- Lungs: There are several nodules in both lungs which have increased in size. There are also some new ones. The report states that a few of the nodules demonstrate "cavitation" which sounds bad but is actually good. My oncologist said this is the effect of the Avastin on the tumors. As the tumors are denied the ability to make a blood supply the area around them dies, cutting off their source. Since there are a fair number of them, localized therapy isn't an option so we will have to keep relying on systemic treatment (chemotherapy).
- Bone: That bone that was irradiated before, in March, has stubbornly remained painful. The MRI of the area only noted edema and inflammation. The CT scan notes "a persistent mottled lytic lesion" in the same area. I'd like a PET scan to break this tie because if it's still active tumor then it needs to be treated. More on that later.
- Liver: There are still the same lesions in the liver. No new lesions. The CT report states that a couple of the tumors have increased in size. I took the CD of the images to my interventional radiologist at Stanford (the one who has been doing the chemoembolization) and this is what he had to say in the email back to me: "Overall,
I am very pleased with what I see on the new CT scan. 2 of the lesions
are each 2 mm larger, 3 lesions are a few millimeters smaller. 4 of the
lesions (including the 2 that are a little larger) look uniformly dark and
sharply outlined, indicating necrosis. 1 lesion is still fuzzy edged and
enhances a little bit, suggesting that it is not completely dead, but it has
gotten smaller. I also do not see any new spots."
- Cervix: The cervical lesion wasn't even mentioned on the CT scan but we know it's there. A biopsy was done on it, as noted and shared on my last post. Here's the plan for that: We thoroughly discussed radiation options with the radiation oncologist and surgical options with two gynecologists. The consensus is that surgery isn't the best option for me right now, mainly because in order to do surgery of any kind I would have to stop taking the Avastin for 4 weeks prior and 6 weeks after. But the Avastin is being credited for holding the stuff in the lungs steady and overall the chemotherapy is also to be credited for the disappearance of the lesion on the lower left side of my abdomen. If I do the radiation I'll be able to treat the lesion in my cervix and still receive my chemotherapy which is needed for the other stuff. Radiation should start next week. I'll do three weeks of conventional radiation, followed by a two-week break, and then 5 sessions of CyberKnife in the same area.
The insurance company has been a real pain in the ass this time around. My oncologist finds a PET scan most useful for monitoring my condition, coupled with a CT or an MRI for clearer imaging. The CT and MRI will identify tumors but cannot distinguish between dead or alive ones. The PET scan will tell which ones are still active or dead. But when he tried for the PET scan this time they refused to authorize it, stating that I had to have a CT scan first and then he could order the PET scan if there was anything inconclusive. Well, it would be nice to know which lesions in the liver and lungs are active or not. I would also like a tie breaker between the MRI and CT scan to see if there is still active tumor in my bone. If so, I need to follow through with additional treatment. When my doctor asked for a PET scan again yesterday they still denied it. This is what they said:
"We reviewed information from Shane Dormady, your benefit plan, and any policies and guidelines needed to reach this decision. We found the service requested is not medically necessary in your case.
We cannot approve the requested study. Your doctor must show that your disease state is such that aggressive treatment of the site would be an option. The information received does not show this."What the F^@& does that mean? What do they consider aggressive if not radiation, chemoembolization, CyberKnife, possible HIFU on the bone if there is still activity there, for which we need the PET scan to help determine? And all of this while on sustained chemotherapy? Maybe the only site that we don't have an aggressive treatment option is in the lungs, but all of the other areas stated above have aggressive treatment options. We will be doing radiation and CyberKnife for the cervix, chemoembolization for the liver, and possibly a new technology being performed at Stanford (HIFU) for the bone, if we can determine that there is in fact tumor activity there.
David works for Cisco and the insurance is Cigna. Cigna manages the insurance but in the end it's Cisco that pays the medical bills. So, there are channels within Cisco to try to get this overturned. David has activated these channels and right now this issue is being escalated up in about 3 or 4 directions and has caught a lot of attention, both at Cisco and at Cigna. Apparently there was a meeting this afternoon between Cigna and Cisco about this. At this time I don't know if they have come to a resolution.
[EDIT: David just sent me this note: "OK, I'm getting clarity. It sounds like it is going to get approved. I'm talking to Mary and she said all their doctors think it needs to happen. There is a call tomorrow that is between Cigna and MedSolutions and she's pretty confident it will go fine."]
For those of you who like to read the reports, here's the CT scan report:
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