cannot predict the absence of disease”, that “the presence of residual tumour” within the breast cannot be excluded, and indeed that there are areas that are “presumed to relate to residual disease”.

I had a consultation with the breast surgeon too on Monday, straight after after I’d seen the oncologist, and he made it clear that mastectomy and lymph node clearance were the only safe options when it comes to surgery, again paraphrasing, “given that we’re looking to cure this”. They’ll do tests on the breast tissue and the lymph nodes they’ve removed post surgery to determine how much cancer is there. Clearly there will be less than there would have been had they done the mastectomy and nodal clearance in August before I’d had chemo. The lower your “residual tumour burden” at the time of surgery, the better your long-term prognosis.

There’s been a bit of a glitch with regard to chemo side-effects. I have developed in the ball and toes of my right foot some degree of chemotherapy induced peripheral neuropathy, a known side effect of paclitaxel, the chemo drug I’ve now had three sessions of after today. It’s a very strange type of pain, like a mixture of numbness and pins and needles and throbbing that comes and goes. It’s been enough to wake me up a few times in the middle of the night. The oncologist did a test whereby I’d to say whether she was touching my toes with a sharp object or a non-sharp object. I felt the touch, but pretty much “consistently failed” on whether it was from the sharp or non-sharp object. The oncologist therefore reduced the dose of the drug for the chemo session I had today by 25%.

I’ve to report back at my consultation with the oncologist in two weeks’ time – before my fourth paclitaxel session, which is my eighth and final chemo session (yippee!) – on whether this problem has got worse. The aim is to see the chemo regimen through as it’s having such a positive effect on the cancer, but not at the expense of long-term nerve damage that won’t get better. If the neuropathy continues to worsen – it started after the first round of paclitaxel – we won’t do the final round of chemo.

Lastly, the effect the chemo has had may also have positive implications for the reconstruction I’m having done at the same time as the mastectomy and lymph node clearance. Yes, I’ve decided in the end to go for an immediate reconstruction and indeed first thing yesterday morning met with the plastic surgeon who’ll be doing the procedure. It looks like the operation could be on 19 December. More on this at some point. It’s been a busy few days.

PS I’ve preferred to go to most of the consultations on my own but my husband was there on Monday when I met the oncologist and breast surgeon. This whole thing has been a massive education for me. Think what it’s been like for a man who claims not to have known until after I started chemo that we had white as well as red blood cells! When I told him I was adding this to the blog, he said he wanted to know first whether I was holding any other colours back from him. I think he was joking on this last point. Either way, our consultant haematologist friend is going to despair when she reads this.

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