After waiting what seemed like an eternity, I emailed Dr. McAuliffe on Thursday morning (July 4) to let her know that my PET scan results were not yet in my medical portal. She replied quickly to say that it must’ve been a technical glitch, and she’d have someone in her office publish them the next day (since it was a holiday). Clearly not realizing what I really wanted was the ACTUAL RESULTS, I wrote back to ask if she’d seen them and if she’d share them with me. She did:
Thankfully, no distant metastatic disease. There’s an expected bright spot where the cancer is. There is also a spot on your low abdomen where you had the infected stitch that Dr. Gimbel excised. Radiology wants to biopsy it, just to make sure there’s nothing else going on there. My ofc is working on arranging an appt for that.
Great news – no metastatic disease!
Here are the relevant parts of the actual report that showed up in my portal yesterday morning:
There are postsurgical changes status post bilateral mastectomies with TRAM flap reconstruction. Lobulated enhancing 2.2 x 1.8 cm mass in the upper outer reconstructed right breast with focal FDG uptake max SUV 9.2 is compatible with biopsy-proven malignancy. In the left anterior pelvic wall, there is subtle nodular thickening just anterior to the left rectus measuring approximately 2.6 x 1.7 cm, with suspicious focal FDG uptake max SUV 8.5. Clips in the right axilla compatible with prior axillary lymph node sampling.
So, let me backtrack about this infected stitch/anterior pelvic wall thing. I’ve gone through all of my prior posts, and I am shocked to see that I did not write about this at all, especially because it was so beyond frustrating that it is exactly the kind of thing I would’ve taken to the keyboard to bitch about profusely. I’ll try to give the short version here.
As we all recall, in January 2013, I had a bilateral mastectomy with abdominal flap reconstruction (muscle-sparing free TRAM on the left, SIEA on the right — ideally the surgeon wanted to do SIEA on both sides, but an individual’s anatomy dictates what they are able to do); this results in a hip-to-hip scar across the entire abdomen. My plastic surgeon, Dr. Gimbel, did a really nice job revising the scar in December of that year so that, over time, it has smoothed out with the rest of my skin, and the color has become quite pale although it will probably always be visible. In October 2017 (almost five years after the initial surgery), I began to notice swelling on the far left side of the scar. I sent him these pictures to show the difference between the left and right side:
You can easily see how the left side is dimpled, raised, and inflamed, while the right side scar more easily blends in with the stretch marks on my skin. He suspected this was a “suture site infection or “spitting sutures”; while not uncommon immediately after surgery, 4.5 years later is pretty odd. He prescribed antibiotics. Within a few days, however, these raised areas opened up into large gaping holes (I’ll save you the details of what came out of them — also, this is where I swear I wrote about this already, because I was at a Feminists Rhetorics conference at the time giving a talk on women’s health advocacy, and the irony of having to pack my own wound in a hotel bathroom so that I wouldn’t ooze goo all over my presentation clothing was not lost on me).
I saw Dr. Gimbel twice to have him attempt to fix these wounds in his office; they healed once, opened up again, he fixed them again…. all to no avail. Eventually, he scheduled me for surgery, which I had on December 15, 2017 (almost five years to the day that my DCIS was found via mammogram).
Apparently the surgery was pretty easy. I notice on my calendar that I went to a pretty big work event only two days later, my son was home from school with me for two days later that week, and my husband and I went to see the new Star Wars movie that weekend. I guess I felt fine. Here’s what the pathology from the surgery said:
SKIN AND SOFT TISSUE, LEFT ABDOMINAL WALL, EXCISION: SKIN AND SUBCUTANEOUS TISSUE WITH SCAR, FOREIGN BODY GIANT CELL REACTION,CHRONIC INFLAMMATION AND HEMOSIDERIN DEPOSITION.
All cultures of the site, however, showed “Rare Pseudomonas aeruginosa,” which to me sounds pretty bad especially because I am immunocompromised due to RA, but he said the site had simply been “smoldering” and should be fine now that he’d removed everything from there and sewed it back up.
I haven’t had a problem with it since…. until now, it lights up on the PET scan. So I start doing some research on “pelvic wall” and “PET scan” to see what could be showing up there. Most of what I found related to peritoneal or some other kind of gynecological cancer. Since this is my biggest fear — way scarier to me than breast cancer — I emailed Dr. McAuliffe immediately to ask if there’s any chance that the abdominal “hot spot” could be peritoneal cancer. Her response was reassuring, if vague:
the area is superficial, right under the skin, not deep enough to be peritoneal ca
Ok, so what is it? – and why do they want to biopsy this little piece of skin on my abdomen if it’s so “superficial?” What gives me a bit of pause, however, is the phrase in the PET report, “subtle nodular thickening.” There is not one thing I read about this that did not scare the shit out of me. For instance:
Essentially all common causes of nodular pleural thickening are malignant (Radiopaedia).
From what I gather, it’s pretty common in people with mesothelioma from asbestos exposure, but can arise from a number of other issues (including breast cancer). This article makes me feel a bit better about it, since it explains that pleural thickening can often be confused with an effusion, which I gather is just a build up of fluid. It might make sense that there would be fluid in that space under the abdominal scar if, perhaps, that area is infected again. Of course, other research I’ve read explains that an effusion can also signal cancer. So, back to biopsy we go.
I’m also still trying to figure out the whole “FDG uptake” and “SUV” thing, but that is more confusing than the other stuff I’ve been able to decipher. Tips are always appreciated!
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