Ultrasound Scare

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The clinical trial requires that patients have a breast ultrasound within a 14-day window before surgery. I had tried to get out of doing it after I realized how sore I was from the delay procedure, but Dr. Hurvitz asked me to at least try, for the sake of the integrity of the study. So yesterday I went back to Radiology at UCLA for the first time since I had my first ultrasound last August. By coincidence I was in the same exam room as I was on that day, and as I lay back on the same bed I remembered how five months ago I had walked into that room thinking everything was fine, and walked out knowing in my heart that I had cancer.

To my relief, the tech was gentle and the ultrasound was not particularly painful. She imaged the locations where my tumor had previously appeared, and this time there was nothing there. This was what I expected based on my previous clinical exams, where Maddie couldn't feel a distinct tumor anymore. However, the tech then moved the transducer further to my left, and something appeared on the screen. Something round, something black, something that looked like a tumor.

"What is that?" I asked the tech, though I knew that she wasn't allowed to tell me even if she knew. "Was that there before?" "No," she said, seemingly genuinely confused. "I don't know what that is." I then asked to speak to a radiologist, but they had all gone to lunch. I spent the afternoon trying to contact Dr. Hurvitz, a radiologist, Maddie, anyone who could tell me what was going on. I finally spoke with Maddie around 5; she had my preliminary report and it said everything was fine. That thing that we saw on the ultrasound was probably a hematoma from the delay procedure.

Since all of my breast tissue is coming out on Wednesday anyway, you might wonder why seeing a possible new tumor upset me so much. But what was going through my head was, "What if my treatment has stopped working? What if my cancer has become drug resistant?"

Multidrug resistance, the principal mechanism by which many cancers develop resistance to chemotherapy, is a major factor in the failure of many forms of chemotherapy. It affects patients with a variety of blood cancers and solid tumors, including breast, ovarian, lung, and lower gastrointestinal tract cancers. Tumors usually consist of mixed populations of malignant cells, some of which are drug-sensitive while others are drug-resistant. Chemotherapy kills drug-sensitive cells, but leaves behind a higher proportion of drug-resistant cells. As the tumor begins to grow again, chemotherapy may fail because the remaining tumor cells are now resistant.

We haven't discussed this possibility with Dr. Hurvitz, because it's way too soon to start thinking about it. But I know it is a possibility, and a scary one. It's why cancer is such a terrible foe - it is adaptable, creative, clever. It seems to succumb but often is just quietly plotting its return.

This scare was a reminder not to get overconfident, even though my treatment, and others' in the test arm, seems to be going so well. There may be setbacks, and we have to face them bravely. It's also a reminder to me that I need to focus only on the step in my treatment that's in front of me - at the moment, surgery - and not start looking farther down the road. If I can just get through this, there will be time enough to think about the next thing.

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