Thursday, May 3, 2012
Our Cancer Journey Week 20
This has been a busy week moving Kathy, 2 cats, 2 rabbits, and 6 chickens to our farm in Sherborn, Massachusetts. I've spent my nights unpacking boxes instead of posting blogs. I'll return to a normal writing schedule next week.
Here's the MRI results from Kathy's imaging last week:
HISTORY: 49-year-old female with locally advanced left sided breast cancer who is undergoing neoadjuvant chemotherapy. Please assess response to treatment.
COMPARISON: No prior breast MRIs are available. Correlation is made with mammograms dated April 25, 2012 and December 13, 2011.
TECHNIQUE: Multiplanar T1- and T2-weighted images were acquired on a 1.5 Tesla magnet including dynamic 3D imaging obtained prior to, during, and after the uneventful IV administration of 0.1 mmol/kg of gadolinium-DTPA.
Multiplanar 2D and 3D reformations and subtraction images were generated on an independent workstation. The dynamic contrast enhanced 3D series was sent to an independent workstation for computerized assessment of contrast dynamics. CAD analysis facilitated DCE interpretation.
BILATERAL BREAST MRI WITH AND WITHOUT CONTRAST: There is minimal background
parenchymal enhancement. There is no suspicious focal enhancement or mass in either breast. The left breast skin appears thicker compared to right. Post-surgical changes are present in the left axilla consistent with history of sentinel node biopsy. There is no evidence of pathologically enlarged axillary lymphadenopathy.
No suspicious focal enhancement or mass seen on MRI to correspond with known malignancy. The left breast skin appears thicker compared to right; clinical correlation is recommended.
In summary, there is no longer any evidence of tumor. Based on this positive finding, her breast surgeon scheduled an urgent appointment with Kathy to formulate next steps. Together, Kathy and Dr. Houlihan agreed on the following:
"I just saw Kathy Halamka who has had a complete remission by MRI after Cytoxan/Adriamycin times 4 dose dense and 5 rounds of Taxol, which was discontinued due to Taxol toxicity. I plan to do a wire location with two wires of the two clips on 5/11. I plan an en bloc resection. If margins are ok, plan Radiation Therapy. If residual disease, probable mastectomy. Single micro met in sentinel node--plan no axillary dissection based upon current guidelines."
So far so good The numbness in Kathy's hands and feet is better than it was - pins and needles rather than complete lack of sensation.
This week our lives are returning to normal post chemotherapy and post move. Six more chickens arrive tomorrow. Our next milestone will be lumpectomy with local anesthesia on May 11. We're all hoping for negative margins (no sign of active disease).
Posted by John Halamka at 3:00 AM