Oh my, I am tired, so this might be shorter than anticipated. I'll start by saying that Dr. Medical Oncologist was beyond amazing. She spent over two hours on my case, some in my presence and some pouring over my scans with radiologists. In addition, she told me that she serves her professional society on a committee that keeps their eye out for the latest research on Her2 cancers. Her addition to my team leaves no doubt that I am about to receive the best treatments that are available.
Regarding my treatment, she thinks that I should receive chemotherapy before mastectomy. This is consistent with what Dr. Oncologist said on Monday after the PET scan results that showed lung metastases. The drugs will be TCH+P (taxotere, carboplatin, herceptin + pertuzumab). I had the TCH combination previously, only the P will be new to me. It is the C that will make my hair fall out, etc. On Friday I'll discuss the plan with Dr. Oncologist, and we'll set dates.
No one has yet gotten past surgery with the planning, so I do not know what radiation is in store for me. It is probably dependent on what the lung metastases do during chemotherapy, because if they don't respond perhaps there are radiation treatments against them.
About those lung metastases (mets)...
The lung result was devastating on Monday, so devastating that I did not question them. However, today I am full of doubt about the lung mets and hopeful that they are false. Here's why.
On Tuesday I started to feel a scratchy throat coming on. I fully thought it was psychosomatic, like my body was trying to FEEL the lung mets down in my respiratory tract. When at dinnertime my daughter said, mom, I have a sore throat, my head jerked in her direction. Curious, I thought. Additionally, in the middle of the night my other daughter developed a disruptive cough. As I was laying in bed wishing her cough would cease so that I could get some sleep, I realized that we probably caught this cold on Saturday from my nephew. Nephew! Saturday! Could I have been organizing an immune response to this infection on Monday, such that it would be seen as increased metabolic activity on the PET scan?
My symptoms have since turned into a true cold. I asked Dr. Medical Oncologist if this burgeoning cold could have led to false positive lung mets on the PET scan. She said that it is possible, but the radiologists she consulted said it was not PROBABLE. She also examined me and said that at that time I did not have "clinical symptoms" of a respiratory infection.
I seem to be short on clinical symptoms lately. My cancer went undetected on ultrasound, mammogram, and breast MRI. It was only a biopsy that yielded the diagnosis. Also, I am the queen of false positives on PET scans (PET scan false positives have previously put me through a spine biopsy and a colonoscopy, both of which showed "normal" cells and tissues). I daresay that for this patient false positives are PROBABLE.
I'll end my rant there. I don't really care if I have synthesized this crazy-ass story as part of a fancy denial strategy over lung mets. This non-lung-mets scenario gives me significant hope. Also, my dad pointed out that the lung mets have also been good for putting everything else in perspective. Where on Sunday I was dreading chemotherapy, chemotherapy is no longer the worst thing I have in front of me. Lungs!
There's no way to know what's going on in my lungs without a biopsy, and the nodules are all too small to biopsy (largest one is a mere 9 mm). Right now my expectation is that they will be gone on the next PET scan in three months. We'll never know if it was the chemotherapy that cleared the "lung mets" or simply the resolution of the common cold. But they'll be gone. You'll see.