Wednesday, June 6, 2007

My Next Steps

This paragraph deals with the day’s logistics at the MD Anderson (MDA) Cancer Center; the next paragraph is a summary of the results. This paragraph is a bit lengthy. Feel free to skip it if my logistics really aren’t your thing. A friend picked me up at 5:40 AM and dropped me off at the hospital. Thank you. The PET scan began on time at 6:30 AM. The purpose of this scan in my case is to determine if the cancer has spread anywhere else in my body. There is no eating or drinking (except water) for 6 hours prior to a PET scan. I was injected with a liquid in which I believe a sugar substance (glucose) is attached to a radioactive molecule. You then need to rest for 60 – 90 minutes. No TV, no music, no reading, no moving. You’re in a little room about 8 by 5 feet in a Lazy boy-type recliner. It’s lights out. I may have dozed off for a bit. The actual scan takes about 25 minutes. I was through at 8:45. I had them leave the IV in hoping I could avoid another needle stick later in the day. I stopped by the CT scan area at 9:00 to see if they could move my scan up. It was scheduled for 5:30 PM. This test is more specific, in my case, to my neck area. They said they might be able to, but I needed my blood test first. I had blood drawn at 9:15. They had to stick me again because the IV line I had was used in the PET scan and could be contaminated. I went back to the CT scan area. They said they could take me sooner, but I needed to wait until my blood analysis was finished. They post the results online within MDA in anywhere from 30 minutes to 2.5 hours. I visited the dental oncology clinic as a walk-in. I had tried to see them on a few occasions during the past 6 weeks, but either they or I were running late and it had not worked out. I lucked into the shortest wait ever for this clinic. My dental oncologist examined me and provided the advice I was seeking. I was back at the CT scan area by about 10 AM. Unfortunately, my blood analysis results were not posted until just before noon. As soon as they were posted, I had my CT scan with contrast. They were able to use my IV from the PET scan. They injected iodine into me and scanned my neck and head area. I was done by 12:30 and checked in for my 1:00 PM chemo doctor’s appointment. My wife joined me shortly before 1:00. We were seen at about 2:15. There was a preliminary radiologist’s dictation of the CT scan results by this time. That timing is pretty good, less than 2 hours after the scan. There were no preliminary results on the PET scan yet, but my oncologist brought up the images on the computer in my exam room and did a real-time preliminary assessment. We left MDA at 3:00 PM, about 4 or 5 hours earlier than had been scheduled. Yahoo.

The preliminary results showed no surprises. Final results take 3 to 4 days. This allows the radiologist to review this scan versus prior scans and to discuss the results with my doctors. So, I qualify what I write here with the emphasis on PRELIMINARY. The PET scan showed no cancer in my body outside of the lymph node in my neck. The CT scan showed the same thing. There is one lymph node under the right side of my jaw line which shows increased metabolic activity. In layman’s terms, it is consuming more sugar than normal cells, indicating that it is cancer. So, my chemo over the past 5.5 months has had a positive effect, but it has not eradicated the disease from my body. So now what?

The decision tree here becomes very complicated. The chemo course I had has plateaued. So, leaving me on that longer isn’t really useful. It is actually harmful. That lymph node and a few surrounding it could be removed surgically. The surgery would require me to be under full anesthesia, but it is not a major surgery, just one or two nights in the hospital followed by lots of physical therapy to regain movement of my neck. The issue with removing the lymph nodes is that there is probably cancer still elsewhere in my body; it just isn’t big enough to be seen by the current scanning technology. My surgeon doesn’t want to do any more surgery on me, but he will if the chemo doctor and I decide it’s the best course of action to pursue. If he removes the lymph nodes, there is a very good chance it will pop up elsewhere in the near future and the place that it pops up will be difficult to treat surgically. My chemo doctor will talk to my surgeon tomorrow. Ideally, he would like to put me on the chemo drug Erbitux. Unfortunately, I tried this drug in December and had an immediate adverse and severe allergic reaction. This is the latest approved chemo drug for Head and Neck cancer. I’ve heard that less than 10% of people are allergic to it. There are other promising drugs out there, but they have not yet been approved by the FDA for my type of cancer. They run about $400 a day for a pill. (And I thought the Tarceva at $200 a day was expensive!) There are also some phase I clinical trial studies which are one step above tests on animals and are really a crap shoot. I’ll talk to my chemo doctor on Friday, and I’m scheduled to meet with my surgeon this coming Wednesday. Together we’ll unravel this tree and work up my next steps. Ideally, we’ll find a chemo regimen that will take care of this lymph node and eradicate the other unseen cancer. This may be a pipe dream, but I’m an optimist.

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