We had a mini-crisis overnight and this morning where there was some questioning amongst family members as to whether total brain radiation was indeed the best initial course of action. After a lot of research and phone consultations with doctors today, we are back on track and confident that for my particular situation, total brain radiation is indeed the way to go. So now I feel more confident going forward than I had before, which is important.
In the process of questioning the approach however, I had another phone conversation today with my radiation oncologist, Dr. L, that did not leave me feeling very warm and fuzzy. Quite frankly, I was completely turned off with his defensiveness and tone-deaf responses to my concerns and questions. We had similar problems during our long consultation last Friday and so, after today's phone call, I made a request to change radiation oncology doctors in order to have more confidence in this relationship as I go forward into treatment. As a result, my treatment will now start on this Wednesday, September 1 at 2:00 and I will be working with Dr. William Bloomer at Highland Park. He is the senior radiation oncologist there and hopefully will prove to be a better partner for my style and approach to cancer management.
Monday, August 30, 2010
Friday, August 27, 2010
Full Brain Radiation and Second Opinion
Today was an action planning day. The two doctors I spoke to regarding a second opinion both felt I should start full brain radiation immediately and their opinions would really be more focused on the treatment of the lung mass after the brain radiation. So the first day of full brain radiation is scheduled for Tuesday, August 31 at Highland Park Hospital.
I have an appointment scheduled with Dr. Philip Bonomi, a lung specialist at Rush Presbyterian Hospital highly recommended by three different people, for a second opinion next Thursday, Sept. 2 in the afternoon.
So the rest of the weekend should be time for rest, reflection of all that's gone on, preparation, and enjoyment of friends and family.
Thanks to you all for the constant thoughts, support, emails, calls and love - it has been so enriching and comforting.
I have an appointment scheduled with Dr. Philip Bonomi, a lung specialist at Rush Presbyterian Hospital highly recommended by three different people, for a second opinion next Thursday, Sept. 2 in the afternoon.
So the rest of the weekend should be time for rest, reflection of all that's gone on, preparation, and enjoyment of friends and family.
Thanks to you all for the constant thoughts, support, emails, calls and love - it has been so enriching and comforting.
PET Scan and Radiation Oncology Consultation
The Short Version
The PET scan today revealed no additional cancer in my body - very good news! At the consultation with the radiation oncologist, Dr. L at Highland Park Hospital, the recommended course of action was 13 treatments of full-brain low-dose radiation over 3 weeks followed by chemotherapy to address the cancer in the lung and other microscopic cells that may be stealthily carrying cancer in my body.
Based on the fact that I have no detectable cancer in other sites, am asymptomatic for the lung cancer, young, otherwise healthy and have small mass and lesions; the doctor believes I have a good chance of being one of the 20% of outliers exceeding the 2 year life span.
Next step is to get a second opinion ASAP and we are going after two local well-reputed doctors for this. Our hope is to have the second opinion by next week so treatment can commence by a week from Monday at the latest.
The Longer Story
I had the PET scan this morning. They inject a radioactive glucose compound into your system and let it settle in for 40 minutes or so before then using a proton emitting scanner to search for other cancer sites (it strikes me as very strange that to help me, they are mainlining me with radioactive substances). The actual PET scan consistes of me laying completely still on a board that moves back and forth under the scanner for about 20 or 25 minutes to complete the scan.
We got good news this afternoon that the results of the PET scan showed the cancer has not progressed to any other sites beside the primary lung mass and the brain lesions - it is not in the glands or lymph nodes or anywhere else. This is very positive news!
