Two days ago (Friday) I was scheduled to go see an Interventional Radiologist to insert the tiny gold markers around both of my small tumors and possibly collect some suspicious material for a biopsy to confirm that they, are in fact, metastasis. I was instructed not to eat or drink anything after midnight, and I complied. I'm good at that. I arrived at 9:00 for what was scheduled to be an 11:00 procedure. The IR had a very laid back attitude, or was overworked possibly, so he didn't get to me until 1:00 or so, I think.
I was taken into a room with a CT scanner and prepped for the procedure. They positioned me, placed sicker grid markers on my ribcage, and then the IR went back and forth from something behind me (probably a monitor) with a marker and marked the entry spots on my side, using the grid lines for reference. Then they gave me the sedative cocktail. A few minutes later they asked me if I felt it at all and, honestly, I didn't feel any different. (Too bad because I DID feel the "numbing" injections, which was the worst part of it all.) So they gave more to me. And then more. Finally I drifted off into a cloudy space, though I was still aware of some of the procedure.
Since I was in a cloudy space I can't tell you how long the marker placements actually took. I do know that a needle was inserted in the spaces between my ribs to place the markers. But until I remove the bandages I don't actually know how many punctures I have.
I gradually came to in the recovery area. I slept some, ate a tiny bit (which I lost on the car ride home - thank goodness for nice, big, thick high-quality doggie poop bags) and eventually came out of the cloud enough to go home.
When I got home I was very tired. It hurt to take a moderate breath. I couldn't stay awake. I headed right to bed for a nice long nap. Luckily my appetite had returned by evening and I helped David eat a nice Hawaiian pizza. It was the only thing I had all day.
I felt better the next day (yesterday) though I was still a bit tired and my side was still sore. It hurt to breathe deeply, laugh, cough, or sneeze.
Today I feel even better. I can breathe deeper now. Laughing, coughing, and sneezing still cause some discomfort but it's better.
I was given instructions not to lift more than 10 pounds for two weeks so I get to ask David for a lot of little help. Which he's happy to give. :-)
I think now I'll go out to the garden with him to supervise while he helps plant this years' garlic crop.
Sunday, October 28, 2012
Wednesday, October 24, 2012
My Visit With the Radiation Oncologist (or CyberKnife Doctor)
David and I met with the CyberKnife doctor today, otherwise known as a "Radiation Oncologist". Having done some research we feel we already know a little bit about what to expect but he filled us in on the details. Luckily David took a lot of notes. Here's what the doc said:
First he listed the three options that I have to rid my liver of these two tumors.
3-7 days (so sometime next week) I'll return to the CyberKnife center for a CT scan to make sure the beads are still exactly where they put them. There's a chance they can shift since the liver is so vascular.
3-5 days after the CT scan I'll then go back to the CyberKnife center to start the treatments. This should be the week of November 5th. He said that I will have 3-4 treatments. If it's three then it will be Monday, Wednesday, and Friday. If he squeezes a fourth treatment in (which would be done if he has to turn down the radiation dose for any reason) then it would probably occur on Thursday. I would lie on the table in a large room (all by myself) that contains a small CD player and a large robot. I'll be there for about 90 minutes each time. The first 15 minutes will be the special LED-fitted vest taking measurements to get a good fix on my breathing pattern. Once it has my motions down so that they are predictable then the robot will start to move around me and do its thing. He said I may be a little fatigued afterward but I expect that to be mild. I will go home after each of these. That's one huge advantage to not choosing surgery: No hospital stay! Plus with surgery I'd have to go off of the Avastin for a few weeks which would delay the surgery at least a month. With CyberKnife I can take care of it starting right away with no interruption to the chemotherapy regimen.
After the three (or four) treatments they would follow up usually with a PET scan. A CT scan can actually still see the tumors, even if the cells are now dead. So the CT scan may not be a reliable indicator of effectiveness except for if the lesions grow in size. That's why they use a PET scan because a PET scan is looking for metabolic activity. The problem with me is that the PET scan only saw one of these tumors. The one it did see had little metabolic activity and the other one must have been below its threshold. So a PET scan may or may not be helpful in following up. They will just have to use a combination of PET scans, CT scans, and the CEA blood tumor marker to assess the success of the treatments. All that said, he said that these are so small that he expects this to be completely effective. The only way to be certain that these two spots are gone for good is to surgically remove them but I just don't want to go through another abdominal surgery if the CyberKnife can almost definitely kill these tumor cells.
I actually have a couple of pictures to share with you. These are cross sections of my abdomen. If you can imagine that I'm lying on my back and you are looking through my feet that will help you get your bearings. The tumors and some landmarks have been labeled.
The first image is higher up on my liver, closer to my head. That tumor is the smaller one and it's on the front of my liver. The second image is lower down nearer my bowels. It's on an inside edge of my liver. The doctor also pointed out the area of my previous surgical resection (back in 2009) so I noted that on the image below.
Actually I have to give proper credit to David here. He made all of the annotations for me since he has the tools for that on his computer.
First he listed the three options that I have to rid my liver of these two tumors.
- Surgery (liver resection). I'd like to avoid it.
- Microwave ablation. This isn't a good option because one of the tumors is on the edge of my liver right next to my large intestine and microwave ablation would risk the health of the intestine.
- CyberKnife. It's painless and should be side-effect free. There's a risk that my large intestine can get irritated near one of the treatment sites but it would cause GI discomfort for a couple of days and then would return to normal. I think I can handle that. Perhaps they can inject some gel to "push" my large intestine over to get it off of the edge of my liver.
