Familiar Territory

I sometimes feel like I'm living a very slow-motion version of Groundhog Day, the movie. I have (again) a PET scan that shows a spot on my liver. I will now switch to some heavy-hitter drugs that I've done before, plus a new one. I know what to expect and I know how to handle it. I don't have to like it.

Last Friday I had a PET scan done. Since my CEA has remained elevated none of us were surprised to see that there's new activity. This time there's a spot on my liver (a new one - not one of the spots recently zapped by Charlie). According to the PET scan it may appear to be in my lung but the radiologist and the oncologist believe that it's actually behind the lung and in the liver. If I read the report correctly, there's a "5 mm nodular density" that shows no metabolic activity on the PET scan that's also in my lung. I believe that's a different spot. It was seen before and has grown from 2 mm to 5 mm, so they will be watching that one to see what it does.

What's the plan, you might ask? Well, I go on a familiar regimen that I've had before. This week I'll take a break from the drugs and next week the week after next (Feb 11) I will start on the "FOLFIRI + Zaltrap" plan. FOLFIRI is the acronym that indicates a standard chemotherapy drug combination of Leucovorin, Fluorouracil (also called 5-FU), and Irinotecan (also called CPT-11). A new drug similar to Avastin will be used in conjunction with these called Zaltrap. More information about FOLFIRI can be found here. More information about Zaltrap can be found here.The 5-FU will (again) be delivered over a 48-day period using the dreaded pump. Definitely not my favorite part of this experience.

From my experience before I know that I'll be gone from the world for several days after the infusion and will hope to emerge by the weekend. My infusions will be on every other Monday starting next week in two weeks. These drugs usually cause my brain to get very tired, so much so that regular conversation is difficult and draining. I know that I will struggle a lot to find the simplest of words. Therefore for a few days every two weeks my communication will likely be limited to email. That's not as draining to me because I can pause as often as needed to find the right words and don't have to worry about sounding conversational.

After four treatments I'll get a new PET scan to see what effect the drugs are having on the lesions. We will of course continue to monitor the CEA level. The goal is to knock it all the way back down to a normal level and to make the spots disappear. The number of treatments will depend on how quickly and effectively that happens. I may be going through this for four to six months, most likely.

When the treatment cycle is over, I think the oncologist will recommend a liver-directed therapy that involves injecting Irinotecan-saturated beads into the liver to deliver a strong dose of the drug directly to the liver. When and if that happens I'll have more details on that.

For those who like to see the PET scan report, here it is:

The Beginnings of a New Plan

During my visit with my oncologist today, I went crazy and asked him if he thinks there is any chance at a cure for me if we try one more time and hit this cancer very hard with a large arsenal. He said that when I came to him a year and a half ago he was set to fire away but that I had expressed an interest in taking it easy. Up to that point any time I had chemotherapy it was right after a tough surgery and it seemed I was always recovering from surgery and chemotherapy all of the time. Now that I've had a bit of a break I might be willing to try once more if he thinks it's reasonable. So the formulation of a new plan is percolating.

We will do a PET scan next week (it's about time anyway since my CEA hasn't gone any lower) and if we find something then he will consider putting me on a chemotherapy similar to the last time but will add a new drug, an antibody called Zaltrap. Then perhaps after that's completed, and if the suspected activity is in my liver, he would have me undergo a treatment called SIRT. (You can find the details about that here: SIRT.) Basically, that is a method to deliver radiation to my liver using itsy bitsy beads.

We are not completely set on this plan, and there other things we can try. And this all would take place only if new activity is confirmed by a scan. Whatever it is we decide to do, I'll keep everyone posted.

Keeping Watch

It was this past October that a PET scan found a couple of small tumors in my liver. At that time my CEA was 6.4. By the time I was scheduled for the CyberKnife treatments to incinerate those two spots my CEA had increased to 12.7. Since the treatment the CEA has been hanging out around in the 8s. It was 8.2 on 12/6/2012, 8.6 on 1/1/2013, and the latest number is 8.6 on 1/11/2013.

At least it's holding steady. That means we had some effect on the tumor growth. The oncologist suspects that there's still a small growth hiding out in my liver somewhere and future scans will reveal it. In the meantime we continue with the same plan and when it's time for a change he has a few tricks up his sleeve.

I'll give you the details as changes are being made.

In the meantime I'm feeling fine. My energy is normal, as well as my appetite. I have a few extra pounds (which the oncologist actually likes) and I'm in the process of shedding some of the extra weight. I know how to do it, I just have to stick to it.

My next CEA will be in two weeks. I don't know when the next scan will be.