The consultation was probably one of the longest one poor Dr. L has ever had. Doug, my sister Susan and I grilled him mercilessly to get a complete understanding of the approach he wants to take, the reasons for it, alternatives, risks and benefits. We were there for over two and a half hours. In a nutshell, Dr. L believes the best course of action for my condition is likely to meet a pretty significant general consensus, but we still intend to get at least a second, and possibly a third opinion to verify. The plan as he explains it is to do 13 treatments (once a day, 5 days a week for about 5-7 minutes total, including prep, each time) of low dose total brain radiation. The reasoning behind this is that there are likely microscopic cancel cells that don't appear in the MRI that we need to get ahead of before they bloom into lesions that can cause more problems. The other option of using higher focused radiation on the 5 identified sites would actually lead to a higher overall dose of radiation and could miss those microscopic cancer cells. I would have some fatigue, lose my hair and may have a loss of appetite. There is also a risk of some short-term memory loss but that wouldn't become apparent for a long time after the treatment is complete. The radiation causes more inflammation in the brain, which is treated with oral sterioids, which carry their own side-effects but seem relatively manageable. After the 13 treatments, they wait 3-4 weeks before doing another MRI to allow the inflammation in the brain to subside and then see how the lesions reacted. If there are still lesions present, they are then evaluated, monitored and may be treated with a more focused form of radiation or other therapy for removal or reduction. MRIs would continue to be taken every 2-3 months or so for the rest of my life to watch for lesions.
After the initial radiation therapy, we would then look at chemotherapy to address the cancer from the lung mass. It seems like the damage from the lung cancer has already been done since the cancer got into the blood stream and found its way to my brain. The lung mass itself does not seem like it will be any more of a threat than it already has been. However, there again are likely to be microscopic cancer cells in my body that have traveled from that lung mass and the chemo would be used to destroy these. The behavior of the lung mass throughout the course of chemotherapy would be an indicator of our success with the microscopic cancer cells we can't actually see. The chemo would commence somewhere between one day and four weeks after the full brain radiation treatment is finished. There are many courses of chemotherapy available and we don't know yet which course would be the one to apply. There is also flexibility in changing the chemotherapy course midstream if it is not working or is causing other problems. Each different type of chemotherapy comes with its own set of side effects and issues. I guess we cross that bridge when we come to it. We are still waiting for the results of the additional biopsy tests to see if I have the epidermal growth factor receptor (EGFR) genetic marker that would indicate I am a good candidate for the Tarceva drug therapy that has been having some success. This information should be available in the next few days. To the best of my understanding, this drug exploits specific proton functions in a cell so that it inhibits the cancer from spreading. I will have to continue to have CAT scans every 3 months to monitor the cancer in my blood stream for the rest of my life as well.
Because of the fact that the cancer has not spread beyond the lung and brain; that I do not have any symptoms that are caused by the lung mass; that the mass and lesions are small; and that I am overall healthy and young; Dr. L seems to believe I am a good candidate for exceeding the typical lifetime of a lung cancer patient. He says that 20% live beyond 2 years and I could very likely be in that 20%. And "beyond" is wide open to interpretation.
Our next steps are to quickly get that second opinion. With help from family and friends, we have honed down the prospects to a doctor at University of Chicago and one at Rush-Presbyterian, both highly recommended and with excellent reputations. I will be calling them tomorrow to try to set up appointments ASAP. We hope to have our second opinion completed by next week so I can begin treatment no later than a week from Monday. Time is of the essence to avoid a brain lesion causing irreversible damage, so no messing around here.
The PET scan today revealed no additional cancer in my body - very good news! At the consultation with the radiation oncologist, Dr. L at Highland Park Hospital, the recommended course of action was 13 treatments of full-brain low-dose radiation over 3 weeks followed by chemotherapy to address the cancer in the lung and other microscopic cells that may be stealthily carrying cancer in my body.
Based on the fact that I have no detectable cancer in other sites, am asymptomatic for the lung cancer, young, otherwise healthy and have small mass and lesions; the doctor believes I have a good chance of being one of the 20% of outliers exceeding the 2 year life span.
Next step is to get a second opinion ASAP and we are going after two local well-reputed doctors for this. Our hope is to have the second opinion by next week so treatment can commence by a week from Monday at the latest.
