October is Breast Cancer Awareness Month. I’m sharing this part of my journey in the hope of assisting those who are seeking a bit of enlightenment as my way of contributing to the advocacy. With the daunting road up ahead, it usually helps to know what to expect to ease the burden somehow.
After having completed the screening (Mammography and Breast Ultrasound) and diagnostic (core needle biopsy) tests and it had been confirmed that I have breast cancer, more tests were required before therapy starts. As I mentioned in my previous post, my oncologist recommended neoadjuvant therapy, where I would undergo chemotherapy to downstage or shrink the tumor before going under the knife to remove the lump.
Below is a run-through of the list of tests and procedures I had to complete to prepare for my treatment:
Electrocardiography (ECG or EKG)
A common and simple test to check the heart’s electrical activity and rhythm via sensors attached to your skin, ECG is a test to monitor and determine the condition of your heart and detect any risk.
For this test, I was asked to lie down on an examination table and sensors were attached to my arms, legs, and chest. These patches or electrodes have wires connected to a monitor that recorded the electric signals that represented my heartbeats which were displayed and printed in waves on paper.
It wasn’t the first time I experienced it since it was part of our company’s annual physical, yet I was a bit nervous when I had this that I had to do a bit of breathing exercises to calm my racing heart. Good thing I managed to regulate my heartbeat in just a few minutes, and we were able to start right away. I suppose a routine check compared to the preliminary test made a difference to my stress level.
Echocardiography (2D Echo)
The purpose of this test is to check how fit your heart is by using sound waves to create an image of your heart and check the valves of your heart as well as blood flow. 2D Echo, along with ECG would indicate if your heart can handle chemotherapy or if there’s any possible heart condition.
The technician warned me about possible pain as there would be a need to press harder to capture good images. Fortunately, the pressure would be concentrated on the left side of the chest while my affected area is on the right side. There had been discomfort but it’s tolerable. For the procedure, you lie a bit on your left side mostly. As with any ultrasound procedure, the sonographer used gel on the wand or transducer, pressed and glided it to different positions around my chest area to capture images of my heart on the screen. The whole thing took a while. It hadn’t really been painful, but I felt a bit stiff for staying in slightly uncomfortable angles.
Chest CT (Computerized Tomography) Scan with Contrast
CT Scan with Contrast is more detailed compared to the usual x-ray as you would be injected with a contrast tracer that will highlight lesions or areas of concern in your upper body or thoracic structures which include your lungs, heart, and the bones in your chest area. Tumors and lymph nodes are measured with this scan based on the injected contrast which traces the lumps. This test also determines if the cancer already started spreading to other areas and has become metastatic.
Preparations
- Among the first thing they will tell you when you request a schedule for your CT scan is that you are required to have your creatinine level checked first to make sure that your kidneys can handle and flush out the contrast tracer after the scan. A blood work results must then be submitted before the scan for clearance to proceed.
- Before I was scheduled, I was also asked if I was diabetic (which I am) and if I’m taking any medication, particularly Metformin. I had been requested not to take said medication from the evening before the scheduled scan and resume only after the procedure. Apparently, the medication counters the contrast media and would affect the results.
- There should be no solid or liquid intake for at least 4 hours prior the scheduled scan. Depending on your set schedule, you must plan your meals accordingly.
- I recommend wearing clothes that can easily be removed like a button up blouse or loose shirt; avoid dresses as you only need to take off clothing from waist up and will be required to wear a clinical gown instead.
- Arrive at least an hour early for a brief orientation on the procedure with the radiology technologist and you will be asked routine questions like known allergies or adverse reaction to medicines, if pregnant, breastfeeding, and the likes.
What to expect
- The whole procedure usually doesn’t take an hour where most of the time would be allocated to preparations while the actual scan will only take a few minutes.
- The CT scan doesn’t really hurt because unlike the other tests, there’s nothing pressed on your skin or chest. However, you may experience a bit of discomfort, depending on how advance your breast cancer is. You will lie down and be strapped on a movable table with your arms above your head, which would cause the discomfort or pain as we generally have difficulties stretching the side where the tumor and lymph nodes are located, particularly around the shoulder and armpit area.
- It’s usually an individual experience so things can be different for one person to another. There’s likely a minor sting when the contrast is injected and there might be a slight warm sensation, and a bit of metallic taste in your mouth as the dye enters your system but it doesn’t last long. Apparently, some are sensitive that they feel queasy in their stomach while some get a bit of a headache. Good thing I had been spared of these reactions.
- The CT scanner is like a huge doughnut-shaped structure where the movable table will slide into, and the scanner will move around your body. Once you’re in the casing, you must hold still and a voice prompt with instruct you to hold your breath for a few seconds. Wait to be instructed to release your breath. The scans are done before and after the contrast media gets injected into your system.
- You’re mostly left alone during the scan, but the technician would be monitoring you in a booth during the process.
After Care
I was advised to take lots of fluids after the procedure for around 24 hours to flush the dye out of my body. I was also advised to monitor if there would be any adverse reaction because there are rare occasions when these come in later. I was told that I must inform my doctor immediately should I experience anything that would cause concern or rush to the ER for severe reactions.
As with other ultrasound tests, this test captures images through high-frequency sound waves which the computer receives to create the pictures of the organs in your abdomen which includes the liver, gallbladder, pancreas, spleen, and kidneys. This is also relatively painless except for minor discomfort if you’re the sensitive type of person or if there’s any underlying problem in the area. This monitors or checks for possible problems with the organs in your abdomen.
