Thursday, October 27, 2011

A peek inside

I'm going to make this one a bit short as the details are still murky, incomplete, and confusing.

Yesterday I had an MRI, the first since July 1st, the day after my surgery.  Between then and now I've undergone thirty radiation treatments concurrent with 45 days of low-dose chemotherapy, as I've described in gripping detail.

The good news is that everything has either stabilized or improved.  The greatest areas of improvement were along the corpus callosum and into my right hemisphere, which were the most delicate areas.  The corpus callosum is a pretty important structure and we'd much rather keep the cancer restricted to a single hemisphere than have to deal with something transaxial.  That's not to say they've completely eliminated the cancer from those regions; that much is impossible to tell.

However the parts that stabilized were the parts that gave us the most concern.  My original MRI showed two areas of enhancement that lead my oncologists to believe my cancer had recently advanced to a grade 3.  I mentioned this in an earlier post, how they took three weeks to do the pathology, to make absolutely sure they didn't find any grade 3 tissue, and how they didn't, but how they obviously could not test the cells that remained in my head.  Well, those are the two little dots that have stabilized.  They haven't grown any, but my oncologist believes they're still cancerous and still alive.  And they are the most aggressive cells.

He didn't use the term "grade 3," and I don't think he would if pressed.  Instead, he said he thinks that part of the tumor was in "transition."  In other words, it's a grade 2 but we caught it in the middle of becoming something more aggressive.  I guess that means it's a "fast" grade 2, or maybe a "slow" grade 3.  A grade 2.5.  Mid-grade cancer?

I'm reluctant to call this bad news because we aren't really sure what it means.  It's good that it doesn't appear to have grown any but we don't know what it's going to do from here.  We don't have a clear answer on how to treat it, or if we should even treat it at all.  There's also a small possibility that what we saw on the MRI was an artifact left over from the radiation treatment; some sort of swelling or scarring.

We have decided on what they call a 5/28 treatment.  I will take chemotherapy at twice my previous dose, for five consecutive days every month.  Every month they'll check my blood and if they see any problems, they'll stop the treatment.  Every other month, I get another MRI to see how things are going.  This isn't an uncommon treatment, it's just not certain what sort of effect it will have on my particular cancer.  It may kill the problem areas.  It may do nothing at all.  It may even cause me harm without any benefit whatsoever.  The current plan is to do this for a full year, depending on how well I tolerate it.  At that point we'll decide whether or not to do it for an additional year, but the drug manufacturer recommends against taking it longer than that.

We have no idea if this is the right thing to do.  My oncologist believes it is, so for the time being I'm going to defer to his expert opinion, while I make a few calls for second opinions (this oncologist is not the one I've been working with since June, after all).  He told me about a patient with GBM4, a highly aggressive form of brain cancer where life expectancy is typically measured in weeks.  He said this patient had been on a 5/28 cycle for six years.  The fact that this patient was able to do anything for that long seems to speak to the treatment's merit.  That said, I do not have GBM4 and a single anecdote is not data.

We're all kind of flying blind here.  All I can do is hope that I tolerate the chemo as well as I did last time, and just keep fighting.

We literally have no other option.  We can't operate again.  They're worried if they try radiation so soon after the last dose it'll cause necrosis, which can be even more dangerous than the cancer itself.  It's chemo or nothing. 

On the plus side, I've been told that despite my lack of 1p/19q deletion, they expect me to respond well to chemotherapy.  There's a certain enzyme responsible for detecting and treating DNA damage, and mine doesn't seem to be working quite right, which I believe means my body isn't going to try to protect the cancer cells from the effects of the chemotherapy.  On the other hand, had this enzyme been working properly, I might never have gotten cancer in the first place.  That means I'm also more susceptible to secondaries.

I guess there isn't much point to pulling punches against the cancer that I have out of fear of a cancer that I don't.  That's what I'm going to tell myself, because I really don't need to start doubting my doctors and my decisions on top of everything else.

No comments:

Post a Comment