The Longer Story
I had the PET scan this morning. They inject a radioactive glucose compound into your system and let it settle in for 40 minutes or so before then using a proton emitting scanner to search for other cancer sites (it strikes me as very strange that to help me, they are mainlining me with radioactive substances). The actual PET scan consistes of me laying completely still on a board that moves back and forth under the scanner for about 20 or 25 minutes to complete the scan.
We got good news this afternoon that the results of the PET scan showed the cancer has not progressed to any other sites beside the primary lung mass and the brain lesions - it is not in the glands or lymph nodes or anywhere else. This is very positive news!
The consultation was probably one of the longest one poor Dr. L has ever had. Doug, my sister Susan and I grilled him mercilessly to get a complete understanding of the approach he wants to take, the reasons for it, alternatives, risks and benefits. We were there for over two and a half hours. In a nutshell, Dr. L believes the best course of action for my condition is likely to meet a pretty significant general consensus, but we still intend to get at least a second, and possibly a third opinion to verify. The plan as he explains it is to do 13 treatments (once a day, 5 days a week for about 5-7 minutes total, including prep, each time) of low dose total brain radiation. The reasoning behind this is that there are likely microscopic cancel cells that don't appear in the MRI that we need to get ahead of before they bloom into lesions that can cause more problems. The other option of using higher focused radiation on the 5 identified sites would actually lead to a higher overall dose of radiation and could miss those microscopic cancer cells. I would have some fatigue, lose my hair and may have a loss of appetite. There is also a risk of some short-term memory loss but that wouldn't become apparent for a long time after the treatment is complete. The radiation causes more inflammation in the brain, which is treated with oral sterioids, which carry their own side-effects but seem relatively manageable. After the 13 treatments, they wait 3-4 weeks before doing another MRI to allow the inflammation in the brain to subside and then see how the lesions reacted. If there are still lesions present, they are then evaluated, monitored and may be treated with a more focused form of radiation or other therapy for removal or reduction. MRIs would continue to be taken every 2-3 months or so for the rest of my life to watch for lesions.
After the initial radiation therapy, we would then look at chemotherapy to address the cancer from the lung mass. It seems like the damage from the lung cancer has already been done since the cancer got into the blood stream and found its way to my brain. The lung mass itself does not seem like it will be any more of a threat than it already has been. However, there again are likely to be microscopic cancer cells in my body that have traveled from that lung mass and the chemo would be used to destroy these. The behavior of the lung mass throughout the course of chemotherapy would be an indicator of our success with the microscopic cancer cells we can't actually see. The chemo would commence somewhere between one day and four weeks after the full brain radiation treatment is finished. There are many courses of chemotherapy available and we don't know yet which course would be the one to apply. There is also flexibility in changing the chemotherapy course midstream if it is not working or is causing other problems. Each different type of chemotherapy comes with its own set of side effects and issues. I guess we cross that bridge when we come to it. We are still waiting for the results of the additional biopsy tests to see if I have the epidermal growth factor receptor (EGFR) genetic marker that would indicate I am a good candidate for the Tarceva drug therapy that has been having some success. This information should be available in the next few days. To the best of my understanding, this drug exploits specific proton functions in a cell so that it inhibits the cancer from spreading. I will have to continue to have CAT scans every 3 months to monitor the cancer in my blood stream for the rest of my life as well.
Because of the fact that the cancer has not spread beyond the lung and brain; that I do not have any symptoms that are caused by the lung mass; that the mass and lesions are small; and that I am overall healthy and young; Dr. L seems to believe I am a good candidate for exceeding the typical lifetime of a lung cancer patient. He says that 20% live beyond 2 years and I could very likely be in that 20%. And "beyond" is wide open to interpretation.
Our next steps are to quickly get that second opinion. With help from family and friends, we have honed down the prospects to a doctor at University of Chicago and one at Rush-Presbyterian, both highly recommended and with excellent reputations. I will be calling them tomorrow to try to set up appointments ASAP. We hope to have our second opinion completed by next week so I can begin treatment no later than a week from Monday. Time is of the essence to avoid a brain lesion causing irreversible damage, so no messing around here.