Fasting had been required before the ultrasound and I was asked to bring 1 liter of water to be taken just before the test. Just like with similar procedures, I was asked to lie down on an examination table and gel had been spread on my skin for the transducer or wand to glide smoothly. There was no discomfort, so I didn’t pay too much attention on how long the procedure went. Considering that it was checking the whole abdomen, images of the different organs had to be captured, so it took a while but not too long since there was nothing remarkable.
Bone Scan
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Bone Scan is another imaging test that is meant to detect problems related to the bones. This procedure uses radiopharmaceutical, a radioactive drug which is also called a “dye” but unlike with the contrast for CT scan, there’s no staining of the tissue when injected into your system. This test is used to check if the cancer has already spread to the bones.
Preparations are similar as with CT scan although monitoring takes longer, and I was instructed to come 2 hours before my schedule. The radioactive substance was injected ahead of schedule to allow time to spread throughout the body and move toward areas that need repair which will then be traced by imaging during the scan. As this is a whole-body scan, consider wearing loose-fitting clothes for your convenience as you will be required to change into clinical gown.
The structure is slightly like CT scan but there are large, thick plates that will move around to scan your body by sections as you lie on the movable table attached to the structure which starts from your head area to your feet. Thus, the process takes much longer as this test has more areas to cover. It felt like being in a photocopy machine except that the machine moves and circles around you instead of just scanning you from one end to the other.
I was advised to increase my fluid intake after the test to flush out the radioactive tracer. I felt quite tired and sluggish a few hours after the procedure although I still managed to drive home without difficulty. This, however, may be more due to the fact that it was the last of the series of procedures I had to undergo, and I was already feeling drained with the long process. The next two tests on the list didn’t require more physically on my end as they were more related to the tissue samples taken during the biopsy.
Immunohistochemical Test for Estrogen and Progesterone Receptors
ER/PR IHC testing is crucial to the kind of treatment you need; this test will assess the kind of breast cancer you have by determining the status of your ER, PR, and HER2. I find this quite scientifically technical to explain so you might need to read up more on them. In a nutshell, cancer cells are dependent on estrogen (ER) and progesterone receptors (PR) to grow and float freely in the bloodstream. ER & PR with positive receptors are deemed hormone responsive which is a consideration during treatment. ER & PR positive results mean that they respond to targeted hormonal therapy.
Human epidermal growth factor type 2 or HER2, on the other hand, is another receptor considered in IHC testing to determine how aggressive the cancer is based on the excessive amount of protein that the HER2 receptors hold. HER2-positive results mean the cancer grows more aggressively compared to Her2-negative.
The ER/PR Assay and Immunohistochemistry testing is based on the tissue sample taken during the biopsy and I only submitted a request for ER/PR IHC testing. Due to the pandemic, there had been issues regarding supplies according to the Histopathology Department of the hospital, so results took a while to be released instead of being one of the first results to acquire when I set off to start the series of tests & procedures.
Due to the results of my ER/PR IHC testing, I had to have the follow up FISH Test which I will discuss below. The Surgical Pathology Report indicated that I am ER-Positive & PR-Positive, but my HER2/neu was Equivocal, which means that positive and negative controls stain were appropriated, so further test was necessary to clarify. I was only made aware of this follow up test after I have arranged the teleconsult session with my oncologist, under the impression that I was finally done with my series of tests.
HER-2/neu FISH (Fluorescence in situ hybridization) Test
As my HER2/neu results had been ambiguous, more in depth test had to be done to fully determine if it’s positive or negative. According to breastcancer.org,
FISH (Fluorescence in situ hybridization) “is a test that “maps” the genetic material in a person’s cells… FISH testing is done on breast cancer tissue removed during biopsy to see if the cells have extra copies of the HER2 gene.” This type of test is more accurate but is usually only ordered if IHC results are borderline or do not clearly show if the cells are HER2-negative or positive.
Once again, since we are in the middle of the pandemic, FISH Test were temporarily unavailable in the hospital where I had my biopsy. They recommended a government hospital instead, so I had to borrow the slides preserved in wax and transported them for testing. Results likewise took a while to be released.
Around a couple of weeks later, results show HER2-negative, which means that my cancer is not aggressive and is ideal with ER+/PR+ IHC. There’s much hope for my case.
I also had blood work laboratory test that my oncologist required to cover bases for possible conditions or health risks. This was generally only a one-time extraction of blood sample but had to be enough considering the list, one of which required fasting:
Medical Clearances
Cardiologist
A medical clearance from a cardiologist before the treatment ensured that my heart is fit enough to handle chemotherapy. A medical history in the family qualified me as at risk for a heart condition so I must take some prescribed maintenance for precaution and must be monitored mid-treatment.
Endocrinologist
As a patient with Type 2 Diabetes, a medical clearance from an endocrinologist was likewise required. I was briefed regarding what to expect to avoid unnecessary stress when I notice irregular blood sugar level as fluctuation is a known side effect of chemotherapy. Continuous drug maintenance to regulate my blood sugar and monitoring mid-treatment was set.
After having completed all the necessary tests and obtaining medical clearances, my treatment protocol had been established and I was ready to finally start my healing journey. A face-to-face consult with my oncologist took place and arrangements on the start of my chemotherapy was made. At last, the opening to that tunnel leading to the road to recovery was finally in sight at this point.
Thank you for joining me in this rundown of my experience and I hope that it helps paint a clearer picture to those who are yet to embark on a similar path.
Just drop a message in the comment section if you have any question or insights you might want to share.
Stay safe, everyone!
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