Bone Biopsy and Results, Part One

For the fourth time in my cancer career, I reported to the 5th floor Ambulatory Surgery center of Roosevelt Hospital on the morning of my bone biopsy. This is the same place I had to go when I had my liver biopsy and my two surgeries, so I'm pretty familiar with the place by now.

Luckily, unlike those other times, my appointment was not at the crack of dawn, but rather a much more reasonable 10am.  Although, I learned that the price for getting to sleep in a bit meant that I was that much more hungry, since I was not allowed to eat anything after midnight.  Interestingly enough, when we checked in my Dad was remanded to the hallway to finish his coffee, as they don't allow any food or drink in the waiting room.  The reason for this is to not flaunt food and drink in front of the patients who can't have any!  I thought that was pretty thoughtful and considerate, though it did mean my Dad had to chug his coffee in the hall (I guess we didn't remember everything about Ambulatory Surgery!).

We didn't have to wait long before they called me to the back.  As usual, they asked me a bunch of questions (like why was I there, when was the last time I ate, etc.) and then gave me a hospital gown and locker to store my stuff during my procedure.  Then my Dad was allowed to come back.  Once again, we didn't have to wait too long before they were ready for me.

I was wheeled down to the 4th floor, where the procedure would take place, and a nurse came over to put in an IV.  She tried to put it in my hand, since I would be lying on my stomach for the procedure, which would theoretically make a port IV difficult, but the vein blew (hate when that happens).  So, she left to ask the doctor if a port IV would be OK and luckily he said yes (whew).

Once my IV was all set up, a fellow who works with the doctor came over to explain the procedure.  They would be using CT scans to guide a needle into a tumor in my spine to extract a small piece of it for analysis.  I would be given a sedative to relax me, but not put me out (though she said some people do fall asleep).  I would also be given a local anasthetic.  She also warned me that the needle itself makes a noise - kind of like a dental drill - since it would be going into bone, and not to be alarmed by the sound.

While we waited for me to be wheeled into the procedure room, my Dad and I chatted about - of all things - Easter candy.  You see, I gave up chocolate for Lent, and I really, really miss it.  And considering that it was around noon by this time, meaning I hadn't eaten in about 15 hours, I had candy on the brain.  So we discussed what my parents would be purchasing for Easter candy this year and concluded that it would include all of my favorites, especially peanut butter eggs, but also a chocolate bunny, Cadbury eggs, Peeps, and jellybeans.  (And yes, even though I'm almost 35 years old, my parents still do my Easter basket every year!)

After I got wheeled into the procedure room, Dr. Friedman came over to talk to me as well.  I told him that I remembered Dr. Sara saying that they might have to avoid the area of my spine that had radiation, since sometimes that can affect results.  Dr. Friedman said that shouldn't be a problem, but just to be safe, he called Dr. Sara to discuss it before starting the procedure.  And Dr. Sara agreed that the area they were planning to go in was the best place.  I liked that they listened to my concern, and took the extra step to double check with Dr. Sara before doing anything.

Anyway, I was then given Versed and Fentanyl which relaxed me.  I didn't fall asleep during the procedure, so I did hear the "drill".  But it didn't really bother me.  It didn't hurt at all, except for a burning sensation I felt a couple times as the needle was going in.  I mentioned it but they said this was normal too, so nothing to worry about.

I think the whole procedure took about 30 minutes or so, at which point the doctor said they got a good sample, and I was wheeled back out.  I was still very sleepy, but I started to perk up after the drugs started wearing off.

I was then wheeled back up to the 5th floor, where I could finally eat!  They actually had a hospital tray for me with a full meal, but it wasn't vegetarian and didn't really look very appetizing, so I just had some graham crackers and ginger ale.

I was discharged about an hour later, and then I could finally have a real meal.  We went to a nearby diner where I had blueberry pancakes which tasted SO GOOD!

Over the next couple days, I had a slight soreness in my lower back - like I pulled a muscle - but other than that I had no lasting effects from the procedure.  It was pretty easy, all in all.

The following Monday, my parents and I went to Dr. Sara's office to find out the results.  Now, I did not really feel apprehensive about getting these test results - after all, we already knew that it was cancer of course, and we already knew that it was increasing in the bone; it was just a matter of whether or not the cancer was hormone receptive, which would determine the type of treatment.

Dr. Sara told us that the test results showed that the cancer was actually NOT hormone receptive.  It is HER2 receptor positive, but not hormone receptor positive.  This means that determining treatment is more complicated.  If the cancer was hormone receptive, the answer would have been clear - add a hormone treatment to my current regimen.  But that solution will clearly not work, so what do we do now?

Dr. Sara said that there is no clear answer on how to treat this, so he is consulting with other oncologists to get additional opinions and ideas.  By the time I have my next chemo treatment (this coming Thursday), he will have a plan in place.

You see, there are three known characteristics of breast cancer receptors - HER2 and the two hormones estrogen and progesterone.  But, there are other types of receptors which have not been discovered yet.  And it's one of these receptors that is causing the cancer in my bone to respond differently from the cancer in my liver, which is why it's so difficult to determine treatment.

Dr. Sara said one possibility he is considering is putting me on TDM1, which is the latest "blockbuster" breast cancer drug.  It actually has just been approved by the FDA, and will be on the market within a week or so.  It is a HER2 drug, so it's possible the cancer in the bone might be more receptive to this new drug, since it's not responding to the Herceptin and Pertuzamab.  Dr. Sara is consulting with the team at Memorial Sloan Kettering, as they did the clinical trials for TDM1, so they know it well and can tell Dr. Sara if they think it is a viable option for me.  The team at Sloan actually already knows about my case, since Dr. Sara had tried to get me into one of their clinical trials for this drug awhile back.

Another option might be to just keep me on the same regimen that I am on, and repeat my PET scan in 2 months, versus the usual 4 months.  Dr. Sara said that sometimes, there can be a "delayed response" in certain areas, so it's possible that the cancer in the bone is just being slow and will eventually respond to the drugs I'm currently on.

The bottom line is, we just don't know yet.  And the not knowing has hit me a little harder than I expected it too. As I said, I was not really apprehensive about getting these results, but I came away from it a little upset.  It was difficult to hear that there is no clear answer to my treatment.  And while I have full confidence that Dr. Sara will come up with the best solution and there will certainly be a plan when I go for chemo this week, the not knowing is hard.

It's not that I'm worried that the treatment will be more demanding physically or anything like that.  It's just that the fact that we don't know what is causing this cancer to not respond to the current regimen means that there is a greater chance whatever treatment we do choose may not work.  Despite this fact, I think I will feel a little better when I know what the plan is, so I am looking forward to Thursday, and to knowing more.

Until then...