- In 2014, Amy Mannarino underwent treatment for breast cancer at Memorial Sloan Kettering.
- Three years later, she had a seizure, and doctors discovered a mass on her brain.
- She went back to MSK, where she met neurosurgeon Viviane Tabar.
- Dr. Tabar removed the tumor, which was a recurrence of the breast cancer.
- Amy underwent three treatments of radiation therapy and is now back to her normal activities.
Amy Mannarino knew something wasn’t right when her arm started trembling.
It was October 2017 and “just a regular Saturday,” recalls the mother of two from Long Island. “My husband was making soup, and my son was getting ready for work. All of a sudden my arm started twitching, and when I stretched it, it twisted.”
The next moments were a blur. The right side of Amy’s body went numb, so she sat on the floor while her husband, John, called an ambulance. Amy, who is now 55 years old, thought she was having a stroke. At a nearby hospital, doctors did an MRI and found what they thought was a meningioma, a benign brain tumor.
But Amy told the doctors that she had a history of breast cancer. She knew there was a chance that the cancer had come back and spread to her brain.
Calling on Her Network
Back in November 2014 after a routine mammogram, Amy was diagnosed with stage I breast cancer. She went to MSK Commack, where surgeon Lisa Sclafani performed a lumpectomy. Afterward, Amy learned that chemotherapy might not work on her specific type and stage of cancer, so she was prescribed a daily medication called tamoxifen (Nolvadex®) to keep the disease at bay.
But Amy had trouble tolerating the medicine, so in February 2015, she underwent a mastectomy. That summer, MSK plastic surgeon Evan Matros performed reconstructive surgery. After she healed, Amy got back to working as a school guidance counselor and building her life-coaching business.
Amy had developed a close bond with Dr. Matros, so when she found herself in the emergency room on that fall night in 2017 with a possible meningioma, she called him for advice.
“He’s been fabulous,” Amy says. “My intuition told me to go back to MSK, and my gut never steers me wrong.”
Amy left the hospital with a prescription for seizure medication and a recommendation from Dr. Matros to see Viviane Tabar, Chair of MSK’s Department of Neurosurgery.
Birds of a Feather
Dr. Tabar’s nurse, Jenna Longo, called Amy before her first appointment.
“I speak with most patients prior to their first visit because I find it reduces their anxiety and builds a relationship,” Ms. Longo says.
And after meeting Dr. Tabar, Amy knew her gut instinct was right again.
“She was straight to the point, and I love that because I’m a no-nonsense person,” Amy says. “I trusted Dr. Matros to guide me to the right surgeon because birds of a feather flock together.”
Dr. Tabar determined that the tumor’s location was very close to a part of the brain that controls movement, which is why Amy had that frightening seizure. Even though the tumor presented as a meningioma, Dr. Tabar saw swelling around the area that gave her pause.
“At MSK, we have a lot of experience seeing all kinds of tumors, and I suspected that this was likely not a benign meningioma,” Dr. Tabar recalls. “In fact, I thought that this was a metastasis from the breast cancer. I took a minute to think of a gentle but clear way to present this to Amy. I did not want her to panic but to keep her fighting spirit.”
Usually, if early-stage breast cancer spreads, or metastasizes, it does so to other areas of the body before the brain. Amy’s case was unusual. Dr. Tabar said she wanted to take out the tumor, which was on the left side of Amy’s head and controlled her dominant right side. There was a small chance that Amy’s motor skills would be affected by surgery, but forgoing it would only give the tumor an opportunity to keep growing. The procedure was also important to diagnose the nature of the tumor.
“Whenever you propose surgery, you’re proposing risk, but we try to analyze risk in light of the benefits,” Dr. Tabar says.
Amy was relieved when Ms. Longo told her that her hair would cover the incision scar.
“It’s very important to help patients see beyond this big event, and it helps a lot if we’re sensitive to details,” Dr. Tabar says. “It’s important for them to see they’ll go back home and go back to being in control of their lives.”
Once the tumor was out, Dr. Tabar thought Amy would be an excellent candidate for radiation therapy to treat the postoperative cavity, the area where the tumor was touching her brain before the surgery. If she underwent radiation after surgery, the tumor had a lesser chance of returning. But if she didn’t, the odds of it coming back were much higher. Dr. Tabar referred Amy to Kathryn Beal, a radiation oncologist who specializes in metastatic brain tumors.
Amy felt comfortable with the plan and decided to move forward. She also felt reassured to be cared for by a well-connected team dedicated to treating these issues.
On the Road Back to Health
Amy had surgery at Memorial Hospital in October 2017. She had a brain-mapping test before surgery that confirmed the tumor was in the area that controls hand movement. The operation itself was two hours. The postoperative MRI showed that Dr. Tabar had successfully removed the entire tumor, which was indeed a breast cancer metastasis.
When checking on Amy in the recovery room, Dr. Tabar was thrilled with what she saw.
“I remember feeling great relief when I saw her moving her hand and arm very well,” she recalls. “I immediately knew that everything went well.”
Amy recovered in the hospital and then returned home. Soon after, she met with Dr. Beal and began radiation. She tolerated her three sessions of radiation very well, with essentially no side effects. She also met neuro-oncologist Craig Nolan, who now monitors Amy for any changes to her brain in the future. Dr. Tabar remained in close contact with both of them long after Amy’s surgery.
“It’s very important to maintain a continued discussion among all the treating doctors,” says Dr. Tabar. “We made sure everyone was connected.”
Amy was impressed to see all of her doctors working together for her.
“I love jewelry, and MSK is like Tiffany’s,” Amy says. “Everybody is very professional. They tell you exactly what they’re doing when they’re doing it.”
“Cancer Makes You Come Alive”
Amy took time off from work so that she could heal after surgery and radiation, but she’s doing well now. She has no evidence of disease and is even grateful for the challenges she endured.
“Your life is forever changed when you get cancer,” she says. “But cancer makes you come alive. We’re given the opportunity to say the things we want to say and do the things we want to do. I look at this as a gift.”
Her optimism left an impact on Dr. Tabar.
“I knew she was concerned, but she handled it beautifully,” she says. “This is a two-way street: When the patient signals that they’re ready to take care of the situation, that, in turn, is very helpful to the doctor. Amy is one of those people with an infectious smile and a generous spirit that positively impacts people around her.”
EDITOR’S NOTE: A previous version of this story incorrectly stated that Amy is “cancer free.” That was not accurate. Amy currently has “no evidence of disease,” which is an important distinction to make in the context of metastatic disease. We regret the error and appreciate our astute readers for pointing out our mistake.
