Passing My Tests

On September 7, I had two more scans, meant to determine definitively what the effect of my summer’s radiation treatment had been. I’d had one earlier post-radiation CT scan on August 21, but that was meant to make sure that the various side effects I was feeling were in fact side effects rather than something else. These two were focused on whether the radiation had been successful against my tumors – the critical question.

Why two? Because the two scans had overlapping functions. The CT scan looks for actual physical masses, such as tumors. But even if you find a mass you don’t necessarily know what kind of object you’re looking at. The other scan, the PET scan, doesn’t look for physical masses but for activity: if the scan picks up signals of “avidity” – essentially, high consumption of energy, which is characteristic of cancer – that’s a bad sign. What you especially don’t want is for the scans to coincide, as they do if the CT scan finds suspicious physical spots and the PET scan finds those spots fit with cancerous energy consumption.

My scans have now been read by three MSK physicians (and by Teresa and me). They’re pretty technical documents, so we needed the doctors’ translations. But in another way they’re also pretty simple: that is, if the scans are good the doctors are pleased, and if the doctors are pleased then we’re pleased.  All three doctors were pleased; in fact, I think it’s fair to say they were all very pleased. And so we are too!

What the scans showed was first, that all the tumors MSK was attacking with the radiation were now smaller. They hadn’t disappeared, but they were smaller. Second, the signs of extra hunger in the locations of those tumors had also largely disappeared; energy consumption in those areas was now roughly the same as in the normal, unaffected parts of my liver. And, third, the only instances of either physical locations or energy consumption that were at all out of line did not coincide with each other, and so the doctors weren’t worried by these.

In short, the doctors just weren’t worried. The radiation, delivered by the latest techniques so as to give my tumors a high and lethal dose, appears to have done just that. So what do I do now? The answer is: nothing. My next scans are in two or three months; between now and then I won’t receive any treatment for cancer itself, and if the next scans are similar, that will continue.

I should add that though I have no cancer treatment scheduled now, I will continue to have treatment for side effects, such as stomach problems and intense fatigue, and for the side effects of the side effects medicine. Sigh. It was because of possibilities like these that I had yet another scan on September 18. As readers of this blog will recall, one night some weeks ago I had trouble staying upright as I went for a walk, and I’ve also felt from time to time that I’m losing track of my own arguments in conversation. 

With those in mind I had a brain scan. This is an interesting experience in its own right; as the patient, your head goes into a helmet/camera lens which looks a bit like the helmets worn by the evil Empire soldiers in the Star Wars movies, and then you spend 30 minutes being motionless while they scan your brain. The idea of anything out of place in your brain is scary, of course, but the radiation oncologist told us in advance that these scans are usually given to rule out possibilities rather than because the doctors expect to find trouble, and happily that turned out to be the case for me: there’s nothing going on inside my brain except the usual, flawed as that may sometimes be!  I think the moments when I don't seem to be functioning as acutely as I want to are expressions of the fatigue that the radiation has caused me.

Finally, as to my prognosis, I specifically did not ask the doctors to give it a number, and they didn’t, but what the radiation oncologist said is that my prognosis depends on what if anything emerges next; what I already had has been so thoroughly attacked, it appears, that it is no longer a factor. This isn’t quite “NED” – No Evidence of Disease, the modern phrase that doctors use instead of “in remission.” But it does appear to be the next best thing, which I’ll make up: “NEAD” – No Evidence of Active Disease. We certainly didn’t count on achieving this state of affairs back in November 2015 when I was first diagnosed with this insidious, but as we’ve learned not all-powerful, cancer. I’m very grateful to MSK and to Teresa, and others, for all the help they gave me in getting to this point.