Facing breast cancer with an inspirational attitude

Facing breast cancer with an inspirational attitude

Shyla Bodge feels so strongly about cancer awareness that she took her message to the skies.

On Oct. 19, the last day of her radiation treatment for breast cancer, she hired a biplane to fly a banner over Cape Cod Hospital in Hyannis that read: "Cancer Awareness!!! Stay positive and fight!!"

It is a message she took to heart after her diagnosis this past spring, and subsequent chemotherapy and radiation treatment.

"I'm very fortunate that I have a huge power of positivity," Bodge said. "Your mindset needs to be positive to work through anything like this. Sometimes being strong is the only choice you have."

Her Journey Begins

Earlier in the month, she had gone for her annual mammogram at Cuda Women's Health Center in Hyannis, and the radiologist saw something concerning on the scan. She was asked to come back for a biopsy on March 24 and less than a week later, she got the disturbing news through her MyChart, the medical system that allows patients to see and manage their care at Cape Cod Healthcare. As lead EEG technician at Cape Cod Hospital, she is familiar with MyChart and knew the news was urgent.

In March of this year, Bodge received the news no one wants to hear: You have cancer.

"I opened one notification and all I saw was the word 'metastatic'" Bodge said. "And then my phone rang." It was Cuda Center nurse practitioner/breast health navigator Pat Ryan-Blanchard asking her to come in immediately to discuss her results. Bodge said she knew it was not good.

Ryan-Blanchard scheduled her for a consultation and further testing with Cape Cod Hospital breast surgeon Jill Oxley, MD, FACS.

After receiving the traumatic news, Bodge said she left the Cuda Center that day, and when the doors opened, she made a promise to herself, saying 'Shyla, cancer is NOT going to define you!'

"When things like this to happen to me, I set a base, and I kept that in my mind the whole way through."

She also drew on a difficult challenge she had faced earlier in her life. On her 16th birthday, she was in a serious car accident, suffering a traumatic head injury and nearly losing her life. She was taken by Medflight to a Boston hospital, and afterwards, had an extensive recovery and had to relearn to walk, talk, read and write.

Bodge believes that everything that has happened in her life, including the car accident, was meant to be.

"It was part of my path, and it has made me who I am and led me to where my life is exactly supposed to be," she said. "It led me to my career, my beautiful daughter and I found my soul mate."

A Unique Case

Once Bodge knew she would need breast cancer surgery and follow-up treatment, she decided right away that she would receive all her care at Cape Cod Hospital.

"I had all the confidence in the world in my care team at the hospital," she said.

Dr. Oxley explained that Bodge's situation was unique because the cancer had metastasized to the lymph nodes, but they could not locate the originating tumor.

"The way she presented was with an abnormal mammogram," she said. "They didn't see anything abnormal in the breast, but they saw abnormal-looking lymph nodes in her right underarm. So, the radiologist brought her back for additional imaging and ended up doing an ultrasound-guided core needle biopsy of one of the axillary lymph nodes and that showed breast cancer."

A follow-up MRI was done to see if cancer could be seen within the breast.

"Sometimes, especially in women who have dense breast tissue, it may not show up on a mammogram. But we did the MRI and no tumor showed up in the breast on the MRI either," Dr. Oxley said.

Historically, if someone presented with cancer in the lymph nodes, they would need a modified radical mastectomy, but breast surgeons and oncologists now know there is no survival benefit from that, she said. The surgery that Bodge had is called an axillary lymph node dissection. Typically, breast surgeons remove between 10 and 20 lymph nodes. In Bodge's case, Dr. Oxley removed 14 lymph nodes and found two that had cancer.

"What's a little bit different in her situation is that we know lymph node surgery isn't treating the cancer," Dr. Oxley said. "Lymph node surgery is really part of staging so that we can best determine what the most appropriate treatment will be after surgery."

On to Medical Oncology

Next Bodge moved on to chemotherapy treatment with medical oncologist Jaclyn Flanigan, MD.

"We call it an occult breast cancer when someone presents with a positive lymph node or it has spread to the lymph node, but you can't find the primary tumor in the breast," Dr. Flanagan said. "That's actually really rare. Less than one percent of all breast cancers presents as occult cancers."

Dr. Flanagan said there are several theories for why occult breast cancer occurs:

• The primary tumor is so microscopic that it can't be seen.
• The tumor self-regressed because the body's immune system fought it.
• The breast tissue is too dense to see a tumor.

Dr. Flanigan also explained that even though the word 'metastasized' is accurate because the breast cancer had spread to Bodge's lymph nodes, most people immediately associate the word 'metastatic' with stage four breast cancer. However, Bodge had early-stage breast cancer that had metastasized to the lymph nodes.

"The goal of Shyla's treatment is to cure her," Dr. Flanigan said. "People ask me, 'when am I cancer-free?' and I say, 'to the best of our ability the day you had your surgery.' Everything else is sort of an insurance to try to reduce the risk of recurrence in case a little microscopic cell escaped."

Bodge's Treatment

When Dr. Flanigan described the different treatment choices for chemotherapy, Bodge opted for the most aggressive one. She received chemo every other Thursday for four months.

"Her treatment was dose-dense chemotherapy, and she, rightfully so, referred to it as aggressive chemo," Dr. Flanigan said. "In order to give high doses of chemotherapy every two weeks she also had to receive something called Fulphila or granulocyte colony stimulating factor which helped her bone marrow make white blood cells to help protect her from infection, because we're giving these high doses of chemo that are going to suppress her bone marrow and increase her risk of infection."

Fortunately, Bodge didn't have too many adverse side effects from the chemo, and she was able to continue working every day. In anticipation of her hair falling out, she bought custom wigs, but in the end decided to just embrace her new reality and not wear one.

She was very nervous about going to work with no hair, but the responses she got were overwhelmingly positive and she was surprised to learn that she was an inspiration to others.

"I did it because I had to feel comfortable with myself," Bodge said. "Working here is definitely a blessing because through all of this I have such an amazing support system."

On the day of her last chemotherapy treatment, Bodge invited her friends to join her. After it was over, she rang the celebratory bell so hard she broke it - something Dr. Flanigan said had never happened before.

"Shyla has had an incredible attitude throughout this journey," Dr. Flanigan said. "She couldn't be more upbeat and positive."

End of Chemo, Then Radiation

Bodge then moved on to radiation treatment and underwent 15 rounds of radiation under the care of radiation oncologist Ethan Glazener, MD.

"We refer to 15 treatments as hypofractionation and she needed radiation to her entire breast and lymph nodes - what we call regional lymph node irradiation, Dr. Glazener said. "So, it's a little more radiation than usual. Some women we just have to radiate the breast. When it's in the lymph nodes, we often have to radiate the lymph nodes.

"The one nice twist in her favor is that we now have solid 10-year data substantiating that we do not have to do 25 treatments and can do it in 15 safely and effectively."

The data has now matured to the point that he feels very comfortable reducing the number of treatments while simultaneously upping the dosage with each treatment. The overall takeaway for patients is a shorter number of treatment sessions.

Going forward, Bodge will go back to Dr. Flanigan for anti-estrogen therapy called an aromatase inhibitor and, since she had lymph node involvement, she will also take a newer medication called a CDK inhibitor. The two taken together are more effective in reducing the risk of recurrence for higher-risk breast cancer, according to Dr. Flanigan.

"It's a lot of therapy, multimodality, but all of this was done with the goal of curing her," she said.