I had an appointment with my oncologist today to follow up on my recent CT scan and liver MRI. Initially I thought it might be good news, as my appointment was taken by the Registrar, not the lead consultant. Not so.
First up, my CA15-3 was within the normal range. Right at the very top of it, but it’s never been baselined before, so I don’t know what’s normal for me.
Then she wanted to talk about my right breast. This is the one that had the tumour excised and has had the recent protocol of 5 days high dose radiotherapy applied to it. About 5 weeks after radiotherapy, I had developed a fairly nasty burn all around the breast, and it took quite a long time after the burn cleared for the breast to feel comfortable. It felt tight round the same area, almost as if the breast tissue was adhering to the chest wall. It’s actually eased up in the last couple of weeks, but I think it was still uncomfortable when I had my CT scan a month ago. Apparently the scan is showing thickening, and it might be radiotherapy damage, or it might be cancer. She examined me, couldn’t find any lumps. I would put money on it being radiotherapy damage, and another red herring being thrown my way.
Then we went onto the liver. This one was more concerning. In December I had a 3cm secondary in my liver ablated. The process involved burning out the tumour plus a margin. I am guessing I have at least 5cm of scar tissue. The MRI report referred to 5cm of cancer cells in the ablation site. It was unclear whether this meant a tumour of 5cm in the same place, or cancer cells dotted throughout the scar tissue. She was unsure which it meant. I thought can’t you read the actual scan yourself? Apparently not. In addition the report said there was dilation of bile ducts and possibly another lesion elsewhere in the liver. Reading around it when I got home, I see that cancer is one possible reason for dilation of bile ducts. But as this is all fairly unclear, they want to do yet more tests. It’s not looking good.
I will be having another PET-CT scan. I had asked why I wasn’t being offered one of these last time, and was told that a CT scan shows the physiology better. But clearly they now need it to see what’s what, and meanwhile more weeks pass on by. I might also have mammograms and ultrasound on the breast if the PET-CT lights up in that area. I had previously been told my primary tumour was PD-1 positive and that I qualified for Pembrolizumab. Now they want to check the liver tumour is also expressing PD-1. Why they didn’t check this when the biopsy was first taken, I don’t know. Weeks of waiting aren’t sitting comfortably with me at the moment.
More ablation is a possibility depending on the above, as is going onto systemic treatment. Ablation would be easier on me, but I wonder whether there is any point if it was incomplete before, and / or I have spread despite it. Returning to systemic treatment fills me with dread, I have been enjoying having my life back.
I am not in the least bit surprised about the liver. Husband is somewhat devastated. I don’t think he had quite appreciated the poor general prognosis of cancer that has spread to the liver until he did a bit more reading on it a few days ago. At least he has had a few months of ignorance, now he can join me in worrying over whether we will get much of a shared future. Fortunately I have made him aware I don’t want to ask prognosis questions just yet, but unfortunately I think my personal doomsday clock moved on a bit today.
