June 13, 2018
I had an appointment with the Radiation Oncologist today. I will be doing the daily radiation treatments at another facility other than the hospital downtown. This is something of a relief – traffic will be a little easier and I don’t have to worry about parking. Although, while I was downtown for the 1st appointment, I learned that they had parking validation for people doing treatment. Either way, I’m saved the time and stress of a drive downtown.
The Radiation Oncologist (RO) checked my incisions and range of motion before declaring me fit to start treatment. Because I will be having these treatments at a different facility, I will need another appointment tomorrow to finish the planning. As part of that appointment, they do a new CT scan to ensure they know the current “lay of the land” post-surgery. She also wants to do a new PET Scan to look at two Level 3 lymph nodes that were noted previously and were not removed or biopsied. The PET will be done downtown. It’s currently scheduled for the end of the month, but they’re working on moving it up. This means that I need to start my protein-only diet now in case they are able to move the date.
I’m concerned about the issues she’s noted with my lymph nodes. They removed all of the axillary nodes in my right armpit during surgery. There were 20 of them. Apparently, there is still what they call a Level 3 node in my right chest that was identified previously as positive for cancer. This one is under my right pec. I think this is called a sentinel node. I’m not 100% on the terminology.
I also have a hilar node on the other side of my chest that lit up like a Christmas Tree during my first PET scan, which pretty much threw my Medical Oncologist for a loop back in November because we didn’t expect any issues on that side of my body. Hilar means that it’s at my lung root. Since then, both the Surgeon and Medical Oncologist (MO) have stated that they believe that this left side hilar node is an infectious node (meaning it was enlarged and inflamed because I had been sick for 4 months) and that it’s not a cancer concern. It’s not been biopsied, and that’s in part because it’s a deep node and hard and in a hard place to get to for a biopsy without causing problems along the way. Additionally, these nodes were like 6 mm back in November and are now like 3 or 4 mm. This was discussed with the Pulmonary group when I had the 1st PET scan back in November. If it’s still active in the new PET, it sounds like we’re going to schedule another surgery to biopsy it. What I don’t understand is that if they already had me on the table unconscious for surgery, why not just remove the one under my pec and and/or get a biopsy of the hilar nodes so I don’t have to go back in for yet another surgery.
Another concern the RO raised was that one of the lymph nodes in my armpit seems to have gotten bigger while the largest one, the one with the biopsy clip, got smaller. I was confused by these results, too, when I read them. I didn’t raise it because I wasn’t hearing any other issues with nodes until now from either the Surgeon or the MO. Another piece of this is that she said that it appeared that the cancer “escaped” this Level 3 node and was growing into the surrounding tissue. I don’t remember hearing this previously, so I’ll be making some calls tomorrow morning.
The RO said that radiation takes care of microscopic cancer, not cancer that’s already turned into a tumor. So IF these lymph nodes are still there and still positive for cancer, they likely won’t be resolved with radiation alone. That’s not comforting. I know I’m on Herceptin until February, which is the chemo/not chemo that attacks metastatic cancer. However, now I’m wondering what happens if that doesn’t finish the job. This concerns me because I *just* saw the Medical Oncologist last week and we discussed the chemo treatment plan following the tumor board. I’m really wishing I’d have followed through with medical school right now.