Light at the end of (a long) tunnel!

The big news is that it is Stephen's Dad is 80 today and Angela is 50 today! We had a great weekend with all of Stephen's family in Dorset to celebrate and there are some great photos on Facebook for those who are interested!

 Yesterday we saw the consultant for the results of the scans. After the initial diagnosis appointment, this has probably been the next most important and understandably the nerves for both Stephen and I were running high.

Let me bring you back up to speed. This appointment was to look at the results of the most recent scans (brain MRI, breast MRI and CT scan) and then plan the path forward from here. There had been a mix-up with the MRI so it was done a bit early and wouldn't have shown any impact of cycle 3; the CT was then rearranged for the right time. The MRI was looking at the size of the breast tumour and my lymph nodes, the brain MRI was checking to see whether there had been any changes from the previous one and the CT scan was checking that there hadn't been further spread elsewhere and also what had happened with the spread in my lungs.

We were there early which I don't think helped. And so we were beckoned in and the waiting of the last couple of weeks was over. I'm not sure I was quite ready for it.

We started with the usual formalities of "How was the last cycle" and joked about the fact that I had actually managed to stay out of hospital for the first time. Good news all round. We then moved onto side effects of the previous cycle and how had I been feeling. Again, nothing much to report there so it was a fairly short discussion. 

Then on to the main event of the scans. We started with the breast MRI as this was probably the lowest risk, given the discussion at the previous appointment around whether to bother with it or not. It confirmed that the chemo is definitely working and that I am having a "good response" with significant shrinkage. We sort of already knew this, but it was good to have it confirmed and also hear the words "good" and "significant".  They had also had a sneaky look at the lymph nodes nearest the impacted breast. More good news in that he couldn't see any current involvement of my lymph nodes. It doesn't mean that they weren't ever involved as we have had 2 rounds of chemo when the scans were done so anything that was there could have simply been killed by the chemo. But even so, progress in the right direction.

Next was the brain scan. Nothing new there, so pretty uninteresting for everyone, including the neurologist who had reviewed it. So early age related changes it is! If that's my lot, given everything else on offer I'll take it.

The finale, the CT scan, which to be honest is the one that both Stephen and I were most worried about as this is the one that impacts the prognosis most. So, some good news, there has been no new spread outside of my breast and the lungs. So, the lungs. Here is where it gets a little tricky. There are no new nodules (good), the nodules that are there have not grown (good), but equally they have not shrunk. Cue head-scratching. The first time we asked, the response was the on the balance of probability the most likely explanation was still that it was cancer spread in my lungs. However, further questioning did seem to reveal that whilst this is currently the most likely explanation there are others. Unfortunately, or fortunately, depending on which way you look at it, they are too small to biopsy and there aren't really any other tests to give any of us a better idea. I may ask if a thoracic physician may be able to shed more light on it at a later point, but the reality is it doesn't change the treatment for the time being.

The final event for the evening was the usual prodding and poking. Again, more really good news. He struggled to find the lump this evening and said it was too diffuse (squishy to you and me) to try and size properly. Great news and I hope the little buggers are dying slow and painful deaths. Good riddance.

So, what does this all mean, I hear you ask. Let me tell you. 

The really good news is that we have moved from a position of "Optimistically we may be looking at surgery, but currently you are not a candidate for surgery" at the beginning of cycle 1 to "I've spoken to the surgeon and we will get you booked in to see him". Pleased doesn't even come close! He did also mention that there may be the possibility of a lumpectomy rather than a full mastectomy depending on how I respond to the remaining 3 cycles. Fab!

We now also have a little more clarity over timings. We will continue with the chemo, without any changes for the remaining 3 cycles. That means the last cycle will be 22nd March. After that, I will have around 4 weeks off to recover from the impact of the final cycle and then I will have surgery. 4-6 weeks after surgery I will have 3-4 weeks of radiotherapy. When we start radiotherapy I will start 5 years at least of tamoxifen or something similar to help keep me around a bit longer and delay progression. We will also start something to shut my ovaries down around the same time. We will also continue to scan my lungs every few months to see if anything has changed.

I say that the final chemo cycle will be on the 22nd March. This is in fact a slight lie. You may remember that the chemo consisted of 3 drugs; the 2 targeted missiles and the one dirty bomb. 22nd March will be the last time I have all 3 drugs. After that, every 3 weeks I will still get the 2 targeted missiles for at least a year. It's a bit complicated, but how long we continue treatment for is all centred around whether the lung nodules are spread or not. At some point we have to make a decision. If they are (and we have to assume that currently they are) then treatment will continue for as long as I tolerate it, or until the cancer progresses (either the nodules in my lungs grow, or I get further spread elsewhere).

So tomorrow, it's time to line up for cycle 4. I'm quite looking forward to it now we have definitive proof it is working!