May 20, 2009. This is my appointment to go over the results of my May 12th PET/CT scan. (If you are a new to my blogs, I posted a blog that describes what a PET/CT scan is & its significance in May. You may want to read it to understand the importance of this diagnostic test.) I also get my tumor marker number. It is 32.7. This up a tenth of a point from March 23rd, but this is not a significant change. It is more relevant that it remains in the normal range, which is 38.8 or lower. Praise God! (A blog explaining the tumor marker is posted July ’08.)
Dr. Patel explains that the standard of cancer treatment for advanced stage disease is changing. Up to this point the standard has been to not perform surgery on stage III or stage IV cancer patients because it is not possible to remove all of the cancer, due to the fact that it has spread beyond the site of origin.
(To perform surgery & leave known cancer cells is “like pouring gasoline on a fire.” I remember Dr. Patel making this statement to me shortly after my final diagnosis when I inquired about my impending surgery, which he told me was cancelled & I asked him why. He explained that the body’s immune system produces powerful chemicals to aid in the healing process. These chemicals that help the body to heal also stimulate the growth of any remaining cancer cells to a more rapid growth rate & for metastatic cancer, as stage III & stage IV cancer are, more rapid spread of the disease.)
Ed & I are curious; what is this change he’s talking about? If a patient has a very good response to therapy, such as I have had, surgery may be considered. I’m wondering, ‘how can this be?’ He goes on to say, “Surgery at the origin of the cancer may delay the progression of the cancer, if the current activity is confined to that single location,” as mine is at this time. This sounds just like a line from a medical textbook & makes some sense, but I’m still not 100% convinced it’s a good idea. In theory, it sounds like a great idea, but it’s not consistent with the previous information I was given.
I’m mentally trying to make sense of this. My cancer is breast cancer & the remaining location of activity is a lymph node under my left arm. That’s not the site of origin, but that is a single location of activity. I have to make sure I have this straight; so, I ask, “If I have this surgery, will it be a mastectomy & removal of the lymph node, in order to be surgery at the origin & the site of activity, or just removal of the lymph node?” Dr. Patel says it will only be the lymph node since it is a single location of activity.
As noted on the radiologist’s report, this activity is barely visible. Dr. Patel says he has not made up his mind about whether or not I should have surgery to remove this lymph node. He tells us of another patient, with advanced stage cancer, who also has had a positive response to therapy & now has a single location of activity on her PET/CT scan; however, it is a very active lymph node. Without hesitation, he recommended that she have the surgery. Since mine is not so clear-cut, he wants to discuss it again at our next appointment. He will give it additional consideration & asks us to do the same. He asks us to consider that this active lymph node can potentially “seed” other metastases (the spread of the cancer), but he reminds us that there is not a “right” or “wrong” answer.
After all of this focus on the one active lymph node, Dr. Patel asks if I have any other questions. I look over the radiologist’s PET/CT scan report. I see no mention of the malignant breast tissue, the other 3 malignant lymph nodes under my left arm, the numerous malignant lymph nodes behind my breast bone, or the nodules on my lungs; so, I ask why they are not mentioned. After I get my answer, it seems like a really silly question. Dr. Patel says, “That’s because the cancer there is dead!” Oh!!!! Dah!! Praise God!!
I am so thrilled that the PET/CT scan shows only slight activity in only one lymph node! Of course, the tumor marker number is once again confirmed by these results, too. All of my vigilance with taking my medication, following my diet, taking nutritional supplements, exercising regularly, & the prayers of hundreds of people are paying HUGE dividends!!!! Praise God!!!!
Thank you to those who remember me in your prayers! I pray God will bless you for your faithfulness & meet your needs.
As an interesting side note, I ask, “If my cancer diminishes can the stage of it be down-graded from stage IV?” His answer is, “It’s still stage IV; it’s a one way road.”
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We went home with happy hearts!!!! However, we have to give some serious & prayerful thought to the proposal Dr. Patel made. Although Dr. Patel said he would tell us his decision at our next appointment, we know his track record. We might be asked to make the decision. I am already thinking about what I have been told about having surgery if all of the cancer cannot be removed. I cannot divorce my mind from that thought. How can this have changed? I’ll take you through what I know so you can understand why I have reservations. Yes, you are learning more about cancer than you thought you would ever know just as I am learning it as I walk down this path. Perhaps the educational information I share in my blogs will help you or someone you love now or in the future.
The last blog I posted discusses the growth rate of cancer cells & includes a scanned illustration of a growing tumor. The written explanation states that cancer starts as one cell, doubles to 2 cells, then to 4, 8, 16, 32, 64, etc. It continues to double in size every 23 to 209 days. The illustration shows a 1cm tumor, which is the smallest that can be detected by a mammogram (x-ray). In inches, this is slightly larger than 3/8 of an inch. It then shows it doubled in size to 2cm; this is the smallest tumor that can be felt. It is a little larger than 3/4 of an inch. The last doubling shown is 4 cm. This is the average size of a tumor that can be felt. It is a little bigger than an inch & a half. If the cancer is growing at the average rate of growth, doubling in size about every 100 days, it takes approximately 11 years for a tumor to reach 4cm. By the time a tumor is large enough for the patient to feel it he or she has undetected cancer for a long time! Realize there are cancers that grow more quickly & those that grow more slowly. Also, there are factors that can cause the rate of growth to speed up or to slow down, but a complete discussion is a subject for another blog. I considered these facts & realized that although my PET/CT scan shows only slight activity in one lymph node I also know that the multiple lymph nodes, breast tissue & nodules on my lungs still have living cancer cells. The tumors have merely been reduced to sizes that are now undetectable -- smaller than the imaging technology can detect! For this reason, I am uncomfortable with Dr. Patel’s description of the areas that no longer show activity on the PET/CT scan as “dead.” This is misleading, when I know there are undetectable, living cancer cells in these places. I will have to come up with a respectful question or comment to pose about the undetectable cancer cells in the areas that show no activity, for my next appointment, to find out if this was a slip-up or intentional.
I reason: if I have surgery to remove the lymph node that shows slight activity, I still have undetectable cancer in all of the above mentioned places which will be stimulated to a more rapid rate of growth by the surgery. Won’t I be worse off after the surgery than before it? I may seem better off at first, but the remaining cancer will double & become detectable on a future scan & in my future blood test as an elevated tumor marker number. Why would I take that chance when what I have been doing is working so well? Our minds are made up; we both agree. God has been working through the forms of treatment I’ve been doing, & things are going very, very well! We do not feel surgery is part of God’s plan, at this point. It is our sense that I am to keep going on the same path I have been walking on. We are at peace. Praise God!
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