UPDATE: When I got the image disc home, I ran my CT image program to try to evaluate the tumor without waiting for the meeting with the oncologist tomorrow. It was pretty clear to me that the tumor was larger... and though I didn't like to even think that was happening, it fits with Lisa's worsening symptoms. We called the oncologist and asked for them to work us in this afternoon rather than wait for tomorrow, which they did.
As we has surmised from the images, the radiologist's report confirmed that the tumor has grown, now being around 4 inches in size. The oncologist says it's grown 20%, and while true, that's playing it down. The 20% growth is just in the larger dimension, while the smaller dimension has grown faster, and of course, the tumor is not flat but is instead an irregular spheroid with volume and mass. If I do the basic math on the actual comparative 3-D dimensions from the CT scan radiologist report, we unfortunately find that it has almost doubled in overall mass size (amount of tumor volume) compared to the scan 60 days ago.
I've taken the frames showing the tumor at its largest from both the January scan and today's scan and put them side-by-side, with today's scan on the right. By comparing the black (normal lung) area around the tumor you can see how much more of the lung it fills now.
The tumor has also further invaded the mediastinum (area behind the sternum, between the lungs) and has invaded the heart's right superior pulmonary vein and right upper lobe pulmonary artery where they go into the lungs, as well as compressing against and possibly invading the superior vena cava. At the heart itself, the pulmonary artery's right upper lobe is obstructed, and right middle lobe is compressed. None of this detail was provided during our consult with the oncologist, but it is in the actual written CT radiologists report, of which I have a copy.
The oncologist describes the tumor as fast growing, and resistant to chemo, so it's time for the next phase of treatment: Radiation. Now we find out from the doctors that chemo is only effective about 50% of the time. The effectiveness of radiation in shrinking tumors -- though not necessarily eliminating them -- is closer to 85%. However, chemo is better at reducing the chance for spread of the cancer into other areas of the body, and we're grateful for that.
As we've been doing all along, we are once again on a fast track for treatment. At 5pm this afternoon we saw the radiation oncologist (he stayed late just to see us). Tomorrow we will go for "measuring and marking". The radiation oncologist and his team then does the math (physics) to determine the best plan and sequence for the radiation itself, so that it does the most damage to the tumor, while causing the least problems with good tissue and side effects. The initial 5 weeks of radiation will start either Thursday or Monday, depending on several things, including the plan details, and the potential for getting Lisa in for another laser bronchoscopy first. We'd like to get the laser bronch done because the CT shows partial collapse of Lisa's lung behind the tumor where it has closed off the airway again, and the procedure would open that area up as well as again remove part of the tumor itself and any "muck" that's built up behind it. The CT showed that the tumor is not only in the primary branches of the upper right lung, but also at the carina, which is an area that strongly triggers the cough reflex. The lymph node at the carina ("subcarinal node") is four times the mass of the scan two months ago.
After the 5 weeks of 5-days-a-week radiation, a PET scan will be made, which will be used for a determination as to whether surgery could be done then. If it can't, then there would be two more weeks of radiation, and another scan 4 weeks after that. When radiation works, a tumor can continue to shrink for several months after radiation actually stops.
We're done with the "nasty" chemo for now. A relatively smaller and hopefully less symptomatic dose of Navelbine will be used to "support and enhance" the radiation.
We also went to the Ear/Nose/Throat (ENT) doctor today... Lisa does not have an ear infection or any detectable problems in that area. It is presumed that her earaches are "referred pain". This means that the tumor is pressing and irritating the vagus nerve, which goes into the head and ears but also down into the chest in the area of the tumor. That means the pain may be felt in the ears, even if that's not really where the problem is.
We did have some GOOD news in the midst of all this: The CT showed no new tumors, and the bone scan showed no anomalies. We're still Stage 3 rather than Stage 4.
Michael
