Alison very kindly drives me up to Truro and takes Milli on to Pet World or something to try out a new dog basket.
I see Dr. Kruger at 3.45pm; the waiting room is empty, there are non of the familiar nurses about and he calls me in himself.
There’s a problem. He’s straight to the point; both scans show enlargement to a lymph node in my chest. The report from the radiologist has this to say:
“A node in the upper right superior mediastinum has increased in size previously measuring 18 x 13 mm and now measuring 24 x 19 mm. It is noted that this node is avid on the PET scan. Other mediastinal nodes appear slightly reduced in size compared to the previous scan.
Conclusion: progressive disease within the mediastinum with enlargement of a right superior node which is also avid on the PET scan.”
It’s not what we expected or wanted to hear, and it comes as a shock. Dr. K is upset by it too. I feel pretty calm and we discuss options. Could it be something spurious? Perhaps something called ‘brown fat’ which sometimes occurs in thin people? Or my body’s immune system repsonse to fighting off the cold I’ve got and which would have been at its peak when the scans were done? No, nothing convincing comes to mind.
He suggests the way forward is to conduct another biopsy, if the surgeon Mr. Awan is happy to undertake it. The node will be hard to reach as it’s close to the heart and surrounded by blood vessels.
If the biopsy result is negative then I will have further scans to monitor it – negative might just mean they didn’t get a sample of the cancer. If repeat scans show the node is growing or the problem spreads then we conclude progressive cancer.
If the biopsy is positive then we know immediately that I still have progressive cancer in me. It doesn’t appear that there are other simple chemo options available to me – if there’s still cancer there then it’s a resistant or mutated strain and has evaded the new silver bullet drug Brentuximab which I’ve been on the trial for.
At that point there are some rather limited and stark choices to be made;
1) Stem Cell Transplant. This involves a 9 week / 3 cycle dose of what’s called Platinum Chemotherapy using a different cocktail of drugs. That’s followed by three weeks of hospitalisation and a process called Autologous Stem Cell Transplant which involves harvesting my healthy stem cells, then blasting the cancer and my body with a major chemo dose for a few days, and then replacing my stem cells again to allow my bone marrow to start functioning again. Its a tough treatment; hospital for up to a month with a 50:50 chance of success against the cancer, and a 3% chance of death from the procedure itself. It can take up to a year to recover from this. [ These are Dr Kruger’s figures and I admit they’re rather sobering – I’ve just been reading the Lymphoma Association booklet on Stem Cell Transplant and it puts it in to perspective – for many people this remarkable procedure does work.]
2) Radiotherapy. This may be an option, but given the location of the node it may not be very effecive and has its own long term risks to the heart and vessels around it.
3) Monitor only and delay further treatment. For the medical team this isn’t really an option. Do what? Crank up my anit-cancer diet regime, gear up the Pilates and focus properly on that Mindfulness? Is that enough to tackle progressive disease? I guess I’m going to do this anyway, whether I opt for further treatment or not because as before it gives me a sense of conrol, however limited.
So, quite a lot to take on.
Mostly I just feel annoyed. Damn that cancer!
Home for supper we cook some trout, broccoli and potato and watch Prof. Brian Cox ‘Are We Alone?’ on iPlayer. Milli’s delighted with her new outward-bound ready-for-anything bed, snug and draft free…I could just curl up in that myself.