This is going to be a difficult one to write. I’m having a lot of big feelings. I’ve held off on this post, but not sure I can any longer. My mind might actually eat me alive if I don’t get the words and thoughts out.
I have never been in a state of “complete” remission. When my oncologist informed me of my “NEAD” status in April of 2024, little did I know it came with a caveat. Apparently, it was my metastatic disease that was showing no evidence of active disease. Meaning, only my liver and left lung were in “remission”. This also means, my primary tumor site (left breast) has always had its tumor. Through all the treatment, through all the imaging, through all the follow-up’s and blood work- it never changed.
What led to this discovery? A breast MRI. A breast MRI that has opened Pandora’s box. A 30 minute test that has now upended my life all over again. Third times a charm, right?
Second, a little history:
An ER visit in January that required an abdominal CT scan showed a small tumor on my liver and a small tumor on my lung. So, my remission status had been tossed out of the window for the majority of this year anyway. When this happened, at my next follow-up, my oncologist and I agreed to maintain my current treatment plan and do more thorough imaging (MRI) on my next imaging interval. I was shocked at the findings but not really surprised. When remission was communicated to me, I had a terrible reaction and an instant fear it was only temporary. I couldn’t understand how backwards that seemed. I should have been happy and ready to move on. Little did I know my brain was preparing me for what was to come.
The MRI revealed that my primary tumor has not changed in three years of treatment. The radiologist who analyzed the test recommended surgical intervention. I immediately contacted my care-team. Initially, the mass was chalked up to being scar tissue per my oncologist’s PA and I ate that up with a spoon. Two days later, I received a letter from the breast center strongly encouraging me to have the site biopsied triggering another outreach to my care team. This time I was informed my oncologist was on vacation and he would contact me on his return with a plan of action. One week ago, he suggested I have a double mastectomy. While radical, an approach that would eliminate local reoccurrence and greatly reduce instances of future metastasis. He spoke to a surgeon who isn’t onboard with this radical approach. She insisted I have a biopsy to determine medical need. Patients with Stage IV typically never have surgery. The goal is focusing on the metastatic disease, ensuring it’s controlled and in some cases (like mine) reversed. However, if there has been a reversal of metastatic disease, some surgeons will perform surgery to reduce potential local reoccurrence, etc. Today, I had a diagnostic ultrasound to determine the method of biopsy to be performed. Thankfully, we can proceed with the ultrasound guided method. After this test, the radiologist came to speak to me and informed me I will absolutely be having surgery. My tumor is still highly suspicious and suggestive of malignancy and creating problems in the future. The aggressiveness of the surgery will be determined by the biopsy results. A minimum, I will have a lumpectomy. Or, I could still be having a double mastectomy. My biopsy is scheduled for Monday. My results will take 7-10 days and then I will see the surgeon.
Finally, feelings and questions:
Shock, frustration and an overwhelming grief have taken over. How did we get here almost 3 years post diagnosis?!
Why didn’t we do this at the beginning?
Why didn’t anyone tell me CT scans weren’t monitoring my breast?
Why didn’t anyone tell me they saw this on my mammogram in November?
Why did I just assume treatment meant a systemic approach that included my breast?
What did I misinterpret from every appointment since diagnosis?
Did I lose the trust I had in my care team?
As I was getting changed for the ultrasound today, the mirror in the changing room had window clings. “Be Strong” with pink ribbons and hearts. All I thought was “again”.