It could be worse

CT August 8, 2008

It is several months since I have posted. I haven’t felt inclined to tap the blogger’s keyboard, for several reasons, including a bit of lethargy and my usual tendency to wander off to new interests and distractions, but I may have also felt a greater than usual reluctance to put too much of my inner landscape up on the big board.

In the meantime, the main medical news that didn’t get published in this period was my decision, some time ago, to go ahead with the pemetrexed treatment and the first cycle commenced on June 11. There have since been two further cycles and late last week I had a CT scan to check progress.

Unfortunately, the scan showed continued growth and spread in the lungs and so this treatment has now been discontinued.

The oncologist’s recommendation is now to discontinue any further chemotherapy options for the time being and instead try a drug called erlotinib, which instead of acting as a general cytotoxic agent as chemotherapy does, targets something called an epidermal growth factor receptor in the cancer cells. I am now ruminating on this issue, but will probably commence this treatment in a week or two. The drug is administered by a simple daily tablet, there are some probably mildish side effects generally expected and again, this treatment is given an approximately 10% chance of significantly reducing the tumors.

Clearly the situation is looking increasingly perilous, but apart from pain issues, I am still generally in good health, with reasonable energy levels, good appetite and stable weight. My lungs do not yet seem very much, if at all, stressed by any increased lack of capacity.

Now coming to the inner landscape again, there is a lot going on and I am doing my best to understand and deal with my situation in all sorts of ways. This blog then is still active, no matter how minimally for the moment, and I hope to return to it more frequently sooner or later, and perhaps relate a broader range of views and experiences at this extraordinary time in my life.

Radiologist’s report follows below. The CT scan above shows the primary lung tumor and some of the new spots, but of course there are other slides from the scan that show the further spread in the lung and kidneys.

Report: Scans were performed through the chest, abdomen and compared with the previous study 5/5/08.

CHEST: The right upper lobe mass has increased in size and now meassures up to 6.1 x 6 x 6cm (previous up to 5.6cm). There is some central calcificatin. The size and number of lung nodules has increased.

CT ABDOMEN/PELVIS: The right renal mass has increased in size and now measures up to 6.6cm in dimension (previously 5cm). A low density lesion in the upper pole of the left kidney has increased in size and now measures 1.5cm in diameter. The liver is unchanged in appearance – there are small likely simple hepatic cysts. The gallbladder, spleen, pancreas and adrenal glands are normal. There are upper abdominal lymph nodes which have increased in size and now measure up to 1.2cm in short axis diamter. The sclerosis in L4 is unchanged. The lesion in the right 12th rib is unchanged.

Conclusion: The right lung mass is larger and there are new lesions in the lungs. Right renal lesion and upper abdominal nodes are also increased in size and there is a new lesion in the left kidney.

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