Kris, Dave and the Lumps: Round 4

Wednesday September 1^st

Kris had her follow up PET scan which Dr. Moran ordered after the final chemo treatment

Friday September 3^rd

Kris and I went to see Dr. Moran (our oncologist). The nurse gave us a copy of the pet scan results and it was not a good read. There were several areas of ‘uptake’ or areas in which the dye is being picked up and absorbed readily. The dye is designed to be something cancer cells want to eat, so a lot of ‘uptake’ means you have areas that are suspicious. The verbiage was careful to point out that it could be a lymphatic reaction to a chest cold, but that this was not at all likely. The fact is that Kris has had a nagging cough for about two weeks now. Unfortunately, I’ve associated this cough with cancer since she’s had a cough like this for no apparent reason at each occurrence. The areas of concern are three lymph nodes in her neck. The largest of which is just under her mandible… read: just below her jaw… and on the left side. The largest of which is about 2 cm. There was very minor uptake in other locations like the umbilicus but the Dr. who wrote the notes was not concerned by these (based on what was written).

Dr. Moran came in and confirmed what the document said. He was cautious and obviously did not want to cause a panic but did order a biopsy and return visit.

Wednesday September 8^th

Kris and I went in for her biopsy. This was a needle biopsy and the pathologist actually didn’t need much material to get the sample he needed (this was nice). Long and short is that after about an hour we were on our way with a Band-Aid and orders to ice the area. Kris tried the ice and, being Kris, hated it (it hurt more than leaving it alone!) so she abandoned that idea.

Friday September 10^th

Back to see Dr. Moran and the biopsy confirmed that we have cancer again. He said that he’d need material from a full biopsy to confirm which strain of cancer it is but given our history the odds of it not being a recurrence of the breast cancer she’s been fighting all along are extremely slim. He offered two courses of action:

Radiation treatment

Yes, I know, she’s had her lifetime treatment of radiation. However, that ‘lifetime’ dose is in the chest area and we might even argue that it’s localized to the area of her left breast. Because of this we can treat the cancer in her neck with radiation. The downside is that this will leave scarring of the tissue which will mean a sore/stiff neck and likely will affect her salivary glands leading to dry mouth. If done before surgery, this will hamper the surgery.

Surgery

This would be what it sounds like. They go into the neck and remove the affected lymph nodes. He cautioned that back in the day this surgery was rather deformative but things have improved. I read this to mean that it’s still deformative just not as bad as it was. It would also leave Kris with a stiff neck and some loss of motion.

Kris mentioned having seen an article on The Dr.s about a new treatment for melanoma which causes the immune system to help with attacking the cancer. Dr. Moran indicated that this had sparked a memory and excused himself to check on something (with Beth). Beth is the cancer centers liaison with trial procedures/medications. They have a new drug in trial which is a parp inhibitor and works specifically with triple negative breast cancer. Turns out Kris is a good candidate for this trial. The drug is in stage three testing which means that they are done with double blind, control group, tests in which some folks receive the drug under test and others do not. Further, we were told that the drug is expecting FDA approval as late as January so I feel that this stage of testing is really to get more statistical data on its effectiveness and of course when it’s not indicated. We were also that this is to make the drug more widely available to patients until FDA approval.

This would be another round of Chemo with Gemzar and another drug as well as the drug under trial. Kris already has experience with Gemzar. Gemzar (and the other drug) are considered standards of treatment for this cancer. One issue with this is whether or not the insurance company will cover us for this treatment. We think the odds are good that they will since this is stage three of testing and the underlying drugs that the test drug are taken with are ‘standards of treatment’. What I mean is that it’s a risk that has some data behind it so that the insurance company can quantify it and I expect that they will sign off on it. Another issue is that we will be enrolling in a lottery. If we win, we get the drug. We don’t get the drug until we win. Until then, we do get treatment of the two baseline drugs. Beth has not, yet, seen a case where someone has not received the drug but it can happen. This is essentially the drug companies way of controlling how much demand they have versus how much production they currently have, or so we were told.

Dr. Moran said that it might be a few months before we know if the drug is effective in our case or not so I asked him outright what the risk in waiting for a positive treatment is. He was careful in his reply but he indicated that he feels safe that we run no more risk with this course than with either of the other two. Put another way, he said that if the cancer were to express itself in another organ, it would do so no matter which course we take. His words were then ‘the cat would be out of the bag’.

For the record, we can’t enroll in this trial unless we are stage 4. Dr. Moran still feels that this is local but, as with the last occurrence, we can’t really call it stage 3 anymore. Long and short is that technically we have stage 4 cancer but it’s kind of grey. During his reply to my asking after the risk of waiting for treatment (doing the trial) he gave an example of the cancer expressing itself as liver cancer and there would be no arguing with that being stage 4 cancer. This reoccurrence, as with the last one, is so localized that it sort of sits between a 3 and a 4.