What tests and scans used to diagnose breast cancer mets?

I am not on any cancer treatment at all at the moment. My last pembro / NAB-Paclitaxel was in September, just before I became ill with the pembro induced kidney injury. Fortunately the treatment had also significantly reduced my mets (I only had 2, both in my liver) and these were still stable in January. I had them ablated in February and am just about to have a scan to see what has happened since. I am still working my way through weaning the high dose steroids that I had to start in September and have a number of consequences from what happened to me. I am hoping the scan doesn’t reveal new growth as I still don’t feel well enough to contemplate more treatment that has a chemo element. I can’t have more Pembro because of what happened and I think the next line of treatment would be Trodelvy, which is an immunotherapy/chemo conjugate and has a bit of a bad rap for sickness and diarrhoea. 

Hi Coddfish - sorry that you've had a traumatic time and are still suffering with the Pembro after effects. Hope your next scan shows that you are stable, and that you soon feel able to try a new treatment (if necessary).
I wish there were more positive stories about mTNBC :-(

Confirmed mTNBC.  Chemo started.  No hanging around here.  PD L still to come in

Hi Ochno - my results are all back too. Confirmed mTNBC and PD-L1 is negative so immunotherapy would have no benefit for me (so no Pembrolizumab).
I will be on Gemcitabine and Carboplatin, like you, initially for 6 cycles (each of 3 weeks) and if it works then I'll stay on it until it stops working or it's too toxic for me. I think he said I get Gem + Carbo on day 1 of the cycle, then a second dose of Carbo on day 8. By the time you add in the blood tests needed before each chemo I reckon I will be visiting the hospital every week for as long as it works.

Sadly I've got to wait 2-3 weeks to get started - extra blood tests for kidney function etc, plus time to get chemo set up; he said they try to start you in less time if poss.

I asked about a Portacath and they said they would request it but it might not be approved. So it might have to be PICC line (which needs weekly flushing, so another hospital visit). BC nurse said that swimming wasn;t advised even with a Portacath, but I've seen a couple of websites that say its OK. eg www.guysandstthomas.nhs.uk/.../during-and-after-your-procedure

Oncologist said that Gem-Carbo is less harsh than the FEC-T chemo that I had in 2015 so hopefully less side effects. I'll probably try the cold-cap hoping to retain some hair.
He said that if it works for me it will reduce the cancer in the bone, and then bisphosphonates will hopefully help the bone to recover so he is hopeful it will reduce my bone pain.

Hope your chemo today went OK - let me know how you get on so I know what to expect !

Hi there, I had a big old meltdown today, tears and everything.  I’m normally very stoic but it all came out today.   Oncologist was lovely and talked me down nicely.   Straight to first chemo 30 minutes after appointment.  The staff are lovely, with a bit of Spanglish, we got there even had a bit of a laugh and a very nice Spanish lunch given.  Soup, cod and veggies and fruit, oh yum!  Just missed a nice glass of Rioja!

No bloods taken today, they used the ones I taken 3 weeks ago.  She said for a 66 year old I’m very healthy!  Well apart from the old cancer that is.

I had a bag of each today plus saline with anti nausea and a few other goodies. As far as I know same next week plus bloods first.  8am appointment for bloods then onco at 10am then chemo.  I had the option of having bloods day before at my local hospital or health centre but easiest to do a one stop shop.  

Here’s to treatment being a success for both of us.  I so hope it gives you some pain relief.

My oncologist says in general it’s very well tolerated and I shouldn’t lose my hair??  I shall take that with a pinch of salt!  A chemo nurse is to call me later to see how things are going.  My first port of call if any problems in the Urgencias, A&E, at my local hospital.  She says say magic words chemo and fever and they’ll whisk me right in.  I’ve used it once before when I had my breast op and had a wound issue, it works!

Sometimes the advice not to swim (or indeed do lots of things) is because of concern around catching viruses and bacteria, not because the portacath site itself is a risk - once the incisions have healed, it’s all sealed up. I remember having a conversation with my oncologist when first diagnosed in 2022, and the hospital was still operating Covid measures. She advised against public pools because of the viral risk and said she would be happier if I was an open water swimmer. I said she clearly didn’t know what the local water company was chucking into our rivers and seas and there was no way I would risk that whilst potentially immunocompromised. At that point we agreed that the small, private pool I use wasn’t that great a risk. 

Hope you feel a bot better now it’s underway. 

Much!    Hats off to Spanish healthcare so far.   Only blip was sharing a 3 bay room with an old expat who decided it was a good idea to discuss very loudly with her accompanying friend how many friends she’d outlived and how they’d all died of cancer.  The Spanish nurse was having none of it and told her to shut up.  Glad she got in there before me.  Seems not only do I have cancer Tourette’s I also have a bit of rage bubbling in there too.  

I like the idea of swimming in the sea but don’t like the idea of sharing with critters and other lurking nasties.   Our community pool all refurbished and will be filled 1st onwards.  I might use if I think they’re managing it well. I’m thinking early morning once it’s been filtering all night, that’ll wake me up.  Portacath dependent of course.  As you said it needs to go for approval.  Took 2 attempts at getting vein yesterday and a tad sore today.  I’m documenting side effects as they occur, so far that and headache.  Had a big bowl of porridge for breakfast and am drinking copious amounts of mint tea.  My mum had breast then lung cancer, bless her, we swear she lasted so long (81) as she only drank Irn Bru.  Made in Scotland from girders!

I agree with Coddfish about the open-water swimming - with all the reports about sewage dumping in the UK I don't think I'd trust rivers or the sea :-(
Sounds as though Ochno & Coddfish are lucky to have access to private pools whereas I only have the local public pool, so I'll have to see what they say about swimming.
Would still like the Portacath if poss as it is less obvious to other people and would reduce hospital vists (less frequent flushing).

Thanks for recording the side effects Ochno - it will be interesting to see how we compare. Glad that you are OK other than the headache so far - I'm on 2*500mg Naproxen plus 8 paracetamol for pain relief so hopefully I won't notice the headache :-)
Good to hear that it hasn't affected eating too..
Did you try the cold cap for your chemo ? I think my Onco said that Gem-Carbo might not cause much hairloss but told me to ask the Oncology Pharmacist about it when I see them in my pre-chemo appt.

Hope you continue to feel OK .