Wednesday, August 25, 2010
Biopsy Official Results
The Short Version
The official diagnosis from the biopsy is non-small cell adenocarcinoma. Non-small cell is good – less aggressive than small cell lung cancer. Sub-type adenocarcinoma may potentially make me a good candidate for a drug called Tarceva, which is getting some encouraging results. I will be having the PET scan tomorrow to look for any other potential cancer sites and will also meet with one of the radiation oncologists at Highland Park Hospital for a consultation on their recommended approach to treatment. They have already indicated they want to do full brain radiation to reduce the lesions in the brain as the first course of action. After these sessions tomorrow, we should have enough information to begin making decisions about where to go for second opinions and to get the best treatment.
The Longer Story
I received a call from the oncologist, Dr. Law, this evening. The official diagnosis from the biopsy is non-small cell adenocarcinoma. Non-small cell is good – less aggressive than small cell lung cancer. The fact that it is sub-type adenocarcinoma may potentially make me a good candidate for a drug called Tarceva, which is getting some encouraging results. This type of drug more specifically targets cancer cells and does less damage to normal cells. It targets a protein called the epidermal growth factor receptor (EGFR). EGFR, which helps cells to divide, is found at abnormally high levels on the surface of many types of cancer cells, including many cases of non-small cell lung cancer. Researchers think that by interfering with EGFR, Tarcera may keep tumors from growing. They will have to do additional analysis of my biopsy sample to see if I have the right markers in my cancer for this paticular treatment.
In the meantime, I will be having the PET scan tomorrow at 7:30 a.m. to look for any other potential cancer sites. This is done by injecting a glucose compound into the body which is drawn to areas of malignancy and inflammation, then scanning the body for the glucose accumulations.
At 1:30, I am scheduled to meet with Dr. Michael Lacombe, one of the radiation oncologists at Highland Park Hospital for a consultation on their recommended approach. They have already indicated they want to do full brain radiation first to reduce the lesions in the brain. The lung mass is of secondary concern at this point. I probably won't find out if I have the markers for the Tarcera treatment tomorrow (this would be for the lung mass anyway). I may get preliminary results from the PET scan by the 1:30 meeting though.
Once we have the information from tomorrow's sessions, my family and I will begin the work of determining where the best doctors and treatment centers are for my particular cancer type and decide where to get a second opinion (or even a third, if necessary).
The official diagnosis from the biopsy is non-small cell adenocarcinoma. Non-small cell is good – less aggressive than small cell lung cancer. Sub-type adenocarcinoma may potentially make me a good candidate for a drug called Tarceva, which is getting some encouraging results. I will be having the PET scan tomorrow to look for any other potential cancer sites and will also meet with one of the radiation oncologists at Highland Park Hospital for a consultation on their recommended approach to treatment. They have already indicated they want to do full brain radiation to reduce the lesions in the brain as the first course of action. After these sessions tomorrow, we should have enough information to begin making decisions about where to go for second opinions and to get the best treatment.
The Longer Story
I received a call from the oncologist, Dr. Law, this evening. The official diagnosis from the biopsy is non-small cell adenocarcinoma. Non-small cell is good – less aggressive than small cell lung cancer. The fact that it is sub-type adenocarcinoma may potentially make me a good candidate for a drug called Tarceva, which is getting some encouraging results. This type of drug more specifically targets cancer cells and does less damage to normal cells. It targets a protein called the epidermal growth factor receptor (EGFR). EGFR, which helps cells to divide, is found at abnormally high levels on the surface of many types of cancer cells, including many cases of non-small cell lung cancer. Researchers think that by interfering with EGFR, Tarcera may keep tumors from growing. They will have to do additional analysis of my biopsy sample to see if I have the right markers in my cancer for this paticular treatment.
In the meantime, I will be having the PET scan tomorrow at 7:30 a.m. to look for any other potential cancer sites. This is done by injecting a glucose compound into the body which is drawn to areas of malignancy and inflammation, then scanning the body for the glucose accumulations.
