I had an MRI of my brain, with and without contrast, on Monday, March 26th. I was able to come to the Cancer Clinic prior to that to have my port accessed. The MRI went fine. I even joked with the tech: "Should I expect any bad calls about this?" He didn't really say. (Thanks to an amazing friend, Jenn for bringing me and keeping me company.)
The next day, Dr. Fleener called me at lunch.
The was no evidence for acute infection and no evidence for intracranial hemorrhage. However, the MRI found two small spots of abnormal enhancement in the cerebellar vermis, at the back of my brain, around 3mm each. Because of the size, the doctors aren't 100% sure what these spots are. They are suspicious for early recurrent intracranial metastatic disease, but there was no swelling or other sure signs.
Dr. F said she was going to get the opinions of Dr. Goble and Dr. Hoover, a neurosurgeon to make decide how to proceed.
The next morning, I received a call that I needed to have an appointment with Dr. Hoover. (This is probably NOT nothing, I thought to myself......excuse the double negative, fellow teachers and grammar gurus.)
I had a scheduled CT to scan the rest of my body. This procedure uses the *delicious* vanilla shake I just *love* so much!
I do want to add how grateful I was for the tech who took the time and truly listened to my concerns about my veins and an IV. She searched and searched and found a winner. Best IV experience ever!
Lunch, then another appointment. (I forgot to mention that Dr. Fleener wanted me to remove my IUD, so I'd already done that the day before after hearing about the spots.)
I went to the appointment expecting bad news, something that would interfere with my April plans. I was pleasantly surprised. I liked Dr. Hoover quite a bit. He explained that these two tiny spots, these two lesions were only discovered because this was an oncology MRI, using smaller, 1mm cuts. The best news is that this MRI, even with the spots, is significantly better than last year. I can attest to that, as he took me back to view them side-by-side. Last year, my brain looked like a foggy day inside a skull. Now, it actually looked quite normal, with a few battle scars.
Dr. hoover would not recommend any surgical options for me. The spots are too small to biopsy.
There are two ways to proceed. 1) radiosurgery: This involves a blast of focused radiation to those spots. The problem lies in the unknown. If they were to radiate these spots, and they weren't cancer, but perhaps radiation necrosis (dead cells), the spots could potentially grow, leading doctors to believe that they are cancer, and that the radio surgery was unsuccessful. Basically, that option could lead to a false diagnosis and more damage.
2) wait, and repeat an MRI in 6-8 weeks. This was Dr. Hoover's suggestion. And, while we were finishing our appointment, he got a text from Dr. Goble, which said practically word-for-word what he had explained to me.
The next day, Thursday, I met with Dr. Fleener. She went over Dr. Hoover's and Dr. Goble's recommendations, as well as some opinions of other colleagues'. The waiting for another MRI before doing anything was unanimous. The results from my CT came back clear.
Dr. Fleener did say that perhaps these spots were a "God thing," a reason to review my treatment. Herceptin doesn't cross the blood-brain barrier, but estrogen does. So, maybe we should do more to try to block that. She gave me a sample of 2 drugs: Ibrance and Letrosole. At some point, we will probably take away the Perjeta, since it may not be doing enough. She would think on that and decide before my next treatment.
Overall, this news is not the best, but also not the worst. My April plans are still on track. I don't need to worry for 6 weeks!