3-7 days (so sometime next week) I'll return to the CyberKnife center for a CT scan to make sure the beads are still exactly where they put them. There's a chance they can shift since the liver is so vascular.
3-5 days after the CT scan I'll then go back to the CyberKnife center to start the treatments. This should be the week of November 5th. He said that I will have 3-4 treatments. If it's three then it will be Monday, Wednesday, and Friday. If he squeezes a fourth treatment in (which would be done if he has to turn down the radiation dose for any reason) then it would probably occur on Thursday. I would lie on the table in a large room (all by myself) that contains a small CD player and a large robot. I'll be there for about 90 minutes each time. The first 15 minutes will be the special LED-fitted vest taking measurements to get a good fix on my breathing pattern. Once it has my motions down so that they are predictable then the robot will start to move around me and do its thing. He said I may be a little fatigued afterward but I expect that to be mild. I will go home after each of these. That's one huge advantage to not choosing surgery: No hospital stay! Plus with surgery I'd have to go off of the Avastin for a few weeks which would delay the surgery at least a month. With CyberKnife I can take care of it starting right away with no interruption to the chemotherapy regimen.
After the three (or four) treatments they would follow up usually with a PET scan. A CT scan can actually still see the tumors, even if the cells are now dead. So the CT scan may not be a reliable indicator of effectiveness except for if the lesions grow in size. That's why they use a PET scan because a PET scan is looking for metabolic activity. The problem with me is that the PET scan only saw one of these tumors. The one it did see had little metabolic activity and the other one must have been below its threshold. So a PET scan may or may not be helpful in following up. They will just have to use a combination of PET scans, CT scans, and the CEA blood tumor marker to assess the success of the treatments. All that said, he said that these are so small that he expects this to be completely effective. The only way to be certain that these two spots are gone for good is to surgically remove them but I just don't want to go through another abdominal surgery if the CyberKnife can almost definitely kill these tumor cells.
I actually have a couple of pictures to share with you. These are cross sections of my abdomen. If you can imagine that I'm lying on my back and you are looking through my feet that will help you get your bearings. The tumors and some landmarks have been labeled.
The first image is higher up on my liver, closer to my head. That tumor is the smaller one and it's on the front of my liver. The second image is lower down nearer my bowels. It's on an inside edge of my liver. The doctor also pointed out the area of my previous surgical resection (back in 2009) so I noted that on the image below.
Actually I have to give proper credit to David here. He made all of the annotations for me since he has the tools for that on his computer.
Friday, October 19, 2012
CT Scan Report
Yesterday I had a follow-up CT scan performed to confirm the PET scan findings. It found two small spots on my liver. We will meet with the oncologist on Monday to discuss the strategy. I suspect these are CyberKnifeable unless one of them is too small. I'll let you know what we know as soon as we know it. :-)
Here's the report:
Here's the report:
Monday, October 15, 2012
This Week's PET Scan Report
As you know, we have been getting worried because my CEA level has been steadily rising. Since my last post here are the CEA readings:
Here is the report:
What this boils down to is that there's a suspicious spot on my liver that's just under 1 cm in size. The PET scan is great at detecting activity but when something is found in certain areas (like the liver) they like to follow up with a CT scan to get a very detailed image. Later this week I should be scheduled for a follow-up triple phase CT scan which will give us a better idea about what's going on, and it may (or may not - let's hope for not) find some additional activity that may be smaller. If this is an isolated lesion then it may be removed with the CyberKnife procedure. You can find out what that's all about here: http://www.cyberknife.com/. The patient brochure (a pdf download) gives some great information about the procedure. The oncologist said that if CyberKnife is an option for me it can make this go away with just 2-3 CyberKnife treatments and we won't even have to interrupt our current chemotherapy treatments to do it.
I will likely get the CT scan on Thursday. There's a chance I can get a copy of the report on Friday. If not, I'll get it next Monday (a week from today) when I return to see the doctor. Of course I'll keep this blog (and Facebook) posted.
On a different, but related, subject I have no idea what the significance is of my MediPort catheter tip being in the atrium of my heart. I assume that's where it's been for the last three years and I 'm not sure why it's being noted in this report. I can ask the oncologist (and also my primary doctor, whom I see next week as well) about it when I see them.
Until then, that's it for now.
- 9/14: 3.8
- 9/28: 4.7
- 10/12: 6.4
Here is the report:
What this boils down to is that there's a suspicious spot on my liver that's just under 1 cm in size. The PET scan is great at detecting activity but when something is found in certain areas (like the liver) they like to follow up with a CT scan to get a very detailed image. Later this week I should be scheduled for a follow-up triple phase CT scan which will give us a better idea about what's going on, and it may (or may not - let's hope for not) find some additional activity that may be smaller. If this is an isolated lesion then it may be removed with the CyberKnife procedure. You can find out what that's all about here: http://www.cyberknife.com/. The patient brochure (a pdf download) gives some great information about the procedure. The oncologist said that if CyberKnife is an option for me it can make this go away with just 2-3 CyberKnife treatments and we won't even have to interrupt our current chemotherapy treatments to do it.
I will likely get the CT scan on Thursday. There's a chance I can get a copy of the report on Friday. If not, I'll get it next Monday (a week from today) when I return to see the doctor. Of course I'll keep this blog (and Facebook) posted.
On a different, but related, subject I have no idea what the significance is of my MediPort catheter tip being in the atrium of my heart. I assume that's where it's been for the last three years and I 'm not sure why it's being noted in this report. I can ask the oncologist (and also my primary doctor, whom I see next week as well) about it when I see them.
Until then, that's it for now.
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