I had my CT scan yesterday and a virtual follow-up with my oncologist. And the results are that the liver tumors that I've been so worried about continue to shrink, my bladder looks even better, no more signs of hydronephrosis, etc. My oncologist is quite happy with the results.
But he started the call noting that the news was not as good north of the diaphragm. There are some new lymph nodes in the area of my lungs that are enlarged, but I just had a Covid shot which has been known to cause enlarged lymph nodes, so maybe a nothing burger. There is a recommendation to avoid routine CT scans for 4-6 weeks after getting a Covid shot to avoid this effect. However, given that some vaccines are two shots given 3-4 weeks apart, that's up to 10 weeks of delay which is almost the time between routine scans. And it's not like it's easy to schedule a vaccine shot the week after a scan. Ugh.
But what concerns me most is that in my February scan there was a 9mm lesion in my left lung that my oncologist looked at, and said he'd debate the radiologist about whether it was cancerous or not. That lesion is now 2.1 cm at its widest and still isn't worrying my oncologist, but it's got my attention. Throw in the lymph nodes and some ground glass in the lungs and the radiologist (who didn't know about my Covid shot) says this is all consistent with disease progression.
What to do?!? Continue Folfiri for now, because it's doing such a good job in my liver and most everywhere else. But while that's going on, do I pursue that lesion in my lung? I'm thinking this may be a good reason for another visit to Dana Farber for a second opinion and perhaps yet another biopsy to find out what we're dealing with. If this is progression, it'd be nice to act early enough that perhaps a zap of radiation may put it out of commission before it has a chance to spread further.
But ugh, do I really want to spend my limited good days during chemotherapy pursuing this instead of having fun? What would all you cancer warriors do in my situation?
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tom67inMA
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Thanks for the feedback. To answer your questions: Radiation to my bladder was 10 days, and I'd expect the same for my lung if that was the path taken. I'd be inclined to ask for a three week chemo cycle and do the radiation in the second and third weeks, to avoid taking my portable 5-FU pump to radiation treatments, not to mention having a moderately long infusion and radiation on the same day at the start of the cycle.
It roughly doubled in size sine the previous scan, so if it does that again we're talking about it potentially approaching two inches in size. Not a very comforting thought.
I don't know how to get information such as Covid shots to the radiologist. It might come up when he talks about his findings with my oncologist. It probably wouldn't change his mind anyway, since the report tends to say things like "consistent with progression" which isn't an actual diagnosis. That's left to the oncologist to decide. One other oddity is that each time I get a scan a different radiologist is reading it, but my oncologist also reads the scans himself so at least he gives consistent opinions from scan to scan. He's been doing this for years and he's a smart guy so I expect he's developed a reasonably good filter as to what to worry about, and at the moment my liver is more worrisome than my lungs. I can say with reasonable certainty that if we stopped treatment today I'd die of liver failure before the lungs became a major problem.
Another way to describe the dilemma is that I haven't seen my aging mother since Christmas 2019 due to Covid. I'm getting my second shot this weekend and would like to visit her in May. Following up on whatever is happening in my lung may extend my life, but could cause side effects that prevent me from driving the three hours to visit her and several friends in the area. And if that treatment doesn't work then I've just wasted a couple months of reasonable quality of life. There are no easy answers with advanced cancer.
If it were me I would definitely pursue the lesion in the lung while continuing the Folfiri, which as you say is doing a good job. Go for the second opinion, factor in the COVID vaccine you had (i.e. make sure whoever you see knows about it), and probably do a biopsy of the lesion. The more information you have, the better the decisions you can make. Radiation may well be a good option. Wishing you all the very best. G&J
I tend to agree, but want to avoid turning my life entirely into a battle with cancer. See my reply to RSH1 above for a longer version. The key point will probably be that I can take it one step at a time without any obligation to continue down that path. And who knows, perhaps a clinical trial has recently opened that could attack all my cancer with fewer side effects than chemo. I'm specifically thinking of the DLL3 targeted therapy that Tall Allen is a huge fan of.
Any treatment that combines only short term side effects with more comfort for you. Ask - if I had a year or two to live would I want to spend it doing....
My friend who had a second primary lung cancer (1.4 cm, confirmed by biopsy), was treated with 2 high dose shots of SBRT (13 Gy each). This completely ablated the tumor and 3 years later, his lungs are cancer-free (he has annual PET scans).
My wife has a friend with a similar story, except het itty bitty lung tumor was removed surgically. The doctors wanted to watch and wait, but she insisted on a biopsy.
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