It has been an exciting 7 days, which when you are talking about cancer is rarely a plus. I had a bump in the road, a thyroid nodule. I did just get good provisional news, so I feel ready to talk about it. But let me start at the beginning.
Way back, almost 2 weeks ago (time passes fast at the moment) I had a PET scan, because my oncologist and my radiation oncologist wanted to get a fix on some nodes in the midline of my chest. This could be important for planning the radiation field much later for my radiation therapy. In a PET scan you get pulsed with radioactive glucose and since cancer loves glucose more than any normal tissue, except perhaps the brain, it lights up like a Christmas tree. If the nodes light up, they probably have cancer in them, and would be included in the target area. We had to do the test as early as possible, as chemo could well suppress the cancer, and so the signal, without actually eradicating it. So we did PET, and the nodes were negative. Hurrah! (I have 3 positive nodes in my axilla, or armpit. Booh!)
However, the test did find something new – a PET positive signal in my thyroid. The blessings of tests… they find stuff. Of course, as soon as we knew about it, we had to deal with it. Joking aside, I am grateful for the finding – after all the thing was there, but without knowing about it, we couldn’t tackle it. I thanked my oncologist for being so careful and comprehensive.
So on Friday of last week I went for an ultrasound and then a biopsy. I am getting pretty good at these now. I can even sometimes watch along on the monitor as they draw the needle back and forth and back and forth through the node or tumor or nodule. They also took a fine needle aspirate from another neck lymph node that had looked enlarged in the ultrasound. The node was negative, but the thyroid sample came back from cytology with a suspicion of a papillary thyroid carcinoma at the first pass. So they went back in for more tissue, to send for cell block paraffin and H&E. That takes several days. By the way, never schedule a biopsy for Friday afternoon 😉
On Tuesday I went to see one of our senior experienced endocrinologists and we talked about what it might be, and how we might manage it. Various scenarios were discussed, from wait and watch to planning for surgery. My fears from over the weekend that we might change course were removed – whatever that was in the thyroid, the breast cancer is still the bigger threat, and so must remain of primary concern. Also, we need to have more data. The final pathology was one, but my endocrinologist also ordered blood tests for thyroid hormones and thyroglobulin. Well the blood tests were normal, and the final read on the FNA by cytology was atypical cells of undetermined significance or ACUS. This is a relatively new diagnostic category that falls between benign and suspicious and carries with it a small risk of malignancy – 5 to 10% probably. You can read more about it here (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807535/). Hurrah!
So the plan is to watch it with imaging, probably ultrasound will do mostly, and then perhaps redo the biopsy at some future time, if indicated. Surgery is not warranted based on what we know today, and unless the nodule activates to start causing problems by secreting things, or starts growing, maybe I get to keep it!
I feel lucky again. One, because we found it when we did, which might not have happened. And two, because it is just a wait-and-watch. But I sure learned that no cancer journey is ever the same, or a simple path. There are often bumps on the road. This one, I dodged, at least for now.