At 1:30, I am scheduled to meet with Dr. Michael Lacombe, one of the radiation oncologists at Highland Park Hospital for a consultation on their recommended approach. They have already indicated they want to do full brain radiation first to reduce the lesions in the brain. The lung mass is of secondary concern at this point. I probably won't find out if I have the markers for the Tarcera treatment tomorrow (this would be for the lung mass anyway). I may get preliminary results from the PET scan by the 1:30 meeting though.
Once we have the information from tomorrow's sessions, my family and I will begin the work of determining where the best doctors and treatment centers are for my particular cancer type and decide where to get a second opinion (or even a third, if necessary).
Tuesday, August 24, 2010
The Lung Biopsy
On Monday, August 23, I had a CT-guided lung biopsy performed by inserting a needle through my back and into my lung to pull out 4 or 5 tissue samples while they moved me back and forth into the CT scanner to make sure they steered the needle into the correct site - this was a somewhat difficult procedure since the mass is near my aorta. The procedure lasted about an hour and 15 minutes under pain medication and very light sedation - I had to be alert to breathe in and out when requested. As they take the samples, a technician evaluates them to see if they are good. At the end of the procedure they will be submitted for further staining and analysis. But after they finished the procedure, the doctor said that it looked pretty likely that the mass was lung cancer.
I will have the official report of the findings, including just what type of lung cancer it is, in about 3 days. There is a chance that my oncologist, Dr. Law, may be able to get an oral report sooner - perhaps on Wednesday. So now we wait.
I will have the official report of the findings, including just what type of lung cancer it is, in about 3 days. There is a chance that my oncologist, Dr. Law, may be able to get an oral report sooner - perhaps on Wednesday. So now we wait.
Background: How we got here...
The Short Version
Based on some tremors I was experiencing in my right hand starting June 8 and a single odd episode of speech disturbance on July 3, I saw my primary doctor and then was referred to a neurologist who suspected I was having partial seizures. After an EEG and MRI test were performed, they found several small lesions in my brain. An MRA (magnetic resonance angiogram of the blood vessels to the brain) and CAT scans followed, which revealed a small mass in my upper left lung. The doctors suspected lung cancer that had spread to the brain.
The Longer Story
The first sign of something amiss occurred on June 8, 2010 when I was taking notes for several hours for a training session. My right hand suddenly spasmed and jerked while I was writing. This happened several times that afternoon. Since that day, I have continued to have difficulty writing fluidly and have to concentrate on relaxing my arm and slowing down to keep my writing more legible. I initially attributed this problem to fine motor muscle fatigue, but as I said it continues to occur and it also became more frequent and now includes trembling at times when holding a glass or even a fork full of food.
The next sign came on July 3 at a barbeque when I had about a 15-minute episode where I could not speak the words for common concepts that I could almost visualize in my brain. It was very similar to a "tip of the tongue" situation, but I knew it was something different and could tell when it started and when it subsided. The last minute or so of this episode included some tingling in the tips of my right fingers. I thought this may have been brought on by dehydration, but checked the symptoms of dehydration on the web and found it was not a match. My next concern was a TIA, which is a warning mini-stroke. I sent an email to my doctor describing my symptoms. As it was a holiday weekend, she was not available, but I received a reply on July 5 from one of the associates at the practice saying I should make an appointment.
I did not rush to make the appointment in part because I didn't want to make this a big deal and in part because I was in the midst of a very busy travel season for work and leisure. I finally had my appointment with Dr. Caplan on July 23. She thought the tremors were intentional tremors and the episode was not too serious, but worth looking into further so she had me go to see a neurologist, Dr. Mary Angelopolous.
I had my appointment with Dr. Angelopolous on August 11. She suspected that the tremors and the episode with the speech problem were related and were possibly due to partial seizures. She ordered an MRI with and without contrast, and an EEG. I had the EEG on August 13 and the MRI on August 14. I was scheduled to have a follow up appointment with Dr. A on August 20, after I returned from another week of business travel.
But instead, on Monday August 16, Dr. A called me at 9:30 in the morning saying she wanted to see me that afternoon at 1:00. That's when I first knew there was trouble. I called Doug who came home immediately from work to be there with me at the 1:00 appointment. At the appointment, Dr. A told me that both the EEG and the MRI came back abnormal. The EEG showed slowed reactions in both parts of the brain and some sharp waves, indicating that I was having seizures. On the MRI, there were 4 or 5 small rounded lesions scattered across different parts of the brain. These were apparent both with and without the contrast, but lit up with the contrast, indicating inflammation. The possible causes she cited were cancer (most likely a secondary site), a blood clot that spattered in the brain, some kind of infection, or vasculitis (a swelling/inflamation of the blood vessels in the brain, potentially caused by some autoimmune disease).
Dr. A wanted me to cancel my business trip (I was to leave two hours after this meeting) and have more tests done ASAP. I was very reluctant to cancel my trip, but ultimately decided I should. So then I had an MRA (magnetic resonance angiogram that looks at the blood vessels in the brain) of the head and neck and a CAT scan of the chest, abdomen and lungs on Wednesday, August 18. She also put me on anti-seizure medication since the lesions had caused some short circuits in the brain's electrical system that led to the seizure I had on July 3 and could cause other more serious seizures if left untreated.
I had a follow up meeting scheduled with both Dr. Caplan, as my primary physician orchestrating all of this information, and with Dr. A, for Friday, August 20.
At the 11:30 meeting with Dr. Caplan on August 20, I learned that the CAT scan revealed a 2.5 cm x 1.4 cm mass in the upper left portion of my lung. The mostly likely prognosis was lung cancer that had already spread to my brain.
Dr. Caplan arranged for Doug and I to meet Dr. Theresa Law, an oncologist, that afternoon at 3:30. At that meeting, Dr. Law showed us the film of the CAT scan where the mass appeared and told us it was very likely that it was lung cancer.
She said that due to the fact that it had already spread to the brain, there wasn't much likelihood that surgical removal would be of much benefit. And because the lesions in the brain were so small and scattered in so many different places, surgery was unlikely for that as well. She said the likely timeline was six months to two years.
She said the top priority was to reduce and control the brain lesions, which would likely be done with radiation and then possibly followed by chemotherapy, but this was getting ahead of ourselves. The next step was to do a biopsy of the lung to determine if in fact it was a cancerous mass and if so, what type of lung cancer it is. The biopsy was scheduled for August 23. In the meantime, she prescribed a high dosage of steroids to begin to reduce the inflammation of the brain lesions. The next step would be to do a PET scan to determine if the cancer had spread anywhere else. This has not been scheduled yet.
We then had the weekend to try and process all of this information and start to share the bad news with family and friends.
Based on some tremors I was experiencing in my right hand starting June 8 and a single odd episode of speech disturbance on July 3, I saw my primary doctor and then was referred to a neurologist who suspected I was having partial seizures. After an EEG and MRI test were performed, they found several small lesions in my brain. An MRA (magnetic resonance angiogram of the blood vessels to the brain) and CAT scans followed, which revealed a small mass in my upper left lung. The doctors suspected lung cancer that had spread to the brain.
The Longer Story
The first sign of something amiss occurred on June 8, 2010 when I was taking notes for several hours for a training session. My right hand suddenly spasmed and jerked while I was writing. This happened several times that afternoon. Since that day, I have continued to have difficulty writing fluidly and have to concentrate on relaxing my arm and slowing down to keep my writing more legible. I initially attributed this problem to fine motor muscle fatigue, but as I said it continues to occur and it also became more frequent and now includes trembling at times when holding a glass or even a fork full of food.
