09:50am Friday 24 November 2017

Charting A Course: Mammography, Mastectomy and Another Tumor Discovery

Eight weeks into treatment, Rider says the “first and only mammogram in her life” was scheduled to see how her tumor was responding to chemotherapy.

“The mammogram showed that there were calcifications in my left breast that were suspicious and needed additional testing,” she says, adding that she was going to have to make another hard decision.  “Some experts recommended minimal surgery to ensure we had clear margins around my initial tumor which would allow me to move on from treatment as quickly as possible. Others thought the best plan would be a complete mastectomy. If we went that route, I would have to decide if I wanted to have a double mastectomy and if I would want reconstruction.

“Dr. (Jaime) Lewis recommended that I have a needle biopsy to test suspicious spots that remained, which is a minimally invasive procedure that would remove a few cells to be tested for cancer and provide additional information to guide in decision making. Unfortunately, my biopsy results were positive.”

Rider decided to move forward with the double mastectomy, and on Dec. 29, 2014, during surgery, a second, 2.3 centimeter tumor was found in her left breast.

“I was miserable the day after my surgery, but once I was out of recovery, the quality of care that I received was excellent,” she remembers. “I spent a lot of time in the hospital, and it’s a wonderful community. Lee Ann Liska, the president and CEO of UC Medical Center, even stopped in my room to check on my progress. Her visit was one of many moments that made me feel like I was in really good hands.”

Rider says Lewis, a breast surgeon and assistant professor within the UC College of Medicine, called her late the next day with the pathology report.

“There was a tumor that we were not expecting, and one of my lymph nodes was positive for malignancy, meaning that cancer cells had spread outside of my chest area and that I could expect additional treatment,” she says. “The Tuesday after surgery, my medical chart and pathology slides were reviewed by the Tumor Board. The thought of a team of bright medical minds coming together to talk about my treatment offered hope. My job was to focus on recovering from surgery and slowly rebuilding my strength, and their job was to figure out the best treatment plan for moving forward.”

Lower presented the team’s recommendations in Rider’s next appointment. 

“First, I was scheduled to have a full axillary lymph node dissection which was another big surgery where additional lymph nodes around my chest wall and under my left armpit would be removed and checked for cancer,” she says. 

Lower also introduced Rider to Kris Huang, MD, PhD, assistant professor of in the Department of Radiation Oncology at UC and a physician within the UC Cancer Institute. 

“He prescribed radiation therapy to destroy any cancer cells that were missed in surgery, making recurrence less likely,” she says. “Because of my young age and the fact that I had lymph node involvement, my treatment plan warranted a full-court press, including radiation. Dr. Huang explained that radiation therapy would improve my overall prognosis and emphasized the importance of maintaining a healthy lifestyle during and after treatment. 

“Because both tumors were in my left breast, not too far from my heart, there would be some risks to my heart that could not be prevented. Radiation would also slow down my recovery from surgery and prolong the timeline for breast reconstruction.”

“My course of radiation was 28 sessions, which meant coming to the Barrett Center Monday through Friday for six weeks,” Rider continues. “The thing about radiation is that it takes time to start working; the first few weeks I felt great, but then, my skin became sore and started to peel, and the familiar cancer fatigue returned. While radiation is intended to destroy any stray cancer cells that weren’t removed surgically or by chemo, it also affects healthy cells, and they take a lot of energy to heal which makes you tired.”

Rider says she started to meet with Tammy Ward, registered dietitian and specialist in oncology nutrition from the UC Cancer Institute, who helped her find a food plan that worked best for her.

“Good nutrition, including high protein foods and lots of veggies, helped offset the exhaustion that comes with radiation fatigue,” she says. “We also talked about long-term lifestyle changes that I would have to make to keep my heart healthy and curb my chance of cancer reoccurrence.”

Sometimes after lymph node surgery, patients develop lymphedema, or swelling which results from the disruption to their lymphatic system.

“Halfway through radiation, I noticed that my arm was heavy and starting to swell,” she says. “I had the beginning signs.” 

Lymphedema is just one of many ongoing side effects with which many breast cancer patients must deal. Rider continues to have weekly physical therapy to help manually circulate fluid through her lymphatic system. 

“The effects of cancer treatment certainly linger,” Rider says, adding that she went back to work shortly after finishing radiation but admits that she still deals with fatigue. “The transition after chemo, surgeries and radiation was harder than I expected. There are days that I am exhausted, and I am working to rebuild my strength. Yoga and long walks are really helpful for my body and mind, and I hope to get back to running again someday soon.”

Media Contact:     Katie Pence, 513-558-4561 Patient Info:      Join the UC Cancer Institute for “Charting a Course: Breast Cancer Research, Risk Factors and Resilience,” a day of free education about prevention, detection, treatment and living with breast cancer for patients and members of the community. The event will be held from 9 a.m. to 3 p.m., Saturday, Nov. 7, at the Kingsgate Marriott Conference Center. Hear about some of the most exciting research in breast cancer from trendsetters in the region. Continental breakfast and lunch are included.


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