8/28/06 At Last, a Solid Plan

Friends and Family,

Gen and I met with the oncologist, Dr. Helen Ross, for the first time today. The first news that we received was the results of the repeat CT scan, which was done to see if the tumor had grown, and the MRI scan, which was done to see if there were any tumors in the brain. Good news on all fronts – The size of the tumor in my lung was about the same, there was no tumor found in my brain, and they found a brain. Whewwwwwwwwwwwwwwwwwwwwwwwwwwwwwwww.

We got a much clearer picture of the diagnosis, treatment options beyond surgery, and statistics now that we are talking with the oncologist rather than a pulmonologist and a surgeon. The tumor has been identified as an adnocarcinoma, which is a fairly slow growing variety. However, there is a 50/50 chance based on the CT scan that there is a second tumor within the same lobe of my lung. It would come out just the same since that lobe will be removed, but the suspicion that it could have spread to a second site qualifies me for chemotherapy. Even though chemo reduces the odds of getting cancer again, it has only been approved for cases where it is suspected that the cancer has spread.

The surgeon will remove all the lymph nodes he can get during surgery, each of which will be tested for cancer that was too small to be picked up on the CT or PET scans. If they find any traces it means that I will have chemo after I have recovered from surgery to get the rest.

The “Saturday stroll in the park” version of chemo that the surgeon described to us is not quite the same chemo that Dr. Ross is recommending. Because I am so (ahem) young and healthy, Dr. Ross suggests taking a more aggressive cocktail of Docetaxel and Cisplatin. The upside is that we are attacking the little monsters with Shock and Awe. The downside is the national budget of white blood cells, red blood cells and platelets goes into deficit about 7-10 days later, leaving me more vulnerable to attack from other foreign bodies, but this passes shortly before election day. I’m also likely to lose hair, but Dr. Ross informed me that I had (ahem) plenty of thick hair to spare, so it may get thin rather than vanish altogether. It grows back, but 21 days later it’s time for Shock and Awe Round 2. About 21 days after Round 2 it’s time for surgery, and after that… possibly more rounds of chemo. If I go completely bald by Halloween I’m going to glue horns on my skull like Jai Dev did last year.

I’m likely to be energetic for a day or two after chemo due to the use of steroids, and then become very fatigued for an unknown number of days after that. Pacing will be the issue for me. Nausea is supposed to be fairly minimal. There’s a laundry list of other side effects, none of which is intolerable given the benefit that chemo brings.

Follow-up after surgery includes CT scans, lab tests and full physicals every three months for the first two years after surgery, then every 6 months for years 3-5, then annually. The surprising news from Dr. Ross is that about 1 out of 3 people who go into complete remission for 5 years end up with some form of lung cancer again at some stage of their life, and not necessarily the same type. With this type of close long-term care, it improves the chances of catching it early enough to prevent the spread again. Beyond that, we will deal with tomorrow when tomorrow comes.

After we go to chemo on Thursday we will meet with the surgeon who does the minimally invasive procedure. We will then find out if this procedure is a fit for me, and probably pick a tentative surgery date about 6 weeks out. We will have more news to share after that.

Thank you for tolerating my Encyclopedia of Cancer Treatment approach to keeping you informed. Some people want to know just the highlights, and others want all the details. Partly I write these so that Gen and I will have a way of remembering the entire process. There is so much to learn along the way, and so much to be grateful for. We were reminded of that by Dr. Ross, who said they NEVER catch lung cancer this early unless it is by accident, the way mine was found. How lucky can you get!!!!

Gen and Dann