It’s amazing how quickly scan results can be turned around when a consultant pushes. I think she was slightly embarrassed when I saw her on the 31st and she found that none of the scans they requested had happened, despite being requested 4 weeks earlier. They were however in the diary for that week. The molecular analysis of the original tumour also wasn’t back at that point. So I was a little surprised when she booked me back into clinic 9 days later.
However all 3 results were in - the PET-CT scan, the MRI, and the molecular analysis.
The PET-CT scan was a whole body scan. It found that the lesion on my liver did have live activity going on, but was shrunken when compared with the CT scan of 10 weeks earlier. No mention in the report of the other things found on the earlier CT scan - the growth on my adrenal gland that they thought benign, or the goitre. However the report did say there was was no other evidence of cancerous deposits. The liver MRI was consistent. So the current theory is that Boris the breast tumour spawned Liz the liver tumour via cells in my bloodstream prior to my WLE in March. The consultant was seriously considering whether they should change practice to take a baseline CT scan of small TNBC breast tumours before beginning treatment. My situation was discovered accidentally when I needed to be scanned for something else.
As it’s an isolated lesion, and I am healthy and don’t have any signs of compromise to the liver, and the chemo seems to have reduced it, the plan is to kill off the rest of it. The plan is to take a biopsy to be sure it is a metastasis of the original tumour, and then use ablation. This was described as sticking a probe into it and microwaving it. It is apparently less invasive than surgery, so will have less recovery time. It does involve general anaesthetic and possibly an overnight hospital stay.
They also decided to follow up on the adrenal growth. First steps in that are to complete a 24 hour urine collection. That sounds fun.
Following the ablation, and assuming the adrenal issue isn’t cancer, the plan is then surveillance. 3 monthly scans to look for new lesions. If one is spotted I will then probably go back onto systemic treatment.
The molecular analysis found my original tumour tested positive for PD-L1 (programmed death ligand 1). A simple explanation is that many TNBC cancers have this, and it’s an explanation of why the body lets the cells merrily and explosively sub-divide. In effect, it acts as an invisibility cloak so the immune system doesn’t see them and therefore doesn’t destroy them. The immunotherapy agent Pembrolizumab (sold as Keytruda) has been designed to turn off their ability to hide. Unfortunately as with any immunotherapy, it can also make your immune system destroy healthy cells. So, further down the line, I have the option of going on Keytruda. It’s normally initially given alongside chemo, so it would be a few cycles of chemo plus immunotherapy, followed by immunotherapy alone, until it’s either no longer working or I can’t tolerate it.
I am realistic that it is likely to come back at some point, and given the aggressive nature of TNBC, this could be sooner rather than later. The best course of action seems to be to take and enjoy each 3 month chemo free block I get and try to not worry about the future. I know I have at least 3 months to enjoy.
Meanwhile I have another dose of Zometa on Saturday and my 5 days of radiotherapy starts on 21 November.