The next sign came on July 3 at a barbeque when I had about a 15-minute episode where I could not speak the words for common concepts that I could almost visualize in my brain. It was very similar to a "tip of the tongue" situation, but I knew it was something different and could tell when it started and when it subsided. The last minute or so of this episode included some tingling in the tips of my right fingers. I thought this may have been brought on by dehydration, but checked the symptoms of dehydration on the web and found it was not a match. My next concern was a TIA, which is a warning mini-stroke. I sent an email to my doctor describing my symptoms. As it was a holiday weekend, she was not available, but I received a reply on July 5 from one of the associates at the practice saying I should make an appointment.
I did not rush to make the appointment in part because I didn't want to make this a big deal and in part because I was in the midst of a very busy travel season for work and leisure. I finally had my appointment with Dr. Caplan on July 23. She thought the tremors were intentional tremors and the episode was not too serious, but worth looking into further so she had me go to see a neurologist, Dr. Mary Angelopolous.
I had my appointment with Dr. Angelopolous on August 11. She suspected that the tremors and the episode with the speech problem were related and were possibly due to partial seizures. She ordered an MRI with and without contrast, and an EEG. I had the EEG on August 13 and the MRI on August 14. I was scheduled to have a follow up appointment with Dr. A on August 20, after I returned from another week of business travel.
But instead, on Monday August 16, Dr. A called me at 9:30 in the morning saying she wanted to see me that afternoon at 1:00. That's when I first knew there was trouble. I called Doug who came home immediately from work to be there with me at the 1:00 appointment. At the appointment, Dr. A told me that both the EEG and the MRI came back abnormal. The EEG showed slowed reactions in both parts of the brain and some sharp waves, indicating that I was having seizures. On the MRI, there were 4 or 5 small rounded lesions scattered across different parts of the brain. These were apparent both with and without the contrast, but lit up with the contrast, indicating inflammation. The possible causes she cited were cancer (most likely a secondary site), a blood clot that spattered in the brain, some kind of infection, or vasculitis (a swelling/inflamation of the blood vessels in the brain, potentially caused by some autoimmune disease).
Dr. A wanted me to cancel my business trip (I was to leave two hours after this meeting) and have more tests done ASAP. I was very reluctant to cancel my trip, but ultimately decided I should. So then I had an MRA (magnetic resonance angiogram that looks at the blood vessels in the brain) of the head and neck and a CAT scan of the chest, abdomen and lungs on Wednesday, August 18. She also put me on anti-seizure medication since the lesions had caused some short circuits in the brain's electrical system that led to the seizure I had on July 3 and could cause other more serious seizures if left untreated.
I had a follow up meeting scheduled with both Dr. Caplan, as my primary physician orchestrating all of this information, and with Dr. A, for Friday, August 20.
At the 11:30 meeting with Dr. Caplan on August 20, I learned that the CAT scan revealed a 2.5 cm x 1.4 cm mass in the upper left portion of my lung. The mostly likely prognosis was lung cancer that had already spread to my brain.
Dr. Caplan arranged for Doug and I to meet Dr. Theresa Law, an oncologist, that afternoon at 3:30. At that meeting, Dr. Law showed us the film of the CAT scan where the mass appeared and told us it was very likely that it was lung cancer.
She said that due to the fact that it had already spread to the brain, there wasn't much likelihood that surgical removal would be of much benefit. And because the lesions in the brain were so small and scattered in so many different places, surgery was unlikely for that as well. She said the likely timeline was six months to two years.
She said the top priority was to reduce and control the brain lesions, which would likely be done with radiation and then possibly followed by chemotherapy, but this was getting ahead of ourselves. The next step was to do a biopsy of the lung to determine if in fact it was a cancerous mass and if so, what type of lung cancer it is. The biopsy was scheduled for August 23. In the meantime, she prescribed a high dosage of steroids to begin to reduce the inflammation of the brain lesions. The next step would be to do a PET scan to determine if the cancer had spread anywhere else. This has not been scheduled yet.
We then had the weekend to try and process all of this information and start to share the bad news with family and friends.
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