ypT0, ypN0, pCR…And Doing The Happy Dance

Following her release from the hospital last week, Carol has been doing pretty well. She’s been able to only use Tylenol for pain medication (big win) and has been slowly increasing her activity level – first 1000 steps, then 2000 steps and then 3500 steps yesterday.

I empty her surgical drains several times a day and watch the quantity go down with every measurement. The target to get a drain removed is to have less than 30mL per day coming out of that drain. Being a scientist/engineer-type, I did what comes naturally and plotted the rates and trendlines over time.

Today was Carol’s first checkup after her surgery last week. It’s been clear that her left drain was definitely ready to come out, but that her right drain wasn’t quite finished yet. So we drove down to the surgeon’s office expecting to have one drain removed and were waiting in the reception area when Carol got a text from her oncologist.

He wondered if she had seen the pathology report in her electronic chart yet (which she hadn’t). The pathologist hadn’t been able to find a single cancer cell in any of the tissue from the lymph nodes or the main tumor itself. Not one!

Image by ktphotography from Pixabay

We met with Carol’s surgeon and she confirmed the pathology report and talked about it with us for a few minutes. She said “you scored a home run” She was quite happy with my Excel chart of Carol’s drainage output (nothing like data to drive decisions instead of people who say that they “think it’s ready” but never actually took a measurement). She also looked at the incisions and was pleased with how Carol is healing from those as well. The previously irradiated skin is healing fine. She wants to see Carol in about another month as a last checkup from the surgery.

From a tumor staging standpoint, this makes her status at surgery as ypT0 ypN0. The “y” means that she had neoadjuvant chemotherapy before the surgery; the “p” means that it was determined by a pathology stain; the T and N are for the primary tumor (T) and lymph node (N) sites respectively; and “0” means zero evidence of any active cancer.

This is much better news than either of us had hoped for. Carol could still feel the mass of the tumor (it was 5cm in size) before the surgery, but the mass that was still there was just fibrous dead tissue. The chemotherapy and Keytruda did the job we hoped it would when we first started this process back in May. [SIDE NOTE: The FDA just approved Keytruda for use in advanced triple-negative breast cancer cases; Merck has applied for a broader approval that would be more for cases like Carol’s – that is still under review].

Medical oncologists call this kind of cancer stage as pCR (Pathological Complete Response) to the treatments they have been giving. Achieving pCR in treatments for triple negative breast cancer essentially doubles the statistical chances of long term survival from cancer from about 40% to around 80% according to a recent paper by Min Huang and coauthors in the American Association of Cancer Research.

By no means was this the last step in Carol’s treatments – she’ll still be getting physical therapy, radiation, and more Keytruda over the next few months (plus there is still another surgical drain to come out). But for now, it’s time to strike up the band and dance.