How I imagine cancer growth

I picture little cancer cells in my body as having a squiggly outline, messy hair and enormous mouths.  I imaging these little monsters hanging out wherever they hang out a in my lymph and blood system, which look like a lazy river.  Each time a source of cancer fertilizer floats by their oger-like mouths start chomping.

This week, with the results of my biopsy, it has been clarified that my cancer is indeed Her2 positive still.  When the cancer originally presented 8 years ago the biopsy came back showing triple positive.

What is triple positive?
It indicates that the my tumors grow in response to the hormones estrogen (as in as many as 75% of cases) and progesterone (as in as many as 65% of cases).  The third + comes from being HER2/nue positive (as in 20-25% of cases).  Her2/nue, often shortened to Her2, is a more aggressive type of cancer.  This was definately the case with me.  

When my cancer was discovered there was a very large and palpable mass.  My Ongologist figured it was probably 10cm.  Between my first and second chemo I could feel one or two additional lumps.  So, in the course of a very short time I believe new masts were growing.  Luckily it was also very responsive the the A/C, paclitaxel and Herceptin regimen I was given. I didn't have any heart health issues which are possible with these drugs other than HBP that was easily controlled and has since almost reversed completely.

When my cancer returned about 3 years ago it was found in my bones.  While a biopsy was performed and extensive testing was done across the country, the results did not indicate the tumor was HER2+ any longer.

So, how did it go from + to - to +?  Bone tumors are very difficult to biopsy - it's a solid matter versus soft tissue.  So, it was probably HER2 positive all along.  In fact, even the biopsy this week failed to indicate being HER2+ in the first test - an ImmunoHistoChemistry (IHC).  Protocol would be to trust the results of the IHC.  But, luckily Dr J requested that they move forward with the next test, a FISH test.  (I say luckily not because I was lucky, but because if she hadn't I would have been angry and insistent that we go back and get the test done. I mean lucky for her since she didn't have to hassle with me.)  It's a little funny to say, "Yeah, I had a FISH test." I feel like I could follow that up with, "they found out I am a mermaid."

Since I was probably always HER2+ and the treatment protocol is different when they aren't treating HER2 I did receive 3 years of treatments that weren't as custom tailored to my cancer as they could have been.  It is easy to ask the question, what was the price I paid for not getting the HER2+ treatment for the last 3 years?  And I will never know the answer.  I don't have to know, because the treatment I received did a great job of keeping the cancer pretty controlled.  I had results that far exceeded average experiences.  I also was able to exhaust a long list of medications.  Had I been treated with a HER2+ regimen for the last 3 years I would have already cycled through a number of chemo therapies that I am just starting now.   Additionally, the drugs I have taken in the last 3 years, while not without side effects, have had side effects that were manageable and allowed me to work and raise my kiddies. 

As I have gone through treatment it has often been my prayer that I would have peace when the choices about treatment I made were good choices that would offer me the best balance between being a druggy and a mommy.  I have had a lot of peace over the last 3 years about the medical choices I have made.  I have been so blessed to know the questions to ask and have felt guided in what I have done.  Another case in point, after visiting with Dr J Thursday I talked to her about adding the bone treatments back into my protocol.  Not that she would have forgotten or not done it, but I am so thankful to know what I need and be able to ensure that my medical team is giving the best of everything I need. 

from the Perjeta website homepage

Starting this week I am going from my 30 minutes of medication (which requires 2-3 hours at the doctor) to a 4-5 hour infusion.  I will go from pre-meds (the anti nausea meds) and a 5 minute injection to premeds, bone strengthener shot and 3 chemo treatments.  (technically 1 is a chemo and 2 are monoclonal antibodies, they are often referred to as chemo, side effects are more mild than many chemo drugs) I will go back on Herceptin, which I took before and had good results with.  I will add perjeta, which from the website looks like it may turn me into a cat. And, to round out the cocktail, taxol. Taxol is a chemo that stops the division of cells, thus making it impossible for those hairy little monsters to divide and grow.  And, because it stops the division of fast growing cells, all fast growing cells are going to get beat-up including hair, nails, gums and the mouth in general, GI track and blood cells, etc.

So I will probably become a hair-less cat. Yes, this is the 3rd time I am loosing my hair this year.  I lost it right about Halloween last year, I remember thinking I should be a pirate.   And, It will probably be gone before the first week of November ends again.  This year I am considering something permanent to decorate my perpetually bald head.  To keep from going on and on about how much I just want to grow long, dark, thick hair I am going to close now. 

Meow.

The whole story of my pending biopsy

I have had a down-turn in my cancer situation.  Recently I completed my 6th cycle of Halaven chemo.  So, in spite of completing CT scans a couple of weeks ago, which came back clear, Dr J wanted to get a PET scan.  The insurance company began denying PET scans about 9 months ago when my CA27.29 blood tests had been dropping.  I just wasn't sick enough to justify the cost of PET scans.  But, in the last few weeks my blood counts have been climbing.  This justified authorization of PET scans, so that is what I got last week.

The PET scan day came - I went in at 6am, got the scan and then went on with my day just like any other day.  The PET returned results I wasn't expecting.  I was expecting nothing since that is what the CT had just shown.  But, instead, the PET showed activity in my back where it has been before, but has been inactive for a long time.  There are also a couple of new spots on my spine.  Additionally, there are spots on my ribs on both sides.  Finally, soft tissue has been compromised again with at least one lymph node in my stomach that is active.

(Active refers to the cells in each of these regions having a higher uptake of the tracer (radioactive glucose) than other areas.  This increased uptake points out where the cancer is making itself at home.)

All those years ago when I was originally diagnosed with metastatic breast cancer they did a biopsy on my bone.  The pathology showed the cancer was still hormone positive, but HER2-.  (Original diagnosis was triple positive for those of you familiar with this) Now, with soft tissue involved again, we are going to get another biopsy. That is the silver lining of this storm cloud.  I don't know if one result is better than another - it only matters that the tests are accurate and conclusive so we can make the most intellegent treatment decision.

Given that the cancer is back in my bones also I need to remember to talk to Dr. J about going back on a bone strengthening treatment regimine.

So, tomorrow I will have a biopsy.  There is a lot of hoopla involved in any medical procedure.  Arrive 1.5 hours early, wait around, be poked by a needle (at least a needle biopsy is what I am hoping for) and endure 30-45 minutes of waiting around until they will release you into the hands of a driver.  So, local anesthetic and lots of waiting, but I can't drive myself tomorrow.  This is my first medical procedure where I have not had my parents to drive me - first time, but not a big deal - thanks to my amazing friends.  I am so thankful for good friends around me who make this all so easy.

Hoping for un uneventful procedure and highly accurate biopsy results.