Yesterday at the oncology consult, I asked my oncologist why the radiology report on my CT scan of this past Monday only referenced two tumors, when I have three in my liver. They followed up with this email later that afternoon:
"I just got into the imaging system, and the 3rd lesion is not well seen on the current scan, it appears to be gone."
That's one down, two go! Rumsfeld is dead (or at least shrunk below the scanning resolution margin of error, +/- 5 mm). Only Bush and Cheney remain.
The lack of growth in the two larger tumors over the past eight weeks is in and of itself encouraging. I asked if lack of growth and shrinkage were equivalent processes, i.e., a spectrum of results, or if they were separate. Both my oncologist and their resident essentially shrugged at this question, saying lack of growth is a good result. Given that the tumors grew 50% in the four weeks prior to beginning chemo, I'm fine with this.
The oncology resident noted that the mild shrinkage in the largest tumor was more of a reconfiguration. Again, per the above, we're focused on lack of growth.
Discussing the CEAs, the resident pointed out that as we hadn't tested since before the start of chemo, the result we saw just now could as easily have been the downward trend of a spike right after the last test. Which had we known that would have been a lot less alarming. We have agreed to start checking my CEA levels every time we do bloodwork for chemo prep.
Both my oncologist and their resident seemed surprised at how healthy my blood chemistry was overall. The resident was also extremely surprised that I exercise every day.
I also queried a couple of minor items on the CT report, just to make sure of my own comprehension.
We had a discussion about whether or not it might make sense to prescribe me low dose Ritalin to deal with the chemo fatigue. (This is used by some oncologists, but not others.) My oncologist felt the science behind this application of Ritalin wasn't solid, and that I risked other complications from the Ritalin that would offset what they considered marginal benefits. Though they didn't phrase it quite this way, what I took out of the conversation was that Ritalin might make me feel more awake and focused, but it wouldn't do anything to address the underlying fatigue, and I would be at risk for making myself worse off by overdoing things.
The net result of all the recent tests is no changes in the current treatment plan or medications. (This is a good thing, as almost any changes we might have made would have been to the worse.)
Barring unexpected developments, I’ll be out 11/30 through 12/3 for chemo and recovery. I’ll be out again 12/14 through 12/17. Then I'll take a break and recover for surgery.
I’ll have a CT scan around the end of the year sometime, then meet with my surgical oncologist right before or right after New Year’s, and have surgery probably sometime the week of January 14th. That will have me in the hospital about 4-5 days, and out of work 7-10 days inclusive of the hospital time and depending on how things fall over the weekends, through the second half of January.
At that point, we’ll evaluate whether to do the next six chemo courses February-March. I believe the plan is to continue, but we may have some different ideas once the surgical report and biopsy are in.
Not so good but completely unsurprising news:
The oncology resident remarked offhandedly (while my oncologist was out of the room) that in cases of recurrent metastatic disease, they don't really expect to achieve a cure. Rather, we're playing for time and trying to stay ahead of it. This jibes with what I've been told before by everyone, including my oncologist, but was far more blunt than most oncology clinicians are willing to be with me. Take that for what it's worth.