We got the report, and the news is very disappointing. As the CT Findings Report stated it, "There has been significant detrimental change since the previous study." That was difficult to take. Yes, I was correct about seeing a pleural effusion, but unfortunately if you correlate that with another view, you find the cause of it, which is a new tumor in the wall and outer lining of the lung, and the body is responding to it by putting fluid around that area. There are also other small new tumors in the same lung, and now some tumors also in the opposite (left) lung, the largest of which is just under an inch in diameter, which weren't there in the scan September 20th. Lisa's original tumor mass has also started growing again, and is 50% larger than it was in the June CT scan post-radiation. The tumor at Lisa's central chest (subcarinal area) that extends into the lymph nodes there has increased in size by 10% compared to the June scan.
Thankfully, there is no evidence of any suspicious masses in any of Lisa's other organs or vasculature around the heart. But with the growth in the right lung and having spread to the other lung now, plus the knowledge of the bone spread and likely scattered cells elsewhere similar to those found in the stomach biopsies, the doctor recommended chemotherapy to start right away. They gave Lisa a B12 vitamin injection today, and she'll be taking vitamin B9 (folic acid) pills as well. The high vitamin doses have been found to reduce unpleasant side effects of this particular chemo combination in most people. The chemo mix itself, consisting of ALIMTA and Carboplatin, will start on Tuesday. Wednesday Lisa will have a Neulasta shot to help her maintain her immune system, and then just monitoring each week before she has to do it again three weeks later. She will not be taking the Xgeva injections again until after she finishes with chemo. The doctor will keep an eye on the fluid level in Lisa's lung, but right now he believes it's better to just leave it alone since she has plenty of air capacity and adequate blood oxygenation.
I asked the oncologist a question about the chemo... something like, "If the cancer is responsive to this type of chemo, does it matter if the cells are sparsely spread out, versus if they're clustered in tumors?" His answer was that no, it doesn't matter... if the cancer responds to the chemo, it will do so on the cellular level, and the cancer gets no strength or protection by being in a cluster or tumor. Part of my reason for asking was to determine if we might have made a mistake by waiting this long after the cancer had gone to Stage 4, rather than starting chemo again almost immediately as our previous oncologist had recommended. The answer is 'no', it wouldn't have made any difference, and we're grateful that we do not have any reason to regret that earlier